BOISE (Idaho Statesman) — Gov. Brad Little has said that the state will implement Medicaid expansion “in an Idaho way.”

But since voters started collecting signatures to get the measure on the ballot, the debate around Medicaid expansion has been backed by opaquely funded groups from outside Idaho, including a group funded by a California labor union. And now, as the Legislature debates how to implement the expansion, a Florida think tank with ties to conservative mega-donors has become one of Idaho’s most vocal supporters of work requirements.

These types of organizations, sometimes called “dark money” groups, use their charitable 501(c)(3) or 501(c)(4) tax status to accept unlimited amounts of money from donors who remain anonymous, because the groups don’t have to disclose their names. Those groups can then turn around and participate in political activities that work in their donors’ favor.

The Foundation for Government Accountability has spent years testifying for stricter access to Medicaid in states like Utah, Kentucky, Kansas and Arkansas.

In Idaho, after 61 percent of voters supported Medicaid expansion last November, the foundation hired Boise lobbyists John Foster and Kate Haas to advocate for a Medicaid expansion bill that would strengthen work requirements.

The measure voters passed expanded Medicaid to cover adults whose income is below 138 percent of the federal poverty line, roughly 100,000 Idahoans. Opponents said that Medicaid expansion would be costly and would increase Idaho’s dependency on the federal government, which is providing 90 percent of the funding to cover the expansion.

Work requirements are popular among conservatives, who say they keep people from relying needlessly on government assistance. The House on March 21 approved a bill that would require adults on Medicaid to work, train or volunteer at least 20 hours a week, the Statesman previously reported.

Lobbyists put words into legislator’s email

The Foundation for Government Accountability has implemented many of the strategies in Idaho that have made it successful in other states.

Foster and Haas have been working alongside lawmakers such as Rep. Bryan Zollinger, an Idaho Falls Republican who sits on the House Health and Welfare Committee, to advocate for legislation that would reduce the number of people eligible for Medicaid.

Earlier this month, Haas forwarded Zollinger an email written by foundation Vice President Jonathan Ingram. In it, he outlined concerns with a bill drafted by Nampa Republican Rep. John Vander Woude that proposed requiring adults on Medicaid to work, train or volunteer at least 20 hours a week. He also noted ways to shore up language in the bill so the work requirements could not be weakened by the department implementing them.

Hours later, Zollinger copied and pasted the body of that email into an email of his own and sent it verbatim to House Majority Caucus Chair Megan Blanksma, R-Hammett, without mentioning where it came from.

The Foundation for Government Accountability’s government affairs director, based in Florida, also sent talking points to Zollinger, coaching him on how to cast suspicion on figures that the Department of Health and Welfare had provided over the cost of administering work requirements and monitoring compliance.

Zollinger said those emails resulted from several discussions he had with the foundation’s staff about how to improve the legislation. “It’s important to listen to these groups, because they’ve worked with many other states that have implemented work requirements,” he said in an interview.

Zollinger also distributed a poll among Republicans paid for by the Opportunity Solutions Project — the foundation’s lobbying arm — that indicated Idahoans’ support for work requirements. One of the questions asked whether Idahoans would support “requiring able-bodied, working-age adults to work, train or volunteer at least 20 hours per week to receive Medicaid benefits?” Three out of four people polled supported the statement.

“You will want to have this data as we move forward,” Zollinger wrote to his fellow Republicans, blind-copying Foster and Haas on the email. The Idaho Statesman obtained the correspondence from the Legislative Services Office in response to a public-records request.

“Facts are facts and data is data,” Zollinger told the Idaho Statesman. “What they’re giving us is information. To me it doesn’t matter where their money comes from.”

Rep. Ilana Rubel, a Boise Democrat who sits on the Health and Welfare Committee, said intervention from the foundation has dramatically shifted legislators’ support for work requirements since the foundation began lobbying four weeks after the legislative session began on Jan. 7.

“Everyone was on board with an optional work approach, like Montana has done, until this outside money group came in, and all of a sudden they got the process started to push for mandatory work requirements,” Rubel said in a phone interview.

A spokesman for the foundation declined to make anyone available for an interview. In a statement, CEO Tarren Bragdon wrote: “We focus on welfare, health care, and work reforms to create opportunities for more work, better jobs, and bigger paychecks for all Americans. FGA has partnered with groups across the country who share our concern in the massive dependency crisis that Medicaid expansion has caused.”

The Foundation for Government Accountability works by allying itself with conservative legislators and think tanks in the states where it operates. In Idaho, it has partnered with the Idaho Freedom Foundation.

