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: Some lawmakers have made it clear they want to see deep cuts to Medicaid spending in Idaho.

But there are multiple ways to accomplish that, including a proposed full repeal of Medicaid expansion.

So if that passes, what's next?

I'm Melissa Davlin, Idaho Reports starts now.

Hello and welcome to Idaho Reports.

This week, producer Ruth Brown sits down with House Health and Welfare Committee chairman, Representative John Vander Woude to discuss the future of Medicaid expansion.

Then Kevin Richert of Idaho Education News, James Dawson of Boise State Public Radio and Doctor Stephanie Witt of Boise State University School of Public Service.

Join me to review the first month of the 2025 legislative session.

But first, Governor Brad Little included in his recommended budget $100 million for tax relief.

House speaker Mike Moyle wants to cut 3 or 4 times that amount across income, sales and property tax.

On Thursday, the House Revenue and Taxation Committee voted to advance the first bill of House leadership's tax package, a $253 million income tax reduction.

That would take the current rate from 5.695% to 5.3% for both corporate and individual income tax rates.

Mike Moyle: If you look back two years ago when we provided the biggest property tax relief in Idaho history, if you remember, it was about $300 million.

Remember that?

We were told the same thing.

You can't do it.

You don't have the money.

And in fact, the good gentleman on the second floor vetoed the bill.

You overrode him, and it turned out to work out just fine.

If you remember, last year when we proposed income and property tax relief, you were told we don't have the money.

Guess what?

We provided the tax relief and the money was there.

Steve Berch: They need at least about up to $200 million a year just for the projects to maintain roads and to replace bridges, and upwards to $5 billion over time for growth projects to handle growth.

We have a we have $1 billion in deferred and ignored school building maintenance that was documented in an OPE report that goes beyond what the previous bonds and levies have already been used to pay for.

We're going to need I what I've heard at least $80 million for a new state public defender system, and we need tens of millions of dollars for EMS services, coroner system Davlin: That bill now goes to the full House of Representatives.

Tuesday marked the 10th anniversary of the only Add the Words hearing the legislature has ever held.

Advocates to add protections for sexual orientation and gender identity to the Idaho Human Rights Act gathered at the state House to commemorate the anniversary.

Cole Lefavour: When we had hearings rejected again and again, and we brought bills again and again, trying to add the words to include sexual orientation and gender identity and our existing nondiscrimination laws of this state.

They didn't want to hear our stories.

They told us, no, there won't be a hearing this year, but maybe next year.

And after a while, we didn't believe them anymore.

and we decided we were going to bring our stories.

Into this building.

Davlin: This came a day after the House passed a memorial to the United States Supreme Court, calling on the court to overturn its 2015 ruling in Obergefell v Hodges, which legalized same sex marriage.

Heather Scott: They claim to legalize same sex marriage nationwide, and it confused marriage laws and constitutions across the country.

Remember, this same Supreme Court used this same reasoning to make its decision for a right to privacy on Roe versus Wade.

And that's how they justified abortion, which, as we know, was overturned 50 years later.

Ilana Rubel: My son, one of my sons, is gay.

He talked to me about this the other week.

He was very upset.

He's not a very political guy, but he was really concerned about whether he is ever going to be blocked from marrying his long term boyfriend and being able to live in this state.

Not everybody in Idaho understands that this doesn't have legal impact.

It's deeply upsetting to some of those folks.

And it makes them not want to live here.

Davlin: Idaho voters adopted Medicaid expansion through a 2018 citizens initiative, with 61% of voters in support of expansion.

About 90,000 Idahoans rely on that expanded Medicaid for their health care, but costs to the state have been much more than anticipated.

Producer Ruth Brown sat down Thursday with House Health and Welfare Committee Chairman John Vander Woude to discuss his bill to repeal Medicaid expansion, as well as other health issues.

The legislature could consider this year.

Ruth Brown: Thanks for joining me, representative.

John Vander Woude: It's good to be here.

Brown: You introduced a bill, last week to repeal Medicaid expansion in its entirety.

Walk me through your concerns.

Vander Woude: My concerns are when this bill.

It's only like, five years ago, we started this program, and I looked up the original appropriations or estimates on what, what this program was going to cost.

And the state's costs were going to be 32 million.

Was the proposal, budget wise, of what it was going to cost.

It is now at 130 million, just the state's cost.

And so that's my concern.

Even, you know, we printed up the bill and it was 110 million.

