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Utah's Medicaid Expansion

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Oct-16-18 error with previous upload
Nov-02-18 Differing POV

Utah's Quixotic Medicaid Expansion Plan, Explained

Utah wants to expand Medicaid under the Affordable Care Act. Kind of.

The state legislature has passed and Gov. Gary Herbert has signed a bill that would partially expand Medicaid through the ACA — up to 100 percent of the federal poverty level (about $20,000 for a family of three) instead of the 133 percent threshold prescribed in the health care law. The Utah plan would also institute a work requirement.

It’s a big deal. Utah is one of the few states to move toward Medicaid expansion under the Trump administration, and the expansion would cover more than 70,000 people in the state. A Republican-led state taking any affirmative steps toward accepting the ACA as reality and expanding health coverage to their poorest residents should not be ignored.

But there is a huge catch: the partial expansion piece. Utah isn’t planning to follow the letter of the law, which would require expanding its Medicaid eligibility up to 133 percent of the poverty level. It wants to go to only 100 percent. That would, in theory, require federal approval.

We have a very recent test case for this: Arkansas, which had already expanded Medicaid in 2014, proposed scaling back its Medicaid eligibility from 133 percent to 100 percent. But when the Trump administration approved Arkansas’s request for a work requirement, it declined to issue a decision about the partial expansion — which some interpreted as a gentle way of rejecting the proposal.

One other Medicaid expansion state, Massachusetts, has also proposed rolling back to a partial expansion. As we covered back in August, there are at least three good reasons to doubt the Trump administration would approve a partial Medicaid expansion:

  1. It might simply not be legal, because the ACA specifically dictates that Medicaid expansion is up to 133 percent of the poverty level.
  2. Under the waiver program that states have proposed a partial expansion, these proposals are supposed to have some kind of legitimate experimental goal. They should “test” some thesis and provide some kind of way to improve Medicaid overall. It’s not at all clear that a partial expansion would have that kind of demonstration value.
  3. It would open the floodgates. States will eventually have to cover 10 percent of the cost for Medicaid expansion enrollees, so if the people from 100 to 133 percent of the poverty level move from Medicaid to the ACA marketplaces under a partial expansion, it would save states money — and cost the feds more, because they would now have to provide tax credits for private coverage for those people.

There is one possible distinction between Arkansas and Utah: The former state had already expanded Medicaid and was asking to pare it back; the latter state would be expanding Medicaid for the first time.

It’s a distinction Utah officials are relying on. “Our request is to expand coverage, while their request is to lower coverage,” one legislator told the Salt Lake Tribune.

But it might not make much difference in the federal response.

”Politically, there is no way that CMS could explain to the governors of either Arkansas or Massachusetts why Utah can get a different Medicaid match rate than they do for covering the same people,” Eliot Fishman, who oversaw Medicaid waivers under President Obama and is now with the health care coverage advocacy group Families USA, told me. “And legally, CMS has never had the discretionary power to award different states different match rates for the same eligibility group, and giving CMS that discretion would be crazy — hugely prone to abuse.”

So in short: Utah opening the door to Medicaid expansion is symbolically important, but, barring some daring legal interpretation on the part of the Trump administration, this specific proposal probably won’t be approved.

In other (brief) waiver news...

We got one other tantalizing bit of Medicaid waiver news last week: Inside Health Policy reported that the Trump administration was expected to deny Massachusetts’s request to establish a drug formulary for Medicaid.

If you need a refresher, we covered the Massachusetts proposal in VoxCare last fall. A drug formulary would allow the state to decide whether or not to cover certain medications, which would in turn hypothetically give it leverage to negotiate deeper discounts with drug makers.

This is an idea that the Trump administration has appeared receptive to; Health and Human Services (HHS) included a similar proposal in its budget this year, though it indicated it might need congressional approval.

According to Inside Health Policy, HHS is reluctant to approve the waiver because officials are worried about drug companies suing over the policy and winning and/or they are concerned that every other state would follow suit if Massachusetts is allowed to set up a formulary.

These rationales were unsatisfying to health policy Twitter. I’d suggest reading this thread from Washington University in St. Louis’s Rachel Sachs. She wondered: If the reason for rejecting the waiver is that HHS doesn’t have the legal authority, why not say that directly?

But if the reason is HHS doesn’t want to set an example for other states, that is even more suspect.

