Idaho's GOP governor endorses Medicaid expansion

Idaho's Republican Gov. Butch Otter has endorsed the state ballot initiative to expand Medicaid in a new ad that also features his wife Lori urging Idahoans to support the measure.

Otter's public support is the latest sign of an opinion shift favoring expansion in GOP-led states. Voters in Nebraska, Montana and Utah will vote on similar initiatives next week. Democratic gubernatorial candidates in several states including South Dakota, Iowa, Kansas, Oklahoma, Florida and Georgia are polling neck and neck with Republicans. None of these states have expanded Medicaid and Democrats are making it a core campaign issue.

"Proposition 2 is an Idaho-grown solution," Otter says in a new ad by the group "Idahoans for Healthcare" that was released Tuesday. Proposition 2 is the expansion initiative that will extend coverage to about 62,000 Idahoans, according to estimates.

Otter could not seek re-election this year because of term limits, but his Republican Lt. Gov. Brad Little is expected to win the bid to succeed him.

In Idaho, healthcare policy has pitted Republicans against Republicans over the last year. While Otter has expressed support for the initiative, the conservative Freedom Foundation continues to fight it, devoting its website with opposition messages.

The Idaho Statesman reported in early September that a new political action committee formed to combat the measure. The Work, Not Obamacare PAC was formed by an active member of the Freedom Foundation, although the two entities are separate, according to the report.

A fight between moderate and conservative Republicans echoes what happened earlier this year when Otter and GOP leadership in the Legislature tried to pass a bill to create a so-called super-waiver —a merged 1332 State Innovation waiver and 1115 Medicaid waiver—to try to close the state's coverage gap without expansion.

The measure, backed by the state's hospital and other industry groups, aimed to cover about 35,000 of the roughly 68,000 uninsured Idahoans. Otter and Little drove the measure against sharp opposition from the Legislature's conservative wing.

Essentially, Otter and his supporters wanted to offer plans on the Obamacare exchanges that would not include all the mandated essential health benefits while still offering rich enough coverage to draw people who were currently opting out of individual market insurance altogether. Medicaid would have been used as a high-risk pool to guarantee coverage of people with chronic conditions.

Officials estimated that this would shave about $200 million off claims costs for private insurers and lower premiums for those who remained in the individual market.

Viewed as a compromise alternative to Medicaid expansion, the measure was spiked by the Legislature after conservatives succeeding in defeating it.