And I just talked to the director and he says, actually, we have new numbers.

Since you printed the bill, it's now 130 million of the state's portion of that program.

Brown: So as of December, health and welfare told me they have about 90,000 people enrolled in the expansion plan.

Are you concerned about them losing health care or is there an alternate plan should they no longer be eligible?

Vander Woude: I think there's a concern of we're spending at least $1,000 a month per person enrolled.

I think there's got to be a better way to spend that money than what we are doing now.

And part of my concern is when we expanded Medicaid, we took 18,000 people that were on the exchange, and we told them they had to go on Medicaid.

6,000 of those said, oh, I found more income.

I can stay on the exchange.

But 12,000 had to go on Medicaid.

And so instead of having private insurance, they had to go on to Medicaid, because the law says that if you're eligible for Medicaid, you have to take it.

You can't go into the, the insurance exchange program and get private insurance.

Brown: So opponents of the bill, I think, or of the repeal would argue that there is a federal match that comes with the, the Medicaid expansion plan, and Idahoans pay federal taxes.

What do you say to that?

To the match specifically?

Vander Woude: Specifically, tell me how much money the federal government has in excess that they are now passing us.

They're running a deeper debt than anybody.

The, the national debt is exceeding and growing way too fast.

I suspect that somewhere down the line that Congress is going to start saying that the 90-10 is going to go back to the normal Medicaid reimbursement rate, which right now is about 70-30, which would then cost us another 200 and some million dollars to do that.

And so we get more money back from the federal government than what we pay.

But I think we saw, as we saw yesterday, the day before, where Trump put out something on not doing any grants and everybody panicked.

The problem is, I think we're getting too reliant on federal dollars in this state and need to get need to get away where we're much more efficient.

Brown: Without Medicaid expansion, there are those folks that were in the gap we used.

I mean, would we need to go back to the CAT fund or is there an alternate, I guess, a plan B for these individuals?

Vander Woude: I think we can come up with a better plan that will spend less money.

I would love if we could go to the federal government, give us a block grant and let us design our own program for this group of people that I think would be much more efficient than all the federal guidelines that we have for Medicaid.

And a prime example is right now, if you go to a doctor, on Medicaid.

It's no charge.

But if you go to emergency, it's no charge either.

So there's no incentive one way or the other.

I would like to develop a program that says, hey, if it's not an emergency and you go to emergency, maybe it cost you something, but if you schedule with the doctor, then you know, and just to try to change that and, and work through that whole process.

Whereas Medicaid does not allow that type of, co-pay or, or charges one way or the other.

Brown: But it does cost more to go to the emergency room.

And they, the bill is the tab is picked up by someone, whether it's the county, the state, the feds.

So I walk me through walk me through your rationale.

Vander Woude: My rationale is I want to change the behavior that I can just as quick Brown: Oh I see.

Vander Woude: go to a doctor as I can go to emergency.

It doesn't make any difference where I go, I get treatment because both of them have to treat me.

And my thing is to if it's not an emergency, to give the incentive for the person to go to the doctor and schedule a doctor appointment and stuff like that, rather than running to emergency.

Cause emergency is the most expensive place you can get any type of medical services.

Brown: Sure.

I want to shift gears now.

Last week, the Department of Justice in Idaho, or notified Idaho that there was an ADA complaint due to its long term care system for adults with physical disabilities.

The notification is new, but the problems are not.

As you know, because the Department of Justice cites issues around the state's limited community services and overreliance on institutional, facilities.

So these problems are not new.

You've heard them in your committee before.

Do you know of any bills or, community engagement to, try and support, community living for individuals who might have physical disabilities?

Vander Woude: I've had some conversations with some people on trying to move into that direction, I've not seen any bills that specifically do that.

And I think we run into one of the main problems that we run into everywhere is it's fine to move them out of facilities, but where is the workforce that can take care of them when they're not in a facility?

I would, I would love to be able to not have them in facilities if at all possible, because I think it's a cost savings.

But do we have the workforce out there to provide that care outside of the facilities?

I don't know.

Brown: I mean, I'm not sure if JFAC will do it this year, but there is a direct care provider rate increase that goes through every year.

Any word on if that's going to happen?

Vander Woude: I have not heard if that’s in danger Brown: Right, you’re not a JFAC member.

Vander Woude: Or if it's going to happen or what it is.

And I think we you know, we did some provider increases the last couple of years.

