BOISE, Idaho — Idaho lawmakers are debating what would happen if the state were to repeal Medicaid expansion, including what it would mean for federal funding and who would ultimately bear the cost as the legislative session begins.
Medicaid expansion, approved by voters in 2018, now provides health coverage to roughly 90,000 Idahoans. Lawmakers agree the financial implications are significant, but disagree on what those numbers mean for the state’s long-term budget.
“It’s the largest single budget within the state of Idaho,” said Rep. Josh Tanner, R-Idaho Falls.
At the same time, Rep. Megan Egbert, D-Boise, called Medicaid expansion “the most cost-effective program that I believe Idaho has.”
WATCH: Idaho's debate over Medicaid expansion
Those competing viewpoints reflect a broader disagreement within the Statehouse over whether Medicaid expansion is controlling costs or contributing to higher spending.
Tanner said Medicaid expansion was originally designed for “able-bodied working adults,” adding, “These are the people that are supposed to be out there working.”
He argued the program has grown faster than expected, putting pressure on the broader Medicaid system and other patient populations. “Should we be cutting children for able-bodied working adults? Should we be cutting the disabled for able-bodied working adults? I think we need to go back to the focus of who we want to actually focus on,” Tanner said.
Egbert argued that Medicaid expansion has done the opposite, saying it has helped Idaho manage costs while covering people who otherwise fall through the cracks. She warned that repealing expansion would not eliminate healthcare needs, adding, “If we repealed Medicaid expansion, that 90%, which is over a billion dollars of funding, goes away, but the healthcare needs of those 90,000 people do not go away.”
Tanner pointed to recent provider rate cuts as a sign of increasing strain on the system. “We saw a 4% cut,” he said. “That didn’t matter if it was children, that didn’t matter if it’s dealing with disabilities.”
Egbert countered that without expansion, hospitals would still be required to provide emergency care, and the cost burden would shift. “People with private insurance will pay for it,” she said.
According to the federal budget rules, Medicaid funding is not a fixed pool of money redistributed between states. If Idaho repeals Medicaid expansion, the state would stop receiving federal matching dollars tied to the program; those funds would not be earmarked for Idaho and would remain subject to federal budgeting decisions.
As the legislative session kicks off, lawmakers will decide whether to retain the voter-approved program or pursue changes that could reshape how Idaho funds healthcare.