”That’s exactly what CMS is doing with work requirements — so why not here?” Sachs wrote.

Disclaimer: This is a leaked report, which appears to originate with sources within the drug industry. We can’t quite take it as gospel. We’ll be watching closely for the official decision.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

But there is a huge catch: the partial expansion piece. Utah isn’t planning to follow the letter of the law, which would require expanding its Medicaid eligibility up to 133 percent of the poverty level. It wants to go to only 100 percent. That would, in theory, require federal approval.

We have a very recent test case for this: Arkansas, which had already expanded Medicaid in 2014, proposed scaling back its Medicaid eligibility from 133 percent to 100 percent. But when the Trump administration approved Arkansas’s request for a work requirement, it declined to issue a decision about the partial expansion — which some interpreted as a gentle way of rejecting the proposal.

One other Medicaid expansion state, Massachusetts, has also proposed rolling back to a partial expansion. As we covered back in August, there are at least three good reasons to doubt the Trump administration would approve a partial Medicaid expansion:

  1. It might simply not be legal, because the ACA specifically dictates that Medicaid expansion is up to 133 percent of the poverty level.
  2. Under the waiver program that states have proposed a partial expansion, these proposals are supposed to have some kind of legitimate experimental goal. They should “test” some thesis and provide some kind of way to improve Medicaid overall. It’s not at all clear that a partial expansion would have that kind of demonstration value.
  3. It would open the floodgates. States will eventually have to cover 10 percent of the cost for Medicaid expansion enrollees, so if the people from 100 to 133 percent of the poverty level move from Medicaid to the ACA marketplaces under a partial expansion, it would save states money — and cost the feds more, because they would now have to provide tax credits for private coverage for those people.

There is one possible distinction between Arkansas and Utah: The former state had already expanded Medicaid and was asking to pare it back; the latter state would be expanding Medicaid for the first time.

It’s a distinction Utah officials are relying on. “Our request is to expand coverage, while their request is to lower coverage,” one legislator told the Salt Lake Tribune.

But it might not make much difference in the federal response.

”Politically, there is no way that CMS could explain to the governors of either Arkansas or Massachusetts why Utah can get a different Medicaid match rate than they do for covering the same people,” Eliot Fishman, who oversaw Medicaid waivers under President Obama and is now with the health care coverage advocacy group Families USA, told me. “And legally, CMS has never had the discretionary power to award different states different match rates for the same eligibility group, and giving CMS that discretion would be crazy — hugely prone to abuse.”

So in short: Utah opening the door to Medicaid expansion is symbolically important, but, barring some daring legal interpretation on the part of the Trump administration, this specific proposal probably won’t be approved.

In other (brief) waiver news...

We got one other tantalizing bit of Medicaid waiver news last week: Inside Health Policy reported that the Trump administration was expected to deny Massachusetts’s request to establish a drug formulary for Medicaid.

If you need a refresher, we covered the Massachusetts proposal in VoxCare last fall. A drug formulary would allow the state to decide whether or not to cover certain medications, which would in turn hypothetically give it leverage to negotiate deeper discounts with drug makers.

This is an idea that the Trump administration has appeared receptive to; Health and Human Services (HHS) included a similar proposal in its budget this year, though it indicated it might need congressional approval.

According to Inside Health Policy, HHS is reluctant to approve the waiver because officials are worried about drug companies suing over the policy and winning and/or they are concerned that every other state would follow suit if Massachusetts is allowed to set up a formulary.

These rationales were unsatisfying to health policy Twitter. I’d suggest reading this thread from Washington University in St. Louis’s Rachel Sachs. She wondered: If the reason for rejecting the waiver is that HHS doesn’t have the legal authority, why not say that directly?

But if the reason is HHS doesn’t want to set an example for other states, that is even more suspect.

”That’s exactly what CMS is doing with work requirements — so why not here?” Sachs wrote.

Disclaimer: This is a leaked report, which appears to originate with sources within the drug industry. We can’t quite take it as gospel. We’ll be watching closely for the official decision.

Medicaid Expansion Finds Grass-Roots Support in Conservative Utah

OGDEN, Utah — In this conservative state, which has not supported a Democratic presidential candidate in more than a half-century, a grass-roots campaign to expand Medicaid is building considerable momentum as Election Day approaches.

If it wins approval here, it could happen almost anywhere.

