HB138's impact could hurt veterans, local healthcare

Greetings. 

House Bill 138, a bill to direct how Medicaid Expansion would be handled over the next two years was heard in the House Health and Welfare Committee on February 13. It passed through the committee with an 8 to 7 vote. There was considerable testimony in opposition. The committee members voiced their concerns and support during the debate as expected.

After the committee hearing HB 138 quickly moved through the House calendar and was heard by the full House on February 19.  As expected, there was considerable debate on the bill.  Many complained regarding the costs for the Medicaid program and their belief the program needed sideboards on its use or to be discontinued completely. Others noted the program had been started by the voters, provided community benefits and had continued support.

It was rumored the bill was written by out of state interests and being carried by a representative who has close to 70 draft bills prepared for this legislative session. I think it’s important to know the background of a bill and to understand its intent. However, it’s the actual bill language that counts.

HB138 is labeled as a trigger bill. It lays out 11 actions that need to happen. If the entirety of the actions are not implemented and working by July of 2026, Idaho will not implement or execute any state plan that supports Medicaid eligibility to anyone under 65 with an income under 133% of the federal poverty level.

To no one’s surprise, this bill created quite a stir. The floor debate was long. Those in favor noted the need to rein in spending and concern for people gaming the system. Those opposed highlighted their concerns with the bill itself and the consequences should it pass.

As I often do, I called home and spoke with one of our family physicians. I also spoke with several medical professionals here in Boise. I also reached out to our veterans’ services as I heard many of our vets use Medicaid services.

What I heard and found was interesting.  My research confirmed that the benefits in question are paid to our healthcare providers directly.

Medicaid funding provides a considerable amount of support for our local medical services. From paying a limited amount for emergency ambulance transports, to routine medical checkups, to medications, to hospital care, and to other essential care providers, Medicaid is a staple of our healthcare system.

I also found we have nearly 2,500 patients in our district getting benefit from Medicaid expansion. Through some calculations, it looks like we have approximately 500 veterans who may be benefitting from the services referenced in HB138. I wasn’t able to determine if the 500 is in addition or included in the aforementioned 2500.

Even though our veterans, might get Veterans’ Administrative benefits Medicaid pays copays and cost sharing locally w. It also pays for nursing homes and home care. While most Veterans’ care is delivered through VA staff at VA facilities; with Medicaid services, veterans can get much of their needed care locally.

As many know, we lost our labor and delivery unit at BGH in March 2023. This closure has impacted our community healthcare and women’s health care specifically. We have lost several doctors since then. The delivery of rural heathcare in our state is in flux. Removing more funding from our local healthcare system will have consequences.

I voted against HB138 for several reasons …

I don’t like the trigger part of the bill, if the state is going to stop a critical benefit for our communities, I believe the Legislature should make the vote at the appropriate time. We shouldn’t leave our critical healthcare decisions to the whim of a Federal agency to grant.

We also should look at each of the 11 trip wires of HB138 and work on them independently. For example, I don’t believe anyone in our district supports public money being spent on medical care for able bodied, young, capable people. Those that can work, should. Let’s hold people accountable. This bill hangs on the federal goveernment approving our "get to work plan." So, what if our plan works, but the Feds don’t bless it, we stop our program and the benefits to others who have nothing to do with this issue?

Our residents will need medical care and will call for it. Despite the ability to pay, residents will call on EMS or arrive at BGH and need care at the ER. Emergency rooms don’t have the option to refuse treatment. So BGH will be forced to provide service. We don’t have this same exception for other service providers. ER care is some of the most expensive care we have.

In years past, there were Indigent funds paid from our counties to offset the cost of care at the local healthcare facilities. With the expansion of Medicaid benefits, the Indigent Care funds were reduced. If HB 138 passes and the 11 tripwires are not successfully implemented, the funding for this healthcare will stop. There is no provision for the restart of indigent care funding in the bill.

We all know the federal government is making daily changes, I wonder, is it prudent to make changes ahead of the federal wave. Additionally, President Donald Trump has said he had no interest in changing Medicaid benefits. HB138 increases our dependence on the federal government and limits our options.

Last, I have received a significant number of messages and calls recommending I vote no on HB138 from District 1 residents and healthcare providers. I listened, weighed the information for my decision and for the reasons above, I voted no on HB138.

I’m hopeful we better bills regarding healthcare in this session. It is an honor to serve our district. Comments or insight, please send to msauter@house.idaho.gov

Mark Sauter represents Bonner and Boundary counties in the Idaho Legislature in District 1A. He can be reached at msauter@house.idaho.gov.