But part of the complaint are that when we looked at it was it is actually going to the providers, so they I know they're trying to write some language so that if we do a provider, it's not a an increase to an agency, and then it doesn't get down to the people that are actually doing the work.

I think that's the main concern that we have of increasing provider rates is does it go actually to the provider, not to somebody in between.

Brown: The person on the ground, the person that’s having the Vander Woude: Yea, the person who’s actually doing the work?

Yeah.

Yeah.

Brown: The new director of health and welfare, Alex Adams, has been very focused on foster care, improving the foster care system.

I wanted to run by you.

What do you expect to see this year regarding foster care?

And how do you measure success with foster care?

Vander Woude: I'm hoping that we really see some improvement.

You know, we've gotten away from where we were, you know, doing VRBO’s for foster kids and putting them all in the same.

So we've developed a facility, what I would like to see is where we actually have a waiting list of parents who want to take in foster kids instead of what we have now is we have a list of foster kids and no place for them to go.

And if we could have a, the quicker we can move some of these troubled kids into foster care, the better off we're going to be for the child and for and for everybody, and even for the cost.

And so I would just love to see.

And when I was on JFAC and that was, that was about 16 years ago, I was two years on JFAC.

We made a proposal just to increase what, the foster parents get for taking foster kids, because to me, those are the most at risk kids that are out in our community.

And that's where we need to focus, is the really at risk children that are out there and it would just be great if we actually had enough information out there that parents were signing up, waiting to take a foster child instead of a foster child, waiting to see if there's somebody that'll take them in.

Brown: I think you and the director are probably in agreement on that.

Vander Woude: Yeah.

Yeah.

Brown: Thank you so much for your time representative.

Vander Woude: All right.

Thank you.

Davlin: We'll continue to follow Medicaid issues throughout the session.

Joining me to discuss the week that was is Kevin Richert from Idaho Education News, James Dawson from Boise State Public Radio and Doctor Stephanie Witt from Boise State University’s School of Public Service.

Big news this week came not from Boise, but D.C.. A Monday night memo from the Office of Management and Budget announcing a temporary pause on grants, loans, and financial assistance programs.

Lots of confusing details or a lack of details in that memo.

And even though that order was rescinded on Wednesday, I know you and I both spent part of Tuesday trying to figure out what programs were and were not affected by this.

And do we have if this were to happen again, do we have any idea what might be impacted in Idaho?

James Dawson: We have the very slightest of ideas.

I guess I mean, you're looking at, things like Medicaid would not be affected, things that go directly to help individuals SNAP benefits, WIC benefits, things like that.

But a lot of other things are still on the table.

Boy, you want to talk about throwing confusion into the mix and making everyone kind of look like a prairie dog looking which way, and that you do something like this because federal spending, I mean, in Idaho last year was $5.2 billion, 37% of the total share of the overall budget.

It's massive.

We're talking about so many different programs, not even just at the state level, but locals, counties, etc.. Davlin: Nonprofits Dawson: Nonprofits.

Davlin: not even government organizations.

Dawson: Exactly.

So, you know, there were a couple of hours there where we thought, we have no idea what this is going to do in a matter of, you know, hours, minutes, let alone days.

And then it all got rescinded, and everything's fine now.

Davlin: Everything's fine.

We one thing that stood out to me and you also had this in your story, the Division of Financial Management said to state agencies, regardless of what is impacted and what isn't, you cannot replace lost federal dollars with state general fund money.

It doesn't matter how important the program is.

It doesn't matter if employee pay relies on those federal dollars.

State agencies cannot replace federal funds with state dollars.

Some agencies, like you said, Medicaid wouldn't be affected.

SNAP wouldn't be affected.

Special education through the Department of Education, State Department of Education wouldn't be, there are a lot of other things that would be, though.

And I know that I talked to some agency heads who were wondering if they could make payroll on Friday.

Dawson: Right.

Yeah.

Because like you said, if a program is even partially funded through federal dollars, you cannot backfill that, with state funds.

I mean, you had the new division of Financial Management director, Laurie Wolf.

It's her first session.

Basically saying that all agencies are supposed to have these exit strategies that will then be submitted to her office.

I have not seen any of those, though I don't really comb through the what I imagine are hundreds of different grant recipients, in the state government.

But it would be very interesting to take a look at those.

Davlin: You know, local government certainly has to rely on federal funds for things like infrastructure projects.