On Nov. 6, Utah voters will consider a ballot measure that would expand Medicaid to cover up to 150,000 more people under the Affordable Care Act. Two other conservative states, Idaho and Nebraska, will also vote that day on Medicaid expansion proposals.

The states, if the measures pass, will join more than 30 others that have expanded Medicaid under the 2010 health care law. In all three states, advocates are trying to outflank Republican lawmakers who have blocked expansion efforts.

The Utah push is five years in the making. State politicians and advocates have tried repeatedly, by one means or another, to expand Medicaid. Gov. Gary R. Herbert, a Republican, and his team have spent countless hours in negotiations with the Obama and Trump administrations. In 2015, the State Senate passed a bill, but it never reached the floor of the State House of Representatives.

Now, supporters of expansion are cautiously optimistic. Opinion polls suggest that 60 percent of Utah adults favor it. Advocates are energetic and well organized, knocking on doors and speaking frequently at public events. Opponents are lying low, but plan to make their case more forcefully before Election Day.

On a recent Sunday, a big blue banner hung inside First United Methodist Church here in Ogden, urging people to vote for the ballot measure.

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“Jesus was constantly healing people,” said the Rev. Kim James, the pastor, whose sermon cited examples from the Gospel of St. Mark. “I’ve been volunteering my time and effort to this cause, Proposition 3, because I believe Jesus cared deeply about people’s health. He didn’t ask, Do you have your insurance card? Did you pay your co-payment and your deductible?”

Among the most effective advocates for the proposal are people like Christie Sorensen, 28, who applied for Medicaid after a fast-growing tumor infiltrated her chest and surrounded her heart.

“Medicaid saved my life,” she said. “Expanding it can save many more.”

State Representative James A. Dunnigan, a Republican who is co-chairman of the Health Reform Task Force in the State Legislature, said he would not vote for the Medicaid ballot measure, but he added: “It’s likely to pass. There is very little organized opposition.”

While there has been little vocal opposition to expansion so far, Republicans in the Utah Legislature worry about costs and note that enrollment far exceeded expectations in some states that expanded Medicaid. The expansion “could ultimately require even greater tax increases, or spending cuts to things like education, other programs for the needy, roads and public safety,” said a statement of opposition drafted by Republican state legislators.

Heather Williamson, the Utah director of Americans for Prosperity, the conservative group funded by the brothers Charles G. and David H. Koch, said: “We are ramping up our efforts against the ballot initiative. We are very concerned that it will lead to out-of-control spending and create a welfare trap for able-bodied adults.”

The federal government would pay at least 90 percent of the costs for newly eligible beneficiaries, contributing roughly $800 million a year. To pay the state’s share, estimated at $90 million a year, the ballot measure would increase the state sales tax rate to 4.85 percent, from the current 4.7 percent.

“The additional tax, on nonfood items, equates to about a penny on the cost of a movie ticket,” Stacy Stanford, a health policy analyst at the Utah Health Policy Project, a nonprofit advocacy group, told an audience of 350 people at a recent forum for federal and state candidates in the Salt Lake City area. “We are asking voters to make a decision if it’s worth an extra penny to provide health care to 150,000 Utahns in need.”

Medicaid has become a driving force in American health care, in part because of the expansion of the program under the Affordable Care Act. The expansion started with 26 states in 2014, and several have come on board since then. Texas and Florida are the biggest holdouts. Republicans in Congress tried last year to roll back the expansion and were surprised to see the degree of public support for the program.

Image

Marchers in Salt Lake City in 2017 opposing Republican efforts to repeal the Affordable Care Act.CreditRick Bowmer/Associated Press

Under the Utah ballot initiative, Medicaid would cover adults with annual incomes up to 138 percent of the poverty level — up to about $16,750 for an individual.

By contrast, the state Medicaid program now covers parents with incomes up to 60 percent of the poverty level, or about $7,300 for an individual. The state has also extended coverage to about 3,000 adults with income below 5 percent of the poverty level — about $600 a year — who do not have dependent children but are “chronically homeless” or need substance abuse or mental health treatment.

Utah officials estimate that 100,000 to 150,000 people will gain Medicaid coverage if voters approve the ballot measure. Monthly enrollment now averages 280,000, so the proposal would increase the number of people on Medicaid by roughly one-third to one-half.

