Narrator: Presentation of Idaho Reports on Idaho Public Television is made possible through the generous support of the Laura Moore Cunningham Foundation, committed to fulfilling the Moore and Bettis family legacy of building the great state of Idaho.

By the Friends of Idaho Public Television and by the Corporation for Public Broadcasting.

Davlin: Two things can be true at once.

Medicaid expansion was a lot more expensive than the state anticipated.

And a lot of Idahoans depend on the program for their health care.

So what's next for expansion?

I'm Melissa Davlin.

Idaho Reports starts now.

Hello and welcome to Idaho Reports.

This week, Lieutenant Governor Scott Bedke joins me to discuss fire and water issues facing Idaho.

Then Representative Jordan Redmond and Representative Megan Egbert share their views on Medicaid expansion and its future in Idaho.

But first, let's get you caught up on the week.

The Senate Local Government and Taxation Committee held a public hearing on a high profile school choice bill on Wednesday.

The proposal would allow up to $50 million in tax credits for private education costs.

Families could receive up to $5,000 per child, or $7,500 for a child with special needs.

Most of those who testified were against the Lori Den Hartog: For me and for those of us who are proposing this and bringing this forward to you for your consideration.

This is a both and option.

This is not an either or.

We don't see this as a threat.

We don't see this as a way to try to dismantle, what we have.

What we have is pretty great, and we can add something pretty great to it.

Melissa Nash: Idaho already has one of the most robust educational choice systems in the nation.

House Bill 93 seeks to shift the cost of that choice to all Idaho taxpayers, including homeschoolers who choose not to use public dollars.

All school choice programs grow government and become more costly over time, because the government is rightfully obligated to manage everything it funds school choice programs actually reduce educational freedom for those they purport to serve.

All options become government funded options.

Chris Cargill: Research is crystal clear that this improves educational outcomes for kids.

We have showed you the 187 different empirical studies that show an 84%, positive impact among many different categories, including civics, education, student outcomes, and more as well.

Sarah Hayes: Transparency is a conservative principle, yet school choice programs completely lack it.

Once taxpayer money leaves the government's hands, there is no guarantee it will be used as intended, leading to waste, fraud and misspending in other states that we've talked about already.

School choice has increased both taxes and overall cost of education, nearly bankrupting some places who have foolishly offered this cheese in The Mousetrap.

Davlin: The bill passed committee on a 6-3 vote, with Senator Treg Berndt of Meridian being the only Republican to vote no with the committee's Democrats.

It heads to the full Senate, the final hurdle before reaching the governor's desk.

On the House side, on Thursday, the House Revenue and Taxation Committee passed a new version of a grocery tax bill that would increase the grocery tax credit to $155 from its current 120. all we're trying to do here is to give more money back.

It's literally that simple.

Check the box.

That's all it is.

Check the box on your taxes.

If you don't make enough money to even file taxes, there's a special one page form that asks for your name address.

Verify that you don't make enough to pay taxes, and then check the box and you will get the credit back as well.

Also Thursday, the House Judiciary and Rules Committee unanimously endorsed a bill that would halt lawsuits meant to stifle free speech and intimidate political opponents.

This proposal would automatically dismiss so-called SLAPP cases.

That stands for Strategic Lawsuits against Public Participation.

The bill is co-sponsored by Senator Brian Lenny and Representative Heather Scott, and has already passed the Senate with bipartisan support.

It now heads to the full House.

2024 was a rough fire year in Idaho.

This week, I sat down with Lieutenant Governor Scott Bedke to ask about Governor Brad Little's recommendations to improve the state's firefighting capabilities moving forward.

Davlin: Lt Governor, thank you so much for joining us.

Let's start with fire.

What has the governor recommended?

Scott Bedke: Well, the governor of a recommended this year, $40 million ongoing.

Now, in the past, we've kind of fight fires with the credit card.

In other words, we fight the fires, we collect the bills, and then we pay them.

And this in the legislative session that follows the fire season.

And that's kind of an, I mean, and we always are.

On average, you're going to spend around $60 million, give or take, every year.

Some years, way more, some years less.

And so to eliminate the, peaks and valleys in the budgeting process, he's proposing that we know we're going to spend about 40 for sure.

So why don't we just put that in every year?

So that if it's a bad fire year, we've got 40 million to start with.

And if it's a good 40 and if it's a good year of not so many fires we'll like, we'll keep some in the account and we can accrue money there.

I think it's just prudent, financial management, we know that when we know that we're going to have fires, we always do.