Stephanie Witt: Oh, absolutely.

I mean, there are, who knows how many infrastructure grants are, and contracts are in progress throughout Idaho.

So we're not just talking about paying government employees, but in those cases, making payments to private companies that are building the roads or providing the material.

The same with, the, for example, section eight vouchers for, those who need housing assistance.

That money does not go to the individual.

It goes to the landlord.

So in that case, we're not hurting the government recipient, the client.

We're hurting the private sector that is in partnership.

Kevin Richert: Well, one area that was definitely in jeopardy there for at least a few hours this week was university research.

University presidents were at the state House pretty much all week.

And presidents love to talk about research.

And it is a big chunk of what universities do.

And it's also a big chunk of where they get their money.

At one point on Tuesday, Robert Wagner, the president of Idaho State University, said that they thought that they had about $25 million that was in jeopardy.

And that all went away obviously, when the the order, when the freeze was thawed.

But that's a lot of uncertainty.

That's a lot of money.

Davlin: This isn't the only impact that President Trump has had through executive orders or internal memos, in not even two full weeks of his first term.

Richert: It's been very dizzying this week to watch what's coming from the federal level with regards to education policy.

Now, bear in mind this is a president who says, I want to get rid of the U.S. Department of Education, but at the same time, he is injecting himself into probably the two hottest debates in education in Idaho right now, DEI and Private School Choice.

He issued an executive order on Wednesday to get rid of what he called discriminatory equity ideology.

And then he issued another executive order that would free up money in some manner and the details again, we still have to sort out that would free up money for states to give money out in terms of some sort of form of private school choice, whether that's ESAs or a voucher program.

You know, these are normally state issues.

And when you talk about what's being taught in the schools, whether you call it DEI or not.

Those are curriculum decisions that even the state doesn't get involved with.

Those are local school board decisions.

Now you’ve got the federal government flying in over the top saying, this is something we don't want to see happening in schools anywhere.

Davlin: And ESAs are education savings accounts.

And so do we have a clear picture yet of how this meshes with some of the proposals we're seeing this year, this week at the Idaho Legislature.

Richert: We really don't.

It's so early on in the process.

And you know, it's early on in the process in terms of what's happening at the state level, what's being debated at the state level.

We have multiple private school choice bills already.

We have the first, maybe not the only bill addressing DEI, that was introduced in committee on Friday morning.

So, you know, there's a lot of moving parts just at the state level.

You throw in the disruption, maybe a kind word, disruption that's coming from the federal level.

It's a very confusing situation right now.

Davlin: Certainly confusing.

You know, back in Boise, last fall's Proposition One campaign is still on some Republican lawmakers minds.

On Wednesday, House Judiciary & Rules Committee Chairman Bruce Skaugg introduced a bill that would give the governor veto power over voter led ballot initiatives unless they reach a two thirds supermajority at the polls.

Bruce Skaug: Because the case law says the people's right to initiate legislation is essentially the same as the legislature's, and because the legislature cannot enact law independent of presentment to the governor for a veto or a signature, should not the initiative process undergo the same, to be presented to the governor for a possible veto or signing?

Davlin: James.

this is just one of four bills that have been introduced on the initiative process this year, tackling different things, but the themes are the same the lawmakers, Republican lawmakers don't like the voter initiative process in Idaho.

Dawson: Right?

Meet the new boss, same as the old boss.

If you want to go back to the Who.

But, this is something that has come up repeatedly since that Medicaid expansion passed in 2018, right?

Specifically, the constitutional amendment from Senator Doug Okuniewicz would put in the Constitution the same law that they tried to pass, tried and did, but then got smacked down in the state Supreme Court where the justices called it tyranny of the minority.

Right.

But something magical happens when you put it in the Constitution.

Usually that means that the court system thinks it's constitutional.

So if that happens to get on the ballot and pass, then suddenly it's okay.

Davlin: Well, and that's the funny thing is that a constitutional amendment does need the voters sign off to end up in the constitution.

Dawson: Restrict their own rights.

Davlin: Well, or, give the governor or the legislature more oversight over the process, as Senator Okuniewicz would say, I'm sure.

Dawson: Yes.

Yes, absolutely.

Davlin: There were only a handful of initiatives in Idaho's history of the voter initiative process that have passed that two thirds majority threshold.

Dawson: Four of them, I looked them up.