Stephanie M. Burdick, who was severely injured in a surfing accident and supports Medicaid expansion, worked through vision exercises during a therapy appointment in Salt Lake City on Thursday.CreditKim Raff for The New York Times

“Polls suggest that the ballot measure is likely to pass,” said Andrew Croshaw, the chief executive of Leavitt Partners, a health care consulting firm founded by former Gov. Michael O. Leavitt of Utah, a Republican who served in the George W. Bush administration. “If it fails it will be close. It could pass easily. So far we have not heard many opposing voices. But the public debate is just beginning.”

The Republican-controlled Utah Legislature voted this year for a more limited expansion of Medicaid, which would extend coverage to 70,000 to 90,000 people with annual incomes up to 100 percent of the poverty level, or $12,140 for an individual. The state law also calls for work requirements and would allow the state to freeze enrollment if it did not have money to care for all those made eligible for Medicaid.

This is not what Congress envisioned in the Affordable Care Act, but Utah still wants the extra federal funds available to states that fully expand Medicaid.

Utah has asked the Trump administration for a waiver to permit the “partial expansion” of Medicaid. White House officials, who oppose any expansion of “Obamacare,” have resisted the idea, leaving Mr. Herbert, the governor, in an awkward position. He had been hoping by now to have federal approval for his preferred alternative to the ballot initiative.

Paul Edwards, a deputy chief of staff to Mr. Herbert, said the governor “fully understands the frustration of voters” who have been paying higher taxes under the Affordable Care Act without receiving the benefits of expanded Medicaid.

“There is no active campaign against the initiative on our part,” Mr. Edwards said. But, he added, the governor “is concerned about the long-term viability” of a full Medicaid expansion and the proposed sales tax increase, and would prefer to see a more limited expansion of the program with “appropriate cost controls.”

One major force in Utah, the Church of Jesus Christ of Latter-day Saints, has not taken a public position on the ballot measure. But a church management employee, David C. Heslington, in a recent letter to The Deseret News, expressed his personal support, saying that a “yes” vote on Proposition 3 would “offer a merciful hand to Utahns in need.”

Utah residents take pride in their reputation as the most charitable state, measured by giving as a percentage of income.

“We are a conservative state, but very compassionate,” said Charles Dubenezic, a retired college professor in Eden, Utah, near Ogden.

Charity is a priority for the Mormon Church, which provides food, medicine and financial assistance to many of the needy. But people recognize the limits of such “church welfare.”

“The church tries to do all it can, but can’t take care of a major chronic or catastrophic illness,” said Reed E. Harris, a former bishop in Salt Lake City. “The purpose is to help people for a short time, until they get work and can be self-sufficient.”

Stephanie M. Burdick, 30, who lives in Salt Lake City, remembers going around rural Arkansas with her father, a Mormon bishop, tending to the needs of local church members who had fallen on hard times.

She suffered a traumatic brain injury in a surfing accident in 2015. When she woke up in the hospital, her life was changed: She had little ability to walk, talk or feed herself.

Medicaid expansion is “in alignment with Utah values,” Ms. Burdick says.CreditKim Raff for The New York Times

“Utah denied me Medicaid,” Ms. Burdick said. “They told me that if I was a mother, a parent, I would be able to get Medicaid. But as a childless adult, I could not. I was told to call my local bishop. I don’t know how I’m supposed to ask the bishop to pay my medical bills.”

She faced thousands of dollars in bills for doctor’s visits, neurological tests, prescription drugs, rehabilitation and different types of therapy. She eventually qualified for Medicaid, after agreeing to spend a significant amount of her limited income on her medical care.

Ms. Burdick has become an advocate for Medicaid expansion. It is, she said, “in alignment with Utah values.”

A version of this article appears in print on , on Page A16 of the New York edition with the headline: A Groundswell Builds for Expanding Medicaid in Conservative Utah

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Utah governor signs Medicaid expansion bill. Now, Utah waits to see if the feds will approve it.

Francisco Kjolseth | The Salt Lake Tribune) House speaker Greg Hughes addresses the crowd gathered in the Gold Room of the Utah Capitol on Tuesday, March 27, 2018, prior to the signing by Gov. Gary Herbert of H.B. 472, which would expand Medicaid healthcare coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government.

