Idaho splits decision on Medicaid expansion, insurance exchange

NEWS IN BRIEF — Posted Jan. 21, 2013

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The Republican governor of Idaho had decided it would be wiser for his state to operate its own health insurance exchange rather than default to a federally run marketplace, but he has opted not to expand Medicaid to more low-income populations starting in 2014.

In a January speech, Gov. C.L. “Butch” Otter contended that his state’s Medicaid program was in need of reform before it could offer expanded coverage to additional populations. The Affordable Care Act calls for states to expand their Medicaid programs up to 133% of poverty (an effective rate of 138%).

A working group the governor convened last year “sets some specific and significant conditions on expanding coverage for the working poor in Idaho. They include a greater focus on personal accountability and steps for encouraging preventive measures and healthy behaviors,” Otter said. The group also recommended basing incentives for Medicaid payments on the ability of health care professionals to keep people healthy, instead of just on the volume of patients they see.

The federal government has imposed no hard deadline for states to decide on expanding Medicaid, so “we have time to do this right, and there is broad agreement that the existing Medicaid program is broken. So I’m seeking no expansion of those benefits,” Otter said. Some of the state’s constituents who had been newly eligible for Medicaid might be able to obtain coverage on Idaho’s exchange with the assistance of federal subsidies.

About 10 GOP-led states so far have indicated that they will not expand Medicaid in 2014, but four Republican governors at this article’s deadline said they would. They include Arizona Gov. Jan Brewer, a staunch opponent of the Affordable Care Act who nevertheless said Jan. 14 that the ACA is here to stay — and that Arizona would not give up the federal funding that would go toward caring for its poorest residents.

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