And, and it's and it's really important for us to protect the state's 2 million acres of, of timberland.

I mean, last year, I believe that that, timberland, the proceeds from that, was approximately $75 million that went into the school systems here in Idaho.

So it's really important for us to be on top of the fire, you know, firefighting, we want those.

We know we're going to get the fires, we're going to get the starts, but we want to be able to put those out.

And I think we do that with preparedness and, forest health.

And the state's really good at that.

Davlin: The state's really good at that.

But the state doesn't own all the public land.

This is true Idaho.

Right.

So what’s the latest on the state of federal lands in Idaho?

Bedke: Well, we do a better job, frankly.

And, I and it doesn't matter how you want to measure, forest health.

I mean, the state's.

The state's land management model is working.

Our fires are smaller, less catastrophic, etc.. Because we take the growth increment.

Now, we have.

Davlin: That means taking out growth that could be used as fuel for a fire so it doesn't turn catastrophic.

Bedke: Well, yeah.

So the forest is a living thing and it's going to grow a little bit every year.

And, if you don't take that increment of growth out through careful harvest, responsible harvest and that and that, those trees accumulate, trees are basically fuel.

And, and then you can have, catastrophic fires.

Now the, the forest management model just threw the fence on the federal side.

Yeah, they don't do it that way.

In fact, there's very little, very few trees harvested.

Now, there is some there is reason to be optimistic.

The last few years, we have entered into these agreements with the federal government called, Good Neighbor Authority, where the state comes in and, we manage federal lands.

That's not on the scale that that it could be.

I mean, I think we should scale it up.

And I'm optimistic that this administration, plays ball.

But in honesty, so did the last administration, because it's just good forest management.

Nobody likes big forest fires.

And, you know, on the on our state through the, through the years has had big ones.

So you go back to the big fire in the north in 1910 when you, you have fuel and you have any nation point and you have winds that are 50 miles plus there's very little that that you can do to stop it.

And Mother Nature has to stop those kind and to the greatest extent possible, we want to avoid that and avoid the conditions that lead up to that.

So that's the Good neighbor Authority.

Would that, you know, would that every sawmill that was in Idaho in 1980 was back in business now, and that we would have had access to the federal forests and that we had, you know, the vibrant timber industry that we had 40 years ago.

That would be nice.

We don't have that, but we can work our way back that way through responsible timber harvest and forest management.

Davlin: And back to the governor's recommendation of the ongoing $40 million into that fire fund.

Any indication on whether or not the legislature is listening?

Bedke: Well, you know, I watched the legislature for a while now, and, Yeah, they're listening.

I know they're listening.

They haven't got around to it yet.

I think that can be good news in that.

Yeah, it's a it's a given.

They're going to do it and they don't have to worry about it.

Don't have to, you know, it's not front and center or it can be a bad thing of, you know, we're just not going to do it.

And I think it's the, the former.

I don't think I think everybody recognizes that, you know, that it's needful that we be ready to fight fires and pay the bills associated with fires.

I think another important part of the governor's budget is a is a recognition that we're competing for firefighters with the other land management agencies, including the BLM and the United States Forest Service.

And so the firefighters that work for the Department of Lands have worked for the state of Idaho, need to be paid competitively, so that we always have a good full complement of firefighters.

Davlin: We have more fire coverage online.

You can find the link at IdahoReports.org Last year also saw the culmination of a long simmering water fight in eastern Idaho.

It's complex, but in short, a looming water shortage prompted senior water rights holders to threaten to withhold the ability of junior rights holders to use their water, at least until the senior rights holders had used their share.

Had it gone through, it would have overwhelmingly affected agriculture and could have meant a lot of fields going dry.

Ultimately, stakeholders worked out an updated agreement that involved, among other things, prioritizing recharge efforts in the Eastern Snake Plain aquifer.

I also asked Lieutenant Governor Bedke about those negotiations and the importance of recharge moving forward.

Bedke: The mitigation agreement contemplates expanding the state's role in manage recharge, but it also allows for individual farmers and individual irrigation districts to do manage recharge as well.

We put the water in the ground when we have a lot of it.

We take it out when we have less.

And so through careful use of our water, plus a robust, recharge program, we can keep the ends balancing the outs.

And that's all we are doing here is just trying to not deplete the aquifer.

There are many states that have.

And, an Idaho policy, it contradicts mining the aquifer.

And so that's kind of where we at.

We every we collectively went to the edge last spring looked over and nobody wanted to jump.

And so we all went back to the negotiation table and worked out an agreement.

It took us all summer because this is, you know, these are tough negotiations.