(Francisco Kjolseth | The Salt Lake Tribune) House speaker Greg Hughes addresses the crowd gathered in the Gold Room of th... (Francisco Kjolseth | The Salt Lake Tribune) Senate President Wayne Niederhauser, left, and House speaker Greg Hughes joke... (Francisco Kjolseth | The Salt Lake Tribune) Gov. Gary Herbert laughs after House speaker Greg Hughes, at left, make a sna... (Francisco Kjolseth | The Salt Lake Tribune) The signing copies of H.B. 472 - Medicaid Expansion Revisions, awaits the sig... (Francisco Kjolseth | The Salt Lake Tribune) Gov. Gary Herbert is surrounded by state representatives in the Gold Room of ...(Francisco Kjolseth | The Salt Lake Tribune) Senator Brian Zehnder, R-Holladay, talks about the challenge of getting H.B. ... (Francisco Kjolseth | The Salt Lake Tribune) Gov. Gary Herbert, surrounded by state representatives in the Gold Room of th... (Francisco Kjolseth | The Salt Lake Tribune) House speaker Greg Hughes addresses the crowd gathered in the Gold Room of th...

(Francisco Kjolseth | The Salt Lake Tribune) House speaker Greg Hughes addresses the crowd gathered in the Gold Room of the Utah Capitol on Tuesday, March 27, 2018, prior to the signing by Gov. Gary Herbert of H.B. 472, which would expand Medicaid healthcare coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government.(Francisco Kjolseth | The Salt Lake Tribune) Senate President Wayne Niederhauser, left, and House speaker Greg Hughes joke around with champion for the homeless Pamela Atkinson following the signing of H.B. 472 - Medicaid Expansion Revisions, which would expand Medicaid healthcare coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government. The bill was signed by Gov. Gary Herbert at the Utah Capitol on Tuesday, March 27, 2018. (Francisco Kjolseth | The Salt Lake Tribune) Gov. Gary Herbert laughs after House speaker Greg Hughes, at left, make a snarky comment about the governor vetoing fewer bills if he gives away enough pens following his signing of H.B. 472 - Medicaid Expansion Revisions, at the Utah Capitol on Tuesday, March 27, 2018. The bill would expand Medicaid healthcare coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government. (Francisco Kjolseth | The Salt Lake Tribune) The signing copies of H.B. 472 - Medicaid Expansion Revisions, awaits the signature by Gov. Gary Herbert in the Gold Room of the Utah Capitol on Tuesday, March 27, 2018. The bill would expand Medicaid healthcare coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government. (Francisco Kjolseth | The Salt Lake Tribune) Gov. Gary Herbert is surrounded by state representatives in the Gold Room of the Utah Capitol on Tuesday, March 27, 2018, as he sign H.B. 472 - Medicaid Expansion Revisions, which would expand Medicaid healthcare coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government. (Francisco Kjolseth | The Salt Lake Tribune) Senator Brian Zehnder, R-Holladay, talks about the challenge of getting H.B. 472 - Medicaid Expansion Revisions to the desk of Gov. Gary Herbert, during a signing ceremony in the Gold Room of the Utah Capitol on Tuesday, March 27, 2018. The bill would expand Medicaid healthcare coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government. (Francisco Kjolseth | The Salt Lake Tribune) Gov. Gary Herbert, surrounded by state representatives in the Gold Room of the Utah Capitol on Tuesday, March 27, 2018, claps alongside those in attendance after signing H.B. 472 - Medicaid Expansion Revisions, which could provide healthcare to 60,000 Utahns below the poverty line. (Francisco Kjolseth | The Salt Lake Tribune) House speaker Greg Hughes addresses the crowd gathered in the Gold Room of the Utah Capitol on Tuesday, March 27, 2018, prior to the signing by Gov. Gary Herbert of H.B. 472 - Medicaid Expansion Revisions, which would expand Medicaid healthcare coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government.

DMU Timestamp: September 17, 2018 17:21

Added October 16, 2018 at 4:56am by Christopher Clyne
Title: error with previous upload

Gov. Gary Herbert signed a measure Tuesday to give more than 70,000 needy Utahns access to government health coverage, ending years of failed attempts on Capitol Hill to expand Medicaid in the state.

But whether House Bill 472 ever takes effect still remains uncertain. Under President Obama’s signature Affordable Care Act (ACA), the Utah law needs approval by the federal Centers for Medicare and Medicaid Services (CMS), which has sent mixed signals on whether it will fully sign off.

Even if CMS does approve HB472, it will likely be about a year — even on an aggressive schedule — before the state can begin enrolling people for coverage. Meanwhile, a competing Utah citizens initiative that would expand Medicaid coverage more widely than HB472 also continues to gather signatures for a spot on November’s ballot.

