House

Bill 644A
2016 Freedom Index Score (-6)
Analyst: Lindsay Russell Dexter
Date: March 24, 2016

ANALYSTS NOTE: House Bill 644a differs from HB 664 in that it adds the Idaho Accountable Care Waiver
Act (IACWA). This act will give the director of the Idaho Department of Health and Welfare the authority
to apply for a waiver from the federal centers of Medicaid and Medicare to provide managed Medicaid
services for individuals 65 or younger, who earn up to 100% of the Federal Poverty Level, who are not
otherwise covered by the state plan. This language was presented earlier this month but was rejected.

Also included in HB 644a is the original language from House Bill 644 that creates a health-care grant
program for people who are at or below 100 percent of the federal poverty level and who are not
enrolled in government health-care programs. One purpose of the bill is to create a report that will
identify the number of low-income individuals who are not covered by insurance and their illnesses,
diseases and treatments. Additionally, House Bill 644a will provide a grant to underwrite outreach efforts
and the provision of health care for Idahoans.

Point No. 1: Does it create, expand, or enlarge any agency, board, program, function, or activity of
government? Conversely, does it eliminate or curtail the size or scope of government?

ANALYSIS: House Bill 644 will create a new health-care grant program administered by the Idaho
Department of Health and Welfare. (-1)

Point No 2: Does it transfer a function of the private sector to the government? Examples include
government ownership or control of any providers of goods or services such as the Land Board's purchase
of a self-storage facility, mandatory emissions testing, or pre-kindergarten. Conversely, does it eliminate a
function of government or return a function of government to the private sector?

ANALYSIS: House Bill 644a has the potential to automatically enroll individuals in the state-run
health care plan who could be enrolled in a private plan. (-1)

Point No. 3: Does it give government any new, additional, or expanded power to prohibit, restrict, or
regulate activities in the free market? Conversely, does it eliminate or reduce government intervention in
the market?

ANALYSIS: House Bill 644a, through its distribution of grants, will require that grantees provide a
superficial sliding scale of fee services to patients. In doing so, the state will be regulating
marketplace activities. (-1) Additionally, the bill places a reporting requirement on the network of
federally-qualified health clinics. Because it is a federally-qualified health clinic the state should
not have any intervention or interference with the federal reporting requirements. (-1)

Point No. 7: Does it increase government spending (for objectionable purposes) or debt? Conversely, does
it decrease government spending or debt?

ANALYSIS: The grant will cost the state $400,000 for the data collection with an additional $5
million for each of fiscal years 2017 and 2018. The monies will come from the millennium fund, to
conduct additional outreach by, and underwrite health care provided through, the network. (-1)

Point No. 12: Does it violate the principles of federalism by increasing federal authority, yielding to
federal blandishments, or incorporating changeable federal laws into Idaho statutes or rules? Examples
include citing federal code without noting as it is written on a certain date, using state resources to
enforce federal law, and refusing to support and uphold the Tenth Amendment. Conversely, does it
restore or uphold the principles of federalism?

ANALYSIS: Once the director of the Idaho State Department of Health Welfare accepts a waiver
the state will be beholden to any guidelines and regulations set by the federal government now or
in the future. (-1)