News outlets across the country are gearing up for the Supreme Court’s ruling on the Patient Protection and Affordable Care Act. That decision is expected to come down at 8:15 tomorrow morning, mountain time. Our mothership, NPR, has planned a robust lineup of coverage. Boise State Public Radio’s news team will be hard at work to gather local reaction. In advance of the ruling, StateImpact reached out to a number of Idaho lawmakers for insight into how the decision could affect the state. Rep. Fred Wood (R-Burley) says he hopes for an up or down vote, upholding or striking down the law in its entirety. He dreads a mixed decision, one that upholds parts of the law but strikes down others.
“That truly is a nightmare scenario, striking down a portion of that law,” says Wood. Such a ruling would create huge questions for state legislators, insurers and health care providers, Wood says. “What have we already implemented, and what have the private insurers in the state implemented that will have to be reversed, and which provisions are they going to continue on their own?” he asks. Wood, who practiced medicine for 34 years and supports the idea of a mandate, says it’s those questions that give him trepidation.
Rep. Janice McGeachin (R-Idaho Falls) has a different take. “It would definitely be best to have them rule against the whole thing,” she says. Barring that, McGeachin, who chairs the House Health and Welfare Committee, is hoping for a mixed decision. “A mixed ruling, in my mind, would probably help to cause the law to just fall apart,” she says, “and cause Congress to go back to the drawing table.”
From Wood and McGeachin’s points of view, the biggest questions for Idaho lawmakers revolve around the Affordable Care Act’s health insurance exchange requirement and the Medicaid expansion. (Last session, the Idaho legislature did not budge to establish a state-run health insurance exchange, a decision that the state’s most powerful business lobby has criticized.)
“If they uphold the whole law, we’re going to have to scramble to institute the insurance exchange provisions,” Wood says. The state will also have to figure out how the exchange will be funded, he says. McGeachin agrees. “If they uphold the mandate and the law stays in place, absolutely, we will have to deal with that issue,” she says.
The court’s ruling on the constitutionality of the Affordable Care Act’s Medicaid expansion has additional implications for the state. Department of Health and Welfare spokesman Tom Shanahan says the department hasn’t done its own analysis of the cost of the expansion — they simply don’t have the resources to undertake that kind of research, he says. Instead, the department has relied on estimates from a 2010 Kaiser Family Foundation study.
According to that study, Medicaid enrollment in Idaho could increase by between 85,883 and 115,730 under the Affordable Care Act. Although the federal government will cover the lion’s share of the costs, state spending could rise by between $101 million and $133 million between 2014 and 2019. Idaho’s Medicaid program currently serves about 240,000 people in the state, at a total cost of roughly $2 billion. About 30 percent of that total cost — $600 million — is state funding.
Shanahan says he doesn’t expect the department to have a quick opinion of the Supreme Court’s decision. “There are already phone calls planned with CMS [the federal Centers for Medicare and Medicaid Services] for Friday morning,” he says. The sorting-through process could be extensive. “We’ll be talking with the federal government and trying to get guidance and advice on how to proceed.”
Idaho is one of the 26 states that sued the federal government over the health care law.