And there's, you know, and everybody was well engaged as if their livelihoods depended on it Bedke: Because they did.

Davlin: Because they did.

Bedke: And so we were able to iron it out.

So what.

So what we so this session it's important now.

So the governor so typically we put a you know we had a lot of one time money through the years that we did water projects on.

And then we had every year in year out $10 million.

Now, the governor proposed putting an additional $30 million ongoing into this, into the into these water projects.

And the water problems don't just exist in the East.

They exist, statewide.

And, we've got a very engaged, very knowledgeable, the, you know, water resource board, Solomon's, if you will, and they will allocate and prioritize the projects all to the end of maximizing the amount of acres and production.

And, but acres in production is not necessarily the issue in the Treasure Valley or in the North.

There are other things they need, and they've been very good.

This is their each region of the state is represented on that board, and they've done a very good job balancing the various concerns statewide.

Yeah.

Those of us in in the South or in Magic Valley or in eastern Idaho think that our problem is the largest one.

And, and it does have a huge economic impact to the state.

But there are but we also acknowledge that our neighbors have them, too.

And so the board has done a good job through the years allocating those resources.

And so this additional 30 million.

So we can call this a fire and water, session is that, you know, take care of the trees and take care of our, our natural resource called water.

That's ongoing.

That's ongoing.

30 million, will go a long ways to do that.

In fact, that would be so bold to say is if we don't the that the plan is so reliant on additional projects above American Falls that if we don't do this 30 million, then I can't see the plan working.

Davlin: If this 30 billion goes into place, if the legislature gets on board and says, you know what this is?

This is a good use of our financial resources so we can consider our natural resources.

Do you think it's possible for us to get to a place where every few years, we're not walking up to that edge again, it's long term stability possible with water resources in Idaho.

Bedke: We, it is possible, but we're dealing with people that need to talk to each other.

And as and as things changed, we thought we had foreseen every, everything that, you know, every circumstance in 2015 and then by by 2021, 2022, we knew we had problems.

23 that came to a head.

And then, in in 24, we had to rewrite it.

So I don't I think we've the 24 agreement is much improved when compared to the 15 agreement, which was better than the oh nine agreement.

And I'm assuming that, x number of years from now we'll have another agreement.

But this but the 24 agreement has baked into it the ability to evolve.

And that evolution within the agreement is only going to take place if the parties sit down, have candid conversations.

This is working.

This is not working, or the circumstances have changed.

And we've got to make and we got to make some course corrections.

And, I hope we don't, come to the precipice every year to, effect those changes.

But if the past is any indicator of the future, then we'll have our moments of conflict, and then we'll listen to our better angels will realize, number one, actually, that we're stuck with each other.

And then we got to work it out.

And it's not about it's not about, liberal or conservative.

It's not about Democrat or Republican.

It's just about a common problem.

We've got limited resources, and we got to.

And we got to work it out.

Davlin: You can see my full interview with Lieutenant Governor Bedke online at youtube.com.

Slash Idaho reports.

On Wednesday, the House Health and Welfare Committee held a public hearing on a bill that could effectively end Medicaid expansion in Idaho.

The bill would require the state to seek 11 new federal waivers, such as adding work requirements for able bodied adults in the program and capping the number of people who enroll under expansion, as well as how long they can stay enrolled.

If the federal government doesn't sign off on those waivers, the state would end expansion.

Nearly everyone who testified was against the bill.

Testimony: Of Idahoans enrolled in Medicaid expansion, one inch three has a primary diagnosis of serious mental illness like schizophrenia, bipolar disorder, and treatment resistant depression.

Medicaid cover services like psychiatric treatment, counseling, and prescriptions, and allows them access to a wider range of behavioral health services for more comprehensive treatment than many would receive otherwise.

Early diagnosis of mental illness improves lives and reduce costs.

Still, the average delay from the onset of mental health symptoms to treatment is 11 years.

Expense and scarcity are often behind this delay, but for Medicaid expansion, access to care for many was almost impossible if you couldn't afford insurance.

Testimony: I'm a two time cancer survivor.

My second cancer was lymphoma, and the process of diagnosing that took a long time and was extremely expensive.

Had I not had insurance, I wouldn't have found out what was wrong in trying to get it treated.

And I would be dead today.

I'm asking you to table this bill because I don't want someone like me, except for the fact that she's poor and uninsured to die when she doesn't have to die.

Testimony: When you look at the payer mix, is what we call it, especially in our rural communities, the Medicaid and Medicare or the government payer mix is a high percentage of the patients that they see in those communities.

