{"id":177990,"date":"2025-09-24T06:28:14","date_gmt":"2025-09-24T06:28:14","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/177990\/"},"modified":"2025-09-24T06:28:14","modified_gmt":"2025-09-24T06:28:14","slug":"idaho-doctors-say-some-will-live-sicker-die-younger-with-medicaid-cuts","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/177990\/","title":{"rendered":"Idaho doctors say some will \u2018live sicker, die younger\u2019 with Medicaid cuts"},"content":{"rendered":"\n

BOISE (Idaho Statesman<\/a>) \u2014 Randi La Salle said Medicaid was a lifesaver for her family. When her youngest son was born without a fully developed ureter, a tube that carries urine from the kidney to the bladder, he had to undergo several costly surgeries that were covered by the government program, which provides health insurance to low-income adults. <\/p>\n

Without it, she would have gone bankrupt.\u200b <\/p>\n

But in 2023 the state began reevaluating Idahoans covered by Medicaid. <\/p>\n

More than 185,000 residents were dropped from the program, including La Salle and her four children. <\/p>\n

La Salle\u2019s family has been on and off Medicaid after being dropped in 2023. <\/p>\n

Now, she worries that coverage is in jeopardy once more, since Congress passed President Donald Trump\u2019s \u201cBig Beautiful Bill\u201d that slashes federal spending on Medicaid to help pay for tax cuts and introduces new work requirements that Medicaid recipients would have to verify at least twice a year. <\/p>\n

\u201cThey didn\u2019t make it easier, they made it harder,\u201d La Salle told the Idaho Statesman. \u201cThere\u2019s a lot of families, ours included, who even recently have had to choose: Do I get the extra meat for the house, or do I save the money for a medical expense?\u201d <\/p>\n

Tens of thousands of Idahoans at risk of losing health coverage <\/p>\n

Under the legislation, about 36,000 more Idahoans \u2014 on par with the populations of Eagle or Lewiston \u2014 are projected to be uninsured by 2034, the Congressional Budget Office estimates. <\/p>\n

Thousands of additional Idaho residents are expected to lose coverage, too, because of changes to the Affordable Care Act, according to an analysis by KFF, formerly the Kaiser Family Foundation, a nonprofit health policy group. <\/p>\n

The bill doesn\u2019t extend the Affordable Care Act\u2019s enhanced premium tax credits that were passed by Congress in the American Rescue Plan. <\/p>\n

Those credits, which are scheduled to expire at the end of 2025, lowered the cost of health insurance premiums for many people who bought plans through the state marketplace. <\/p>\n

The federal cuts to Medicaid aren\u2019t scheduled to take effect until January 2027. But on Sept. 1, the Idaho Department of Health and Welfare cut 4% of Medicaid reimbursements for all providers and services, reducing general fund spending on the program by nearly $40 million this fiscal year, a spokesperson for Health and Welfare previously told the Statesman. <\/p>\n

Gov. Brad Little had ordered nearly all state agencies in August to reduce their budgets for the 2026 fiscal year, which started in July, after state lawmakers reduced income and property taxes by over 20%. He also said the state needed to \u201cmake way\u201d for the tax cuts in Trump\u2019s bill.<\/p>\n

The combined cuts to the Medicaid, which insures about 355,000 children and adults in Idaho, are expected to strain hospitals, nursing homes and community health centers that bear the cost of treating uninsured people. <\/p>\n

Among all enrollees in the state, 42% are children and 35% live in a rural area, according to the KFF. <\/p>\n

Many recipients \u2018already challenged with life circumstances\u2019 <\/p>\n

One of the biggest changes to Medicaid in the bill is a new federal requirement that mandates most people enrolled through Medicaid expansion spend at least 80 hours a month working, volunteering or in school. <\/p>\n

The requirement applies to all able-bodied recipients ages 19-64. To maintain coverage, recipients will have to verify every month that they\u2019ve met the requirement. <\/p>\n

Dr. David Pate, a retired physician and the former CEO of St. Luke\u2019s Health System, told the Statesman that the requirement adds another layer of bureaucracy that could ultimately lead to enrollees losing coverage, even if they\u2019ve met the requirement. <\/p>\n

\u201cThese are people that are already challenged with life circumstances,\u201d Pate said. \u201cWhen you make it really challenging and burdensome to requalify, there are going to be people that are knocked off merely because they didn\u2019t or couldn\u2019t comply, not because they were actually abusing the program.\u201d <\/p>\n

Most adults under age 65 who are enrolled in Medicaid are already working, a data analysis by the KFF shows. <\/p>\n

Those who aren\u2019t are either disabled, have caregiving responsibilities, an illness or health condition that prevents them from working or are attending school, and are exempt. <\/p>\n

Nationwide, about 18.5 million people will be subject to the work requirements each year beginning in 2027. By 2034, the CBO projects federal Medicaid coverage will decrease by 5.2 million adults, with the work requirement increasing the number of people without health insurance by 4.8 million. <\/p>\n

