By Rebecca Smith, MVLA Contributor, March 10, 2025
As Idaho lawmakers push House Bill 345 to cut Medicaid costs, the debate centers on whether its strict work requirements and managed care model will save the state money—or create a coverage crisis. While the bill promises short-term savings, critics argue it could lead to hospital closures, higher uncompensated care costs, and more uninsured Idahoans.
The Trade-Offs: HB 345 vs. A Smarter Alternative
HB 345’s Approach:
Mandates 20-hour work requirements, cutting off those who don’t comply.
Shifts to managed care, potentially reducing hospital reimbursements.
Redirects some recipients to private insurance, increasing out-of-pocket costs.
Cuts Medicaid rolls, lowering short-term state spending.
A Smarter Alternative:
Encourages work with incentives, not strict cutoffs.
Prevents fraud through automated income checks.
Allows a Medicaid buy-in for those just above the income threshold.
Invests in cost-saving strategies like telehealth and preventive care.
The Risk of Doing Nothing
Medicaid expansion has tripled Idaho’s costs since 2013, putting increasing pressure on the state budget. If spending continues unchecked, Idaho could face higher taxes, cuts to education and infrastructure, or even stricter Medicaid rollbacks in the future. Without cost-saving reforms, the system could become financially unsustainable, threatening care for the most vulnerable.
What’s at Stake?
Idaho must balance cost control with healthcare access. HB 345 might save money now, but it risks long-term costs if more uninsured people flood ERs and rural hospitals close. A smarter reform could cut waste, encourage work, and stabilize healthcare access—without forcing people off coverage overnight.
Will lawmakers choose short-term savings or long-term sustainability? The future of Medicaid in Idaho hangs in the balance.
Take action on HB 345 and other bills at the MVLA War Room
