House Speaker Scott Bedke said there isn't enough time left, even though he thinks the potential merits of expansion shouldn't be overlooked. It could mean some $478 million in county property tax reductions for Idaho residents through 2024, according to the report from the Idaho Department of Health and Welfare.
"We are going to be done by Friday," said Bedke, R-Burley. "I don't think we can give that issue the proper vetting it deserves."
Part of the holdup is, Republicans exhausted considerable political capital on another key provision of President Obama's overhaul when they passed a state-based health insurance exchange, after a combined 16 hours of debate in the House and Senate in which backers of the bill were accused by some foes of acquiescing to federal intrusion into Idaho.
Consequently, GOP appetite to tackle Medicaid expansion, a provision of the 2010 federal law that the U.S. Supreme Court left to states to decide, is limited especially given the bruising debate sure to accompany it.
"Politics are what's going to block it," said House Minority Leader John Rusche, D-Lewiston and former insurance executive, favors expansion.
Among other things, Rusche said, expanding Medicaid would move more than 100,000 low-income Idaho residents into a system of medical care that includes mental health services, a departure from the existing program that pays the medical bills of poor patients only after treatment.
That program, Idaho's catastrophic health insurance fund, is running about $65 million annually for the state and counties combined, but would be eliminated under Medicaid expansion.
Another obstacle to adopting expansion this year is Gov. C.L. "Butch" Otter: Jon Hanian, his spokesman, said Friday nothing has changed to move the Republican governor from the position he took in his Jan. 7 State of the State speech: Idaho should hold off on expanding Medicaid, at least until a broken system has been fixed.
At Otter's direction, the Idaho Department of Health and Welfare has been working since then to secure an agreement from the federal government to allow the state to modify how its Medicaid program would cover an expanded population.
Among other things, Health and Welfare Director Dick Armstrong is seeking changes that promote patient responsibility and encourages providers to focus on outcomes, rather than simply providing services for which they can bill the government.
On Friday, Armstrong said he's optimistic about winning an agreement from the U.S. Department of Health and Human Services and believes he could have a new program in place during 2014. He added that officials in Washington, D.C. have at least verbally offered encouragement; now, he said, he wants it in writing.
"We're now testing their mettle," Armstrong said. "We're saying, 'You opened the door, we're walking through.' "
Last year, Otter commissioned a 15-member committee to scrutinize how expanding Medicaid to more people. This week, the panel met again to review Health and Welfare's savings projections and was in the process Friday of sending Otter a letter urging him to back Medicaid expansion, members said.
Idaho Hospital Association president Steve Millard, who is on Otter's panel, conceded it would take nothing short of the full force of the governor's leadership, if something were happen this session.
"I don't know if he appreciates the urgency," Millard said. "Our letter shows that in spades, the urgency."