So when you take Medicaid expansion away, that has a direct impact on those small rural hospitals.

In fact, it has an impact on all of our hospitals.

Davlin: That bill passed the Health and Welfare Committee in an 8-7 vote and now goes to the full House.

On Friday morning, I spoke to Bill's sponsor, Representative Jordan Redman, about why he sponsored the bill and representative make an effort about Thank you both so much for joining us.

Representative Redmond, I wanted to start with you.

Why did you bring this as opposed to just a straight up repeal?

Jordan Redman: The thought with bringing this bill as opposed to a repeal is we actually have a bill brought by House leadership.

Introduced by the chairman of that committee that that we brought that it has been brought to that committee.

I don't think that repeal is the best solution for our state of Medicaid expansion.

And so that's why I wanted to build in safeguards to make the program better, and so that we can keep the program but just run it more efficiently and have better outcomes because of that.

Davlin: Talk a little bit about those safeguards that you want the federal government to sign off on.

Redman: You bet.

Yeah.

Well, so some of them don't necessarily need the federal government to sign off on.

But, so right now we have a large improper payment, on our current Medicaid, budget.

So, you know, it's hard to get exact data because each program has different ones.

But on Medicaid expansion, it's over 18% of improper payment.

And what that means is, is funds that are sent out are going to the wrong place, or there's an eligibility issue.

So it's a large amount of, of waste and sometimes, fraud.

So we want to get that down to like 5%.

Other states have done that.

Another, another, place we're looking at.

So I gotta look at my notes is, presumptive eligibility.

So right now, hospitals can just say you're eligible for Medicaid, put them on a medicaid plan if somebody comes in.

And, and we want to make sure that they're actually eligible for, for Medicaid.

Now, that wouldn't apply to, like, pregnant women or kids.

They would get presumptive eligibility.

But like that expansion population, which is the able bodied adults.

We want to make sure that they, actually are eligible for Medicaid.

I don't want to take all the time.

So, you know, another one would be like, work requirements want people to either be working, volunteering or even, being educated in some way, some sort of training for 20 hours a week.

So there's a few more, but I don't eat all the time.

Davlin: We already have a large, population of people who are on Medicaid expansion who are able bodied, who are working.

It's 25% of Idaho's direct care workforce is eligible for coverage through Medicaid expansion.

And there's already a shortage of direct care workforce workers.

Are you concerned that adding more on top of this, and potentially taking away that program would lead to unintended consequences?

Like, suddenly people can't take these lower paying jobs that are in high demand, and it exacerbates the shortages that we already have.

Redman: I think, to that point, I think that we do have a direct care workforce shortage.

And but I think there's other solutions to help with that.

Right.

And I currently working on some stuff with some other stakeholders to try to find a solution there as well.

I think like as far as the work requirement goes, I think there's dignity in work and I think there's dignity in volunteering.

I think it actually builds the person better than it does.

You know, I mean, obviously it has them out in the community.

I think it feels better families.

So, I think it's very important.

Davlin: Representative Egbert, you you voted against the bill in committee.

You expressed some concerns about it, but it's it's true that this is a lot more expensive than was originally pitched to voters when this passed.

Pass through the initiative process in 2018.

How do you fix that cost problem?

Megan Egbert: Yeah, I think there's a lot actually that we agree on.

First and foremost, that we don't want repeal of the Medicaid expansion program in Idaho.

That's not the option.

I think my concern is that the way the bill is written would ultimately result in that.

So yes, this there is a greater cost than we originally envisioned, I think.

But not in proportion to the rest of the state's budget right now, everything in Idaho is more expensive.

There's inflation.

You know, there is, Idaho's growing.

And as you talked about, we have, wage and hour crisis, I would say, of what we're paying people.

So more people who are working, who are able bodied, are having to be on Medicaid expansion because they don't have another option right now.

Davlin: You know, I, I've been here a while and before voters got this on the ballot, or before Reclaim Idaho, got it on the ballot and before voters voted for it with 62%.

There was a lot of talk in the legislature about trying to solve indigent health care and these soaring costs in an Idaho way, but that never happened.

And in the process of putting together Medicaid expansion after voters passed it, the state got rid of things like the indigent health care funds on the county level.

So it's easier to dismantle things than it is to put em back together.

If this does ultimately end up and getting rid of Medicaid expansion because we can't get those federal waivers.

What's next?

Redman: So I think that's an excellent point.

I think, to that point, I think being more proactive and trying to solve issues ahead of just kicking the can down the road and waiting for something to happen, which is the exact intent of this bill.