You have the Sunshine Law that gives anyone access to campaign finance and lobbying, information, creating the Fish and Game Commission, regulating dredge mining and something called the Senior Citizens Grants act, which apparently gave everybody over 65, $40 a month and also, covered health benefits and burial costs.

Davlin: When was that?

Dawson: 1942.

Davlin: Okay.

Dawson: So I don't know.

Davlin: Not in effect anymore, I’m assuming.

Dawson: I don't know when that got repealed.

I tried to find that.

Couldn't couldn't find that this morning.

Davlin: How did, how do these efforts line up with, what other states do with their initiative process?

Witt: Well, there are 26 states have initiatives, that are available.

Not all of them are statutory only.

In Idaho, the result of an initiative if successful is just another law.

So, the legislature can already, reject or change a, law that got passed via initiative if they want to.

They don't need another thing to do.

We have so far avoided a constitutional initiative process in Idaho.

So, there's that.

By the way, the public policy poll that Boise State does every year included a question about this.

And, people were asked what should happen if an initiative passes.

The about 45% said the law should go into effect with no change, and only about 5% said the legislature should be able to reject the law.

Which probably shows me that not very many people understand how our current process works.

Davlin: Well, it's not something that we think about very often.

It's something that comes up, not even every election cycle, because it's so hard to get on the ballot in the first place.

Kevin, it was Higher Education Week at the legislature.

How did that go?

Richert: Well, it was tense in spots because a lot of the discussion really did focus on DEI diversity, equity and inclusion programs and the scope.

And I think it's worth noting for all the discussion that we had about DEI, this is still something that, universities have not been able to use taxpayer funding to pay for for a couple of years.

You already have a state Board of Education order that is forcing the universities to close DEI aligned student centers.

So a lot of things have already been happening here to rein in DEI even before, these, hearings with the university presidents and the introduction of a pretty far reaching Anti-DEI bill on Friday.

Davlin: Was there any other news that came out of Higher Education Week, other than these tense back and forths about DEI?

Richert: Well, I think that was that was the highlight.

But there were a lot of other things that came up.

One thing that did come up that was interesting, regarding, Boise State, Marlene Tromp was asked repeatedly about the Big City Coffee lawsuit, the status of that and how much money, the university has spent.

At least $1.5 million, as we've already reported on legal fees.

This is a multimillion dollar case that we're going to be watching pretty closely.

Idaho State also came under some scrutiny because of a snafu over a, forensic pathology lab that they went into an agreement with Bannock County to open.

Never opened.

Idaho State has had to refund almost $900,000 back to the state.

Legislators still want to know more about what happened here?

They've asked for an audit.

Davlin: Now, we have about two minutes left.

I did want to ask you about state employee pay, sometimes referred to as CEC, but basically pay raises for state employees in Idaho.

And as a note, we are state employees at Idaho Public Television.

Richert: It was a pretty wild hearing at the Joint Finance Appropriations Committee this morning.

And I'll match, Jimmy Dawson, who references, the kids are not all right at JFAC, they are, they are flailing, trying to figure out what to do with, state employee raises.

And this involves, not just state employees, but it involves public school teachers, administrators and, you know, classified staff are involved, and then higher education employees as well.

It boils down to a debate over whether to do merit based raises, which is what the Senate is preferring, as opposed to something that would give raises and maybe $1 to $1.55 an hour to all employees, which would be more beneficial to employees at the lower end of the pay scale.

That's what the house is, favoring.

JFAC is deadlocked on this issue.

And, you know, that's a pretty it's a philosophical difference between how you want to distribute money.

It's not a numbers issue.

It's a philosophical issue.

And we'll see how this thing plays out.

But right now, they can't really do a whole lot with the budgets.

Especially now with that new JFAC rule that went into place last year, where majorities from both the House and Senate side have to approve something.

Richert: There's going to be some kind of compromise between those two houses, because, again, they can't really do a whole lot with the budgets until they figure out what to do with pay raises and what sort of revenue forecast they want to work on.

JFAC’s got a lot of work to do.

Davlin: Jimmy, we have less than half a minute left.

What are you going to be watching in the next week?

Dawson: Next week would probably be the proposed constitutional amendment from representative Dale Hawkins, which would get rid of the compulsory education attendance requirements, for any student.

Davlin: All right.

We'll be keeping an eye on that.

Thank you all so much for joining us.

And thank you for watching.

You can find more at IdahoReports.org and we'll see you right here 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.