The Battle of Medicaid Expansion in Idaho and John Roberts' Decision in Obamacare, Explained


Idaho Republicans are striving to prevent the Medicaid expansion approved by their constituents in November, another case of GOP lawmakers refusing to accept a Democratic mandate to extend Health care for their constituents under the Affordable Care Act and recall the heavy legacy left by the 2012 Supreme Court decision on the Health Care Act.

The referendum on the Idaho poll was passed by an overwhelming majority in November, between 61% and 39%. The initiative called for a no-frills expansion, expanding eligibility to 138% of the federal poverty line ($ 17,200 for an individual, $ 29,400 for a family of three), as stated in l & # 39; ACA. If implemented, it will provide health insurance to about 120,000 of the poorest inhabitants of the state.

But under a bill passed Thursday by the House of Idaho, Medicaid eligibility would only be partially expanded, up to 100% of the poverty line. Persons above this threshold (approximately 40,000) should purchase private insurance from the state insurance market set up under the ACA.

In addition, Medicaid recipients would be required to work 20 hours a week, look for work or attend school to continue to receive benefits. Exceptions would be made for children, the elderly, parents and those "physically or intellectually unfit for work". If a person did not fulfill this condition of work, she would lose her insurance coverage for two months before she could reapply for Medicaid.

There was a bipartisan opposition to this plan at Idaho House, but the bill was still passed easily because of the overwhelming majority of Republicans. The Idaho Senate is putting forward its own plan, which preserves the full extension of Medicaid and simply includes a provision to help recipients access training and other work-related activities. The benefits would not be conditioned by work, as in the bill.

Newly elected governor, Brad Little, a Republican, said that he supported the expansion of Medicaid but that "we do not want to make people not work." Voting initiative passed by voters had forced the state to submit a statement to Medicaid. federal government's expansion plan within 90 days of the referendum, but this has been delayed, lawmakers seeking to alter the enlargement more to their liking.

Republicans have trouble developing Medicaid, even when voters want

CNN revealed this week a little more about the story that led to the expansion of Medicaid – opting for the kind of debate we are witnessing in Idaho. The expansion was supposed to be mandatory, but states under the Conservative leadership challenged this provision, as well as the rest of the law, in the 2012 lawsuit that determined Obamacare's constitutionality.

In the Supreme Court, Chief Justice John Roberts, according to CNN's Joan Biskupic, initially ruled that the extension of Medicaid might be necessary, as originally mandated by the ACA. But while he was looking for a way to respect the rest of the law – including the individual mandate against which he had initially voted – Roberts eventually negotiated with the liberal judges, exchanging the individual mandate for expansion. . The warrant was retained, as was the rest of the law, but the expansion of Medicaid was deemed optional. States can not be forced to accept it – and for seven years it has been a major topic of debate in conference rooms. Republican-led legislatures from 14 states have consistently refused to expand Medicaid, leaving more than one million people without health coverage.

Voters have increasingly taken matters into their own hands with voting initiatives such as Idaho. Maine, Utah and Nebraska have also voted for coverage extension over the last two years, but in almost all cases the Republican authorities have sought to cancel the vote.

The fight in Idaho follows the same arc as the previous debate in Utah, where voters had approved a full extension of Medicaid and then Republican decision makers had sought to cancel it. The Utah legislature has approved a partial expansion plan for Medicaid with the addition of a work requirement; The Trump administration should decide whether to approve the state proposal from one day to the next.

Legal challenges are likely to wait if these modified Medicaid extension plans are approved in Washington, DC. As previously reported Vox:

Two states, Arkansas and Massachusetts, have already asked the Trump administration to let them move to a partial expansion of Medicaid, covering up to 100% of the poverty line. People above this threshold would be required to purchase insurance from private insurance markets created under the Health Care Act.

But these states have not been approved by the federal government, as Trump's health department has remained silent on the issue. As reported last summer's Robert Pear of the New York Times, government officials have been keenly discussing the issue of expansion, with some arguing in its favor (to prevent states like Utah from fully develop Medicaid), while others refuse to take proactive measures that can contribute to the expansion. Obamacare covers more people.

Massachusetts could then sue if Utah's waiver is approved. In any case, supporters of the referendum on the ballot would run the risk of litigation if the Republicans of Utah follow through on their plan. The state could embark on a legal landmine – all in the name of extending health insurance to fewer people than the plan already approved by state voters and at a higher upfront cost.

But that did not stop Republicans in Idaho from engaging in the same path, seeking to reverse the willingness of voters to provide insurance unless their poorest residents.


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