I think, you know, and again, the intent of this bill is not to repeal it.

Right.

The intent of this bill is to put safeguards and make it a better program for our state.

You know, if that did happen, there's been talks, through the committee, you know, about what we would do next.

And I think there's probably some, feeling of, you know, looking to private plans and trying to figure out a waiver with the federal government on how we can, pay those.

So currently, with the Affordable Care Act, you have what's called an advance payment tax credit and APTC, that gets applied to private plans, for folks, under 138% of the federal poverty level.

I think there's a way to work with the federal government and say, okay, we're going to allow for this population to move on to a private plan, qualify for an APTC, and then the state could share in that cost as well.

In our rough numbers, again, you still have to get it approved by the federal government.

But, it would be a significant savings, to the state.

Davlin: How do you figure out who gets to stay on expansion and who is who needs to get another plan?

Redman: So the way this bill is drafted, so on this bill, so the under, one of the waivers we're requesting is when Obamacare came into effect, they, instead of qualifying for Medicaid, at 100% up, or, you would have to at 138% down was that was a trying to think of how to phrase it at 138% of the federal poverty level, down to 100% you qualified for Medicaid expansion, but you didn't qualify for a private plan.

One of the waivers is asking us to get that back down to zero, so that people could qualify for a private plan, which is better coverage, better access to care.

And again, with that advance payment tax credit, oftentimes, on these silver plans, you know, the the monthly premium is $3.

I mean, they're significantly less.

And that's a better plan for the for that population.

Davlin: You know, Rep. Egbert, Idahoans consistently have sent lawmakers to the state House and to executive offices that have said, we want to cut the budget.

We have deep concerns about the level of spending on both the state and federal levels.

And, you know, you you've brought up some concerns in committee, echoed a lot of concerns from those who were testifying about the Idahoans that this is helping But but ultimately, voters have made it clear that they want to cut spending.

So how how do you square that?

Egbert: Well, yeah.

Thank you.

I think ultimately we have to ask, you know, whose money is it?

Right.

And who should get to vote on how that money is spent?

I think that the people of Idaho have spoken undecidedly on this issue.

In 2018, when they passed the ballot initiative, and multiple times since then, and especially right now, yes, they want to cut the budget.

But is this the way to do it?

I think people are saying that this is a valued program, and that there's not a good alternative option.

I'm all for getting people on to the exchange if we can.

The problem is, we've been asking to do this, for years, and there's not parity.

They haven't found parity yet in that if we can find a way to do that piece of it, then that would be great.

Where they're not having to pay more because that is a requirement under the Affordable Care Act.

We just haven't gotten there yet.

And I think for our people in Idaho, you know, we have safe and secure elections.

We've heard that time and time again from our secretary of state.

Right now, I think we have to focus on how do we make it easier for people to get out and learn about who they're electing, to make sure that their values align, and making voting easy and accessible for them instead of harder, which is what we've been doing.

Davlin: And Rep. Redman, we have about one minute left.

But, you know, on the flip side, in committee, overwhelmingly testimony was against your proposal.

People were saying, this is going to gut health care, it's going to affect rural hospitals.

It's going to make life very, very difficult for vulnerable Idahoans.

How do you square your proposal with hearing from the people who would be most affected, saying this could be disastrous for my family?

Redman: I think where much of that testimony was focused was on the repeal side of it.

Again, this is not a repeal bill.

This is making a safeguard so that we can keep medicaid expansion.

If we wanted to vote on repeal, there is a repeal bill that we can vote on, right?

I mean, that can be brought to the body and we can vote on that.

That's not the intention and the goal.

The goal is to make a better program so that we can, make sure to provide coverage for folks that need it.

Davlin: If that repeal bill, if the straight up repeal bill came to your committee and came to the House floor, how would you vote on it?

Redman: That's a good question.

I think the goal of bringing this bill was so we didn't have to vote on that, right?

I mean, the goal was to have this opportunity to save it before we got there.

So, yeah, that was a political answer.

Davlin: It was then you are politicians.

Rep. Megan Egbert, Rep. Jordan Redman.

Thank you so much for joining us.

have so much more coverage online at Idaho reports.org.

Thanks so much for watching.

We'll see you next week.

Narrator: Presentation of Idaho Reports on Idaho Public Television is made possible through the generous support of the Laura Moore Cunningham Foundation, committed to fulfilling the Moore and Bettis family legacy of building the great state of Idaho.

By the Friends of Idaho Public Television and by the Corporation for Public Broadcasting.