Patient Support & Advocacy

Court sides with doctor, patient call to uphold Medicaid expansion

In a win for Idaho’s doctors and patients, residents whose incomes are under 138 percent of the Federal Poverty Level (FPL)—that translates to less than $35,535 for a family of four this year—can be eligible for Medicaid coverage. 

The Idaho Supreme Court in February upheld a ballot initiative known as Proposition 2, which voters passed in November 2018 to help bring health insurance to families who lacked affordable health insurance options. The state legislature is now working out the funding details and physicians are hopeful that the appropriation will be approved by the time lawmakers end their session this spring. The new program would be in place as of January 2020. 

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How Medicaid expansion has improved care access, outcomes

The Idaho Medical Association (IMA), two patients and a physician who treats the uninsured received the court’s permission to intervene as additional defendants in a lawsuit that challenged the will of Idaho voters to expand Medicaid. 

The IMA and the others then filed an intervenors’ brief in Regan v Denney objecting to the lawsuit, a level of involvement IMA Chief Executive Officer Susie Pouliot noted wouldn’t have been possible without resources and support from the Litigation Center of the American Medical Association and State Medical Societies

The AMA works to improve Medicaid programs, expand coverage options and make it easier for physicians to see Medicaid patients. The AMA has policy stating that, if invited to do so by the state medical society, it will work with state and specialty medical societies to expand Medicaid eligibility. 

“We are extremely grateful that the court ruled in favor of Proposition 2,” Pouliot said. “Our members see patients in their practices everyday who put off health care because they can’t afford it, resulting in a lot of needless suffering and extra costs.” 

She noted that the IMA was one of the main supporters of Proposition 2 and has spent the past five-plus years on the forefront of the push to expand Medicaid to more patients across the state. 

“We are very excited to move to the next phase,” she added. 

Closing a health insurance gap 

Residents lost access to affordable care after a U.S. Supreme Court ruling on the Affordable Care Act (ACA) no longer made it mandatory for states to offer Medicaid to more residents. The ACA originally expanded Medicaid to all Americans living below 133 percent of the FPL and provided insurance subsidies for individuals and families whose income was between 100 and 400 percent of the FPL. When the nation’s high court said states could voluntarily expand Medicaid, some residents in states like Idaho that didn’t expand the program saw patients fall into what was called a “health insurance gap.” 

The IMA’s intervenors’ brief demonstrated to the court that “the consequences of being caught in the gap are significant.” 

For example, the patients who were part of the IMA intervenors’ brief demonstrated that a family of four living in Ada County with an income just below the FPL would spend $903 a month for an insurance policy with a $10,000 annual deductible. The same family living just above the federal poverty level would pay about $30 per month for the same coverage. In Bannock County, a family of five with an income just under the FPL would pay $1,036 per month for a similar policy, while the same family with income just above the FPL will pay just $50 per month. 

Ruling allows Medicaid expansion 

By passing Proposition 2, Idaho voters expanded their Medicaid program and eliminated the health insurance gap. But the ballot initiative victory was quickly challenged in the Idaho Supreme Court by Brent Regan—who was backed by the main opponents to the proposition, the Idaho Freedom Foundation.

Regan claimed Idaho voters didn’t have the right to expand Medicaid because the Medicaid expansion law was unconstitutional, inappropriately delegating legislative authority to the state executive branch and to the federal government. 

The Idaho Supreme Court rejected the argument. Instead, it sided with Idaho Attorney General Lawrence Denney who objected to the lawsuit on procedural and substantive grounds and with the IMA’s intervenors’ brief that also refuted the arguments that Brent made in his lawsuit.