‘Absolutely ferocious’: Idaho introduces plan to repeal Medicaid expansion

Idaho state lawmakers on Monday voted to move forward on a proposal to repeal the state’s Medicaid expansion plan, which provides health care coverage to about 90,000 lower-income residents.

Before a narrow vote in the House Health and Welfare Committee to introduce the bill for a full committee hearing, some lawmakers indicated repeal would be a hasty move before they’ve had a chance to review other opportunities for cost savings in a tight budget year. In 2025, Gov. Brad Little signed into law a plan to keep Medicaid expansion in place, but transition it to a “managed care” model designed to save money. That transition is still ongoing, so lawmakers have not yet seen the results of the change.

“We worked extremely hard last year” on the bill to adjust how the state administers Medicaid expansion, and “we haven’t even had the time to see if that is even going to be implemented or how it’s going to be implemented,” Rep. Lori McCann, R-Lewiston, told fellow committee members. “I think that we are putting the cart ahead of the horse.”

Repealing the entire expansion program would “rip the rug out” from under thousands of Idahoans who need care, she added.

Rep. Jordan Redman, who sponsored the proposal to repeal Medicaid expansion, was also a co-sponsor of the 2025 bill. In committee Monday, the Coeur d’Alene Republican said he was hesitant to propose a full repeal this year, given the many program reforms that have yet to fully take effect, but considered it the best move for the state’s overall budget.

AJ McWhorter, a spokesperson for the Idaho Department of Health and Welfare, which oversees Medicaid expansion, did not immediately respond to a question about how much the state has spent so far on implementing the 2025 law. Sen. Julie VanOrden, a Pingree Republican who co-sponsored that bill, said she didn’t know how much the state had spent.

During a conversation with reporters in January, Little said he would not support repealing Medicaid expansion, though he stopped short of saying he would veto a proposal.

“I don’t commit on bills until I see them on my desk,” he said. But he warned that there would be “all kinds of unintended consequences” of repealing Medicaid expansion.

Enacted by a ballot initiative in 2018, Medicaid expansion subsidizes health care for about 90,000 Idahoans who work and earn too much to qualify for standard Medicaid, but don’t earn enough for private insurance discounts under the Affordable Care Act, or Obamacare.

Those seeking a program repeal or reform in recent years have cited the program’s skyrocketing cost. The federal government pays 90% of the costs of Idaho’s Medicaid expansion, but amid rising health care costs, Idaho’s share of the burden has significantly exceeded lawmakers’ expectations: from $32 million in projected costs in 2018 to $110 million in fiscal year 2026, Rep. John Vander Woude, R-Nampa said on the House floor in 2025.

During recent debates over repeal, lawmakers shared anecdotes suggesting that people were taking advantage of the system, avoiding working full-time jobs so that they wouldn’t lose their Medicaid benefits.

“I believe that oftentimes, this can actually hold people back from their full potential,” Redman said.

Randy Johnson, the government relations director of the American Cancer Society’s Cancer Action Network, told the Idaho Statesman he hasn’t seen data to support the claim that such misuse of the program is widespread.

“I think it’s a talking point,” he said in an interview after Monday’s hearing. “What we’re seeing is a whole population of people who are working. They’re working hard, they’re making money, but they still can’t afford their health care.”

Rep. Dori Healey, R-Boise, said she had heard employers’ concerns that some of their employees wanted to work fewer hours to maintain their Medicaid expansion benefits, but argued that the issue could be addressed without repealing the entire program – a move she called “extremely hasty.”

“Those are the issues we need to address, not just ripping this out, these benefits out, from people that truly need them,” said Healey, a nurse. “I think that that is absolutely ferocious and uncalled-for.”

Redman argued that state money spent on Medicaid expansion came at the expense of programs for more vulnerable groups in the state, including children and people with disabilities. He did not address the role of hundreds of millions of dollars in revenue cuts, including tax cuts, the state had made in recent years. Both Democratic and Republican lawmakers have blamed those cuts for budget shortages this year.

Johnson, of the American Cancer Society, pushed back on arguments that repealing the program would save the state money. Subsidizing health care plans allows people to access early screenings and preventative health care. Without insurance, “they just aren’t going to go to the doctor” until there’s an emergency, he said.

Then, they’ll go to the emergency room, which the state will have to pay for, he said. By that point, their health may be in crisis – and their care more expensive.

Supporters of Medicaid expansion have pointed to its widespread popularity: It passed during the ballot initiative process with over 60% of the vote. But on Monday, Redman argued that voters hadn’t understood the cost of what they were supporting.

“The vote of the people, I don’t believe they had all the accurate information to know what it was really going to do,” he said.

The committee voted 10-6 to introduce the bill for a full hearing.