\u201cI think that people may have the impression that this sounds like a really logical thing to do, to say, \u2018If you can work, you need to work, instead of getting a quote unquote handout,\u2019\u201d Pate said. \u201cBut what most people may not be aware of is that when you put work requirements in place, it increases the overhead for Medicaid, and that cost is going to be absorbed by the state or counties or both. <\/p>\n

\u201cThe other thing is that I have not seen the evidence that there are many people milking the Medicaid program. These are people who have really needed this lifeline.\u201d <\/p>\n

Most of the estimated federal savings in the bill are from the work requirement for the expansion group. <\/p>\n

Idaho voters approved a ballot initiative in 2018 to expand Medicaid, extending health coverage to thousands of low-income Idahoans in a so-called coverage gap who earned too much for traditional Medicaid but not enough for marketplace subsidies. <\/p>\n

The expansion took effect in 2020. By January 2023, around 145,000 Idaho residents were enrolled in the expansion. Those who qualify include individuals with monthly incomes of $1,563 or less or families of four with monthly incomes of $3,192 or less, according to Health and Welfare. <\/p>\n

Over 80% have reportable income. Some, about 24%, are diagnosed with serious mental illnesses.<\/p>\n

Mother works 3 jobs to pay for health insurance, expenses <\/p>\n

La Salle was making just $75 over the income limit to qualify. <\/p>\n

\u201cWe were hesitant to go to the hospital when he had issues,\u201d the 39-year-old from Bliss said by phone. \u201cNot having insurance is hard. You make a lot of tough decisions on whether or not it\u2019s really worth it to go in, and you learn how to do first aid pretty quick, because if you can fix it, you don\u2019t have to go to the hospital to do it.\u201d <\/p>\n

La Salle had to enroll in private insurance through her work. She started working two part-time jobs on the side to afford the insurance for herself and her children on top of her other expenses. <\/p>\n

She took a part-time job working twice a week to clean the same office where she worked her full-time job, and worked as a DoorDash driver too. <\/p>\n

\u201cI was trying to make sure we had grocery money, soccer money, field trip money \u2014 all those little things that come with being a parent,\u201d she said. <\/p>\n

La Salle has been stuck between making just over the limit to qualify for Medicaid and not making enough to be able to comfortably afford to pay for private insurance, rent and family expenses. <\/p>\n

After she divorced her husband, her two youngest sons were able to get on their father\u2019s Medicaid. But once he remarried, the two sons were again kicked off, because he no longer qualified. <\/p>\n

La Salle\u2019s 13-year-old daughter by a different father is the only member of their family who was able to qualify for Medicaid. <\/p>\n

Thousands of Medicaid patients in area could lose care <\/p>\n

When people don\u2019t have health coverage, they do not go get routine care, said Pate, the former St. Luke\u2019s CEO. <\/p>\n

People without insurance are far more likely to postpone or forgo health care visits entirely because of concerns over the cost, research shows. <\/p>\n

And many doctor\u2019s offices don\u2019t accept uninsured patients, so when those people do need care, they often end up in emergency rooms with illnesses that are more difficult and expensive to treat than they would have been had they seen a doctor sooner, according to Pate. <\/p>\n

\u201cI still remember this time I was in the emergency room and a woman came in with left-sided chest pain,\u201d he said. \u201cI ran over to evaluate her because you have to move quickly if it\u2019s a heart attack, and when I pulled back her gown, she had a breast cancer that had completely eaten through the skin, so I was looking at the muscles and bones in her chest cavity.\u201d <\/p>\n

She couldn\u2019t afford to see a doctor and had waited until she couldn\u2019t stand the pain any longer, he said. <\/p>\n

By then, it was too late. <\/p>\n

\u201cMost of the time, if we can get breast cancer early, we can cure it,\u201d Pate said. \u201cShe now had a condition that could not be cured and was going to kill her. When people don\u2019t think they have options, they will let things get to a point where \u2026 really bad things happen.\u201d <\/p>\n

Dr. Ted Epperly, the CEO of Full Circle Health, a federally qualified teaching health center with over 40,000 patients across 10 clinics in the Treasure Valley, worries about the how cuts will affect his patients. <\/p>\n

Federally qualified teaching health centers provide comprehensive care to low-income and uninsured populations and have primary care residency programs that train doctors to serve underserved communities. <\/p>\n

Full Circle Health has about 18,000 patients on Medicaid. <\/p>\n

Epperly expects that number to fall by about 2,000 to 4,000 after the changes to Medicaid take effect. He told the Statesman by phone that the cuts will disproportionately afffect the working poor, rural populations, people of color and the providers and health systems that care for them. <\/p>\n

\u201cBecause of this, they\u2019ll live sicker and they\u2019ll die younger, mainly because of not having easy access in a timely way to getting appropriate health care,\u201d Epperly said. \u201cAnd the way it\u2019s been constructed, most of this won\u2019t come into effect until after the next election cycle. People will kind of forget about it because it\u2019s delayed, but it\u2019s going to be a significant impact, and that is the looming specter of all of this.\u201d <\/p>\n

The downstream effects could affect everyone, he said. <\/p>\n

Hospitals, clinics and nursing homes in rural areas could suffer <\/p>\n

Epperly said that clinics like his, as well as nursing homes and rural hospitals, may have to reduce services, lay off employees or close. <\/p>\n

