Idaho Legislative Report February 4-8, 2019
2019 IDAHO LEGISLATURE
February 4, 2019 through February 8, 2019
Michael McGrane, RN
Joint House and Senate Health & Welfare Committee Hearing
Each year the Committees invite the public to express their concerns directly to the legislators. The session was held Friday morning with hundreds attending. Key issues included
- Proposition 2 – Medicaid Expansion
- Funding for Medicaid Behavioral Health and Community Services
- Funding for Non-Emergency Medical Transport to assist patients in getting to healthcare appointment
Most testimony was from individuals personally affected by the cost of healthcare without coverage and the devastating affects of medical bankruptcy. Only the Freedom Foundation testified against expansion citing unsustainable federal debt that Medicaid expansion would cause. One woman said, “It is absurd that we make too much money, but not enough money to afford healthcare.” Very emotional testimony was given by a woman whose family was affected by breast cancer and the cancer gene that passes through generations of her family. She has five children, she is not able to work and care for her ill mother and her children. Her husband operates a small, struggling, business, and cannot afford health coverage for himself, his family or his employees. Working, they make too much to qualify for Medicaid, but too little to receive help obtaining insurance, so, as much as possible, they avoid getting healthcare.
Medicaid Expansion – The Idaho Supreme Court Decision
On January 29th the Idaho Supreme Court heard the case brought by the Freedom Foundations questioning the constitutionality of Proposition 2. Late Tuesday the Court issued their written decision that Medicaid Expansion as approved by the majority of voters is legal rejecting the argument by the Freedom Foundation that the initiative gives too much authority to the federal government. The Court cited other federal/state programs, including all of Medicaid, that is a legal relationship between the state and the federal government. The Court also rejected the request from the Idaho Attorney General that the case be dismissed as frivolous, and the request that the Freedom Foundation pay the state’s expenses in defending the law suit. The Department is set to submit the Idaho Medicaid Plan to CMS by February 18th. The Court will issue a written decision.
Funding Medicaid Expansion
Under the Affordable Care Act, states have the opportunity to expand Medicaid to cover those caught in the gap between traditional Medicaid eligibility and the ability to obtain subsidy under the Idaho Healthcare Exchange to purchase insurance. The federal government funds 90% and the state 10% of the cost. During his State-of-the-State address, Governor Little expressed his support of funding expansion, but with an Idaho Plan. Discussions among legislators in the halls of the capitol suggest the following potential limitations. Advocates are pushing for full expansion without limitations.
- Work requirements – have a job, seeking a job or enrolled in a job training program
- Co-pay – for those currently in the gap (100% - 138% of the federal poverty level), and copays to discourage missed appointments and inappropriate emergency department utilization
- Lifetime limit – on how long an individual could remain on Medicaid
- Two-year review – require a review of Medicaid eligibility every two years
- Limit of time on preexisting conditions
- Legislative review if the federal/state match changes
- A provision that would allow private mental hospitals, such as Intermountain, to receive Medicaid
Funding the state’s 10% share to expand Medicaid will likely come from a number of sources including the Millennium Fund (money the state receives from the historic tobacco settlement), the state catastrophic healthcare fund (last year the fund paid $19M for Indigent healthcare), and $21M from Idaho counties who currently cover the first $11,000 of indigent costs. Legislators are also concerned with lower than anticipated monthly tax revenues. The debate over funding will continue into March.
HB 109 – Maternal Mortality Review Committee (MMRC) – Introduced House H&W
The Idaho Medical Association introduced a bill this week to create a Maternal Mortality Review Committee within the Department of Health and Welfare. This follows a national trend. The US has a maternal death rate of 26.4 per 100,000 compared with Canada at 7.3, UK 9.2, Germany 9, France 7.8 Spain 5.6, Italy 4.2 and Finland 3.8. Idaho’s maternal death rate is 27.1. Composition of the committee includes physicians and a nurse. The committee would study the causes of death and provide recommendations to reduce the death rate.
HB 64 - Changes to the Complications of Abortion Reporting Law – Passed House, Introduced Senate State Affairs
The controversial law was passed in 2018 to require healthcare providers, physicians and nurses, to report on any complications of abortion including divulging patient information. The law also directs the Board of Nursing to take license action against nurses who fail to report. The law is being challenged in federal court as it requires the reporting of confidential patient information protected under federal law. The changes presented by Representative Greg Chaney of Caldwell clarifies legislative intent and would add requirements to report on a women’s follow-up care after an abortion even when the woman fails to follow-up.
HCR 4 Reject Immunization Rules
Representative Giddings of White Bird is introducing a bill this week to reject the Meningitis Immunization rules that were adopted by the House and Senate H&W Committees.
Religious Exemption to the Child Protection Act
A draft bill is being circulated that would limit the religious exemption to the Child Protection Act in cases where serious illness, disability or the child’s life is in danger. The bill has not been introduced so far.
HB 9 – Physician and PA Licensing – Passed House, Passed Senate H&W, to Senate Floor
The Medical Practice Act was last updated in 1997. The bill simplifies licensing requirements.
HB 12 - Opioid Antagonists – Passed House, Passed Senate H&W, to Senate Floor
The bill introduced by Representative Fred Wood, a retired physician from Burley, would open access to naloxone to anyone without a prescription. Naloxone is a very safe drug, and this bill would put it in the hands of families and friends of those at risk of opioid overdose.
S 1033 – Notification for Organ Donation – Passed Senate H&W, to Senate Floor
Requires EMS, law enforcement, coroners to notify state communications center upon determining death for the purpose of alerting organ retrieval centers.
H 59 - Age for Organ Donation – Introduced
Lowers the age for organ donation to 15.
HJM 1 – 611 Crisis Hotline – Introduced by Representative Caroline Troy, this bill would establish “611” as the Crisis Hotline focused on mental health, domestic violence and suicide.
S 1034 – Oral Chemotherapy – Introduced
The bill would require insurance coverage for oral chemotherapy the same as IV or injectable chemotherapy.
Governor Little – Executive Orders
Governor Brad Little issued two executive orders to reduce the burden of government on individuals and businesses. The first order is to eliminate or significantly reduce administrative rules. For every new rule, two rules must be eliminated or reduced. Each state department or agency must have a Rules Review Officer to identify obsolete, costly or ineffective rules and provide an annual report. The second order is “The Licensing Freedom Act of 2019.” This follows a review and recommendations last year on license requirements, and sets “sunrise” and “sunset” provisions on new and recurring licensure.
Governor Little is requesting an additional $1M in Suicide Prevention Funding with a goal of reducing suicides by 20% by 2025. The creation of the Suicide Hotline, required training, public service campaigns, gun locks, information distributed through gun stores and mental health intervention have already saved lives.
CALL TO ACTION
2019 Nurses Day at the Capitol
Thursday, February 21
8:00 AM – Noon
First Floor Rotunda, Idaho State Capitol, Boise
This is our opportunity to visit with Governor Little and state Senators and Representatives about nursing practice and issues important to nurses.
Nursing is the #1 Most Respected Profession.