The Idaho Freedom Foundation was Medicaid expansion’s most vocal opponent in Idaho. It gave about $6,000 to the Work Not Obamacare PAC, which raised $60,000 overall. After the election, the Freedom Foundation also issued a legal challenge to the constitutionality of Medicaid at the Idaho Supreme Court, which it lost.

The Idaho Freedom Foundation and the Foundation for Government Accountability have received significant funding from two conservative charitable funds that do not disclose their donors: the Donors Trust and Donors Capital Fund. Those groups provide about a third of the FGA’s total funding, which in 2017 was about $7 million.

The Foundation for Government Accountability is also funded by the Lynde and Harry Bradley Foundation, a Milwaukee, Wisconsin, nonprofit worth over $800 million, and a prominent source of ideas and donations for conservative groups. Documents from the Bradley Foundation show that it began increasing its yearly funding to the FGA in 2014 from $25,000 to $200,000 to “provide public-education resources to state think tanks and allies about Medicaid expansion.”

Getting Medicaid on the ballot

Out-of-state interest groups and dark money also played a role in getting Medicaid expansion on the ballot in November.

Based in Washington D.C., the Fairness Project in 2018 backed progressive ballot measures in nine states, including Medicaid ballot initiatives in Utah and Nebraska — and Proposition 2 in Idaho.

The project was founded in 2015 with a $5 million grant from California-based United Healthcare Workers West, a union of hospital workers affiliated with the Service Employees International Union. It also receives funding from individuals and foundations that support expanding access to health care, spokesman Colin Diersing told the Statesman. He declined to list the group’s other donors.

The nonprofit spent about $500,000 on the Medicaid ballot initiative, with $60,000 going to pay signature-gatherers through Washington-based Fieldworks LLC. It also directed $12,000 to fund surveys and polls.

“We support campaigns where we see significant support for Medicaid expansion, and we were consistently impressed by the grassroots organizing in Idaho,” wrote Jonathan Schleifer, executive director of the Fairness Project, in a statement to the Idaho Statesman. “The rich and powerful can always afford to make their voices heard in government, and they had spent years fighting against expanding access to healthcare in Idaho. The Fairness Project helps level the playing field.”

The Fairness Project has not been active in Idaho during the legislative session.

Without help from outside money, the Idaho organizers may have never been able to pass Medicaid expansion, said former Idaho House Speaker Bruce Newcomb, who worked on the failed campaign to legalize historical horse race betting via a ballot initiative last year.

“These initiatives are so difficult that without professional help and money, you just can’t make it happen,” he said.

Blanksma, the House majority caucus chair, said the Fairness Project’s influence left a negative impression on lawmakers: It’s one reason some Republicans are supporting another bill that would increase the number of signatures required from each county in Idaho to get an initiative on the ballot, making it the most stringent such measure in the nation.

“We want to make sure that Idahoans are deciding what initiatives go on the ballot,” she said.

Luke Mayville, the co-founder of Reclaim Idaho, downplayed the importance of the Fairness Project’s role. He said the Fairness Project provided “a fraction of the signatures” needed to get the initiative on the ballot. He said funds for Reclaim Idaho, which is separate from the Fairness Project, came overwhelmingly from small donations.

“We find it frustrating that the legislators who supported work requirements never went to the public and mobilized support from ordinary Idaho citizens,” he said in a phone interview. “Instead they went to Florida-based interest groups.”

Outside groups often have played a role in Idaho politics, Newcomb said. But he said Idahoans are generally weary of outside influence. “If you spend a lot of money, you have to make sure that you don’t offend Idahoans,” he added. “They might turn their back on you.”

Idaho was perhaps a safe bet for the Foundation for Government Accountability. “It’s not unusual for Idahoans to want to put a work requirement on everything,” Newcomb said.

But Newcomb is concerned that Idaho’s Sunshine Law, which is meant to make campaign finance more transparent, may be failing given that influential groups have found ways to hide donors’ identities.

Earlier this session, legislation that would have put more light on who funds candidates and political causes failed to pass. The Idaho Freedom Foundation, the American Civil Liberties Union and other groups complained that it might dry up their sources of donations.

“Idahoans should be allowed to support specific groups or positions without fear of harassment or retaliation from people who may disagree with them,” Kerry Uhlenkott, of Right to Life of Idaho, said at a legislative committee hearing on the bill.

This article was originally published in the Idaho Statesman. It is used here with permission.