BOISE, Idaho — Democrats' hopes of expanding Medicaid coverage to more low-income Idahoans were dashed Wednesday when the House Health and Welfare Committee voted against even holding a full debate on the measure.
Rep. John Rusche, D-Lewiston, had promoted the bill as a way to help the state's poor, who are particularly vulnerable without coverage, as well as save hospitals and businesses millions.
Medicaid expansion was a key part of President Barack Obama's 2010 health care overhaul, but the U.S. Supreme Court left it up to states to decide. Gov. C.L. "Butch" Otter rejected the proposal, in 2013 and again this year.
Lawmakers on the committee Wednesday voted along party lines, with Republicans opposed.
Rep. Fred Wood, R-Burley and chairman of the committee, was among those voted against the bill. He said Idaho's health care system needs changes, but agreeing to expand Medicaid to cover people up to 138 percent of the federal poverty line — about $15,700 for a household of one — wasn't the answer.
"Idaho is never going to go down the road to expanding an entitlement program," Wood said, saying Idaho should at least consider what other states have done with their Medicaid expansion money: Use it not to bolster the federal program, but to pay private insurers to cover them instead.
That's something states including Arkansas have done.
He envisions a system in which only disabled low-income resident receive health care via Medicaid. But it will take time to perfect such a model and put into action, Wood said, though he suggested a bill could come up as early as next year.
"When we do it, we have to do it right," Wood said. "We can't just go down the road we've already been down."
But expansion supporters say that without their plan as many as 54,000 Idaho residents will fall into a coverage gap, ineligible for tax subsidies for insurance sold over the state's Your Health Idaho exchange and without Medicaid help.
Rusche said the Medicaid expansion could have saved Idaho as well as counties about $90 million in 2015 by eliminating the state's existing Catastrophic Care Fund, which pays medical bills of indigent people. The prison system would also benefit, he said.
"That's a lot of money we're passing up, and we're doing harm to our population," Rusche said.
In addition, uninsured people who now skip preventative care and screenings would have an opportunity to address health issues before they become emergencies, Rusche said.
Rusche said he was "disappointed, but not surprised" by his fellow lawmakers' vote.
Otter in his State of the State address last month nixed any hopes that he would support an expansion proposal, and the Idaho Legislature, 81 percent Republican and facing potentially heated primaries in May, was not expected to go against that.
They were bruised last year when they backed a state-based insurance exchange, and don't want to enter another fight this year so close to the election where they could be branded as supporting another provision of President Obama's overhaul.
"Nobody wants to be seen in the Republican primaries as having voted for 'Obamacare,' " Rusche said.