Idaho Supreme Court upholds Medicaid expansion initiative, dismissing legal challenges

On February 5, 2019, the Idaho Supreme Court ruled in a 3-2 vote to uphold Proposition 2, dismissing legal challenges to the initiative that was approved by voters in November 2018.
Proposition 2 expanded Medicaid eligibility to those under 65 years old whose income is 133 percent of the federal poverty level or below and who are not eligible for other state insurance coverage. This effectively increased the coverage level to 138 percent under the provisions of the Affordable Care Act. The measure was approved by a vote of 61 percent to 39 percent.
On November 21, 2018, Brent Regan, Kootenai County Republican Central Committee chairman and head of the Idaho Freedom Foundation’s board of directors, filed a lawsuit in the Idaho Supreme Court seeking to block Proposition 2.
Regan said that “The primary concern with Proposition 2 was that it unconstitutionally delegated legislative authority to the federal government.”
Chief Justice Roger Burdick, writing for the majority of justices in dismissing the lawsuit, wrote, “If we were to accept Regan’s argument that any reference to a federal statute delegates lawmaking authority to the federal government, then many of Idaho’s statutes would be unconstitutional, and in fact, the option of any cooperative federal-state program would be curtailed.”
In court arguments on January 29, 2019, Bryan Smith, an attorney for Idaho Freedom Foundation, said, “When they voted for that, they also understood that the government was going to pay 90 percent. That’s what they understood. The federal government can change that, and if they change that, then the people just voted for something that becomes different.”
Defending Proposition 2 on behalf of the state, Assistant Chief Deputy Attorney General Brian Kane said, “There is simply no delegation to the federal government. This [lawsuit against Proposition 2] is without legal foundation because no cogent legal theory has been advanced, procedurally or substantively. […] You can’t force states to make that change. The state of Idaho has consistently approached any change within Medicaid as requiring the state to opt in.”
As of November 2018, a total of 36 states and Washington, D.C., had expanded or voted to expand Medicaid, while 14 states had not. Medicaid expansion initiatives were on the ballot in four states in November 2018. It was approved in three: Idaho, Nebraska, and Utah. The first ever citizen initiative to expand Medicaid coverage under the ACA was approved in Maine in 2017.
Legislation was introduced in both the Idaho and Utah 2019 legislative sessions to amend or repeal the Medicaid expansion initiatives.