\u201cAll of this has a ripple effect,\u201d Epperly said. \u201cWhen you get out to rural areas, the biggest employer is one of two places \u2014 it\u2019s either the hospital in those small communities or the nursing home in those small communities. So if you take away the No. 1 or No. 2 job in a rural area for people having a place to work, not only have you negatively impacted their health care, but you have negatively impacted their employment.\u201d <\/p>\n

In many small communities, hospitals are among the largest employers and economic drivers. Health and Welfare reports on its website that Medicaid expansion in Idaho actually reduced costs for health care providers. <\/p>\n

Hospitals reporting spending $42 million less on charity care and had $61 million less in bad debt from 2019 to 2021. <\/p>\n

Bad debt is money owed that a creditor determines is unlikely to ever be paid. <\/p>\n

An increase in the cost of uncompensated care could disproportionately affect rural hospitals, many of which are already operating with negative margins. <\/p>\n

The Emergency Medical Treatment and Labor Act, or EMTALA, requires hospitals to treat people during a medical emergency, regardless of their insurance status or ability to pay. <\/p>\n

When a hospital treats a person who doesn\u2019t have insurance and can\u2019t otherwise pay, the hospital has to eat the cost of that care, often referred to as uncompensated or charity care. <\/p>\n

To make up for it, hospitals could raise prices for other people who do have the means to pay. <\/p>\n

Abner King, the CEO of Syringa Hospital and Clinics, the lone hospital in the small farming community of Grangeville in rural north-central Idaho, said the cuts to Medicaid will likely exacerbate his hospital\u2019s finances. <\/p>\n

The hospital, originally built before World War II, is overdue for a replacement, but it doesn\u2019t have the money. For most of the last two decades, the hospital has been operating at a loss, King said. <\/p>\n

Syringa isn\u2019t alone. <\/p>\n

Over a dozen other rural hospitals in Idaho are in a precarious financial position, worsened by rising costs and workforce shortages. <\/p>\n

\u201cIt\u2019s always a struggle to make rural health care work,\u201d King told the Statesman by phone. \u201cIt comes down to volumes. Financial success, particularly for hospitals, is usually attributed to economies of scale, which you get with high volumes. That\u2019s the thing we don\u2019t have in rural health care.\u201d <\/p>\n

Medicaid cuts could exacerbate \u2018extremely tight\u2019 margins <\/p>\n

King said his hospital could be forced to cut some services if the cuts to Medicaid cause an increase in uncompensated care. <\/p>\n

\u201cDelivering babies is always something you look at,\u201d he said. \u201cYou want to be able to do that. You don\u2019t want to think of an expectant mother in labor having to travel any more distance than absolutely necessary. You certainly don\u2019t want to say, \u2018Hey, now you\u2019re going to have to go 70 miles further to deliver your baby.\u2019 <\/p>\n

That\u2019s something that\u2019s always been a priority for us, but that is an example of a service line that may have to be taken back if we can\u2019t carry the cost of providing it with the other business that we do.\u201d <\/p>\n

In the last few years, a growing number of hospitals in Idaho have made the decision to close certain units that bring in less money than they cost to operate. That includes three labor and delivery units in the state, at West Bonner General Health, a critical access hospital in Sandpoint; Valor Health, a nonprofit hospital in Emmett; and West Valley Medical Center in Caldwell. <\/p>\n

The closures mean many pregnant patients must travel further to receive care. <\/p>\n

Brad Turpen, the CEO of Valor Health, said by email that his hospital sees a higher percentage of Medicaid patients and in general, margins in rural health are \u201cextremely tight.\u201d <\/p>\n

Brian Whitlock, the president of the Idaho Hospital Association, which represents 51 rural hospitals across the state, told the Statesman that half of those hospitals have less than 100 days of cash on hand. And half of county, district or nonprofit hospitals have operating margins of less than 1%. <\/p>\n

He said that if hospitals can\u2019t absorb the cost of uninsured people seeking emergency care, hospitals would likely have to shift the costs onto other payers. <\/p>\n

\u201cThe cost for your health insurance and my health insurance \u2014 the premiums are going to go up when those costs for the uninsured get shifted to us,\u201d Whitlock said. \u201cThey have to get paid one way or the other. The only other alternative is to close your doors and go out of business.\u201d <\/p>\n

He said the effects of Medicaid cuts could further dampen physician recruitment to rural parts of the state. <\/p>\n

But there\u2019s work that can be done before the changes are implemented, he said. <\/p>\n

Whitlock urged residents to contact the state\u2019s congressional delegation, which includes Sen. Mike Crapo, Sen. Jim Risch, Rep. Russ Fulcher and Rep. Mike Simpson. <\/p>\n

\u201cChange is coming, and it\u2019s going to impact every Idahoan in one fashion or another,\u201d Whitlock said. \u201cWe would hope that Idahoans would reach out to their Legislature and to their delegation and say, \u2018Enough. Stop the war on health care. We want access to health care and cuts don\u2019t get you there.\u2019\u201d<\/p>\n

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