At a signing ceremony Tuesday at the Utah Capitol, Herbert, lawmakers and other officials were nonetheless thrilled to make it this far. Past efforts to expand Medicaid under the ACA failed repeatedly as conservative lawmakers expressed concern over potentially ballooning costs.

“It’s had its twists and turns, its bumps and bruises, to get us to this point here today,” said Herbert, referring to five years of failed attempts at large Medicaid expansions in Utah. (A small-scale expansion covering a few thousand homeless people and low-income parents took effect last year.)

“This allows us to buy something today, that we can afford tomorrow,” Herbert added of HB472, which includes a spending cap and repurposes money from other Medicaid programs to cover the state’s share of costs.

Under the new law, the feds would pay 90 percent, and the program would automatically end if federal officials were to lower that commitment. Total state and federal costs for the expansion would rise over the next few years, reaching about $500 million by 2024.

HB472 also requires enrollees to prove they are working or participating in volunteering, vocational training or similar activities. The Trump administration has told state officials it is receptive to such tweaks requested by individual states, which were nonstarters under the Obama administration.

“Medicaid should be a partnership between the federal government and the states, not just a top-down program,” said Senate President Wayne Niederhauser, R-Sandy. “It should be a program where states and federal government get together and craft a program that will work in each individual state.”

Yet it remains unclear if even Trump’s CMS will approve one key provision Utah is proposing. The HB472 plan calls for only a partial expansion of Medicaid coverage for adults making up to 100 percent of the poverty line, or $12,140 annually for a single person.

The ACA, meanwhile, mandated that states expand their Medicaid programs to cover those making as much as 138 percent of the poverty line. CMS recently declined to approve a similar request by Arkansas, which wanted to cover only residents making 100 percent of poverty incomes.

But both House Speaker Greg Hughes, R-Draper, and HB472’s sponsor, Rep. Robert Spendlove, R-Sandy, said Tuesday they were hopeful Utah’s request would look more appealing to federal officials. Utah, they said, wants to grow its Medicaid coverage, while Arkansas — which had previously approved a full Medicaid expansion under the ACA — was looking to boot people off coverage by changing its income threshold.

“Our request is to expand coverage, while their request is to lower coverage,” Spendlove said.

And if the feds decline to approve any portion of Utah’s Medicaid waiver request, HB472 would require further consideration by Herbert and legislators. “It’s a package deal,” Hughes said.

“Is it everyone’s perfect? It isn’t,” he said the expansion. “Is it good? Absolutely.”

Pamela Atkinson, a Utah homeless advocate, as well as Bill Tibbitts, associate director of the Crossroads Urban Center, were in attendance Tuesday and supported the measure. They have said it would help low-income Utahns get back on their feet.

But others argue it doesn’t go far enough. Officials with the nonprofit Utah Health Policy Project have said Utah’s work requirement and spending caps could result in some impoverished Utahns, who should qualify for coverage, being left out.

At the same time, Utah’s Medicaid ballot initiative — if it passes in November — would expand Medicaid to those making 138 percent of poverty income levels, or 150,000 more people than are covered currently. Organizers of that initiative continue to collect the necessary 113,000 signatures to qualify for the ballot ahead of an April 15 deadline.

Launched last year, backers of the effort say it reflected years of frustration over the Legislature’s failure to pass an expansion. Polls suggest nearly two-thirds of Utahns support expanding Medicaid.

HB472 will soon be the focus of a 30-day public comment period and two public meetings for input before Utah submits its Medicaid expansion request, said Nathan Checketts, director of Utah’s Division of Medicaid and Health Financing.

DMU Timestamp: September 17, 2018 17:21

Added November 02, 2018 at 10:52am by Christopher Clyne
Title: Differing POV

Guest Opinion: Prop 3 Not Right for Utah

Imagine you’ve decided to make a necessary major household purchase, such as a new car. Let’s say you find a vehicle that suits your family, so you sit down with the dealer. You ask the total price, how much the payment will be and for how long. The dealer says he cannot tell you an exact price or a precise monthly payment, but the term of the loan will be “from now on.” Would you buy that car?

Last session, the Utah Legislature passed a Medicaid expansion measure that includes cost controls and allows enrollment limits. It establishes clear and reasonable eligibility rules and gives us options should the costs exceed our means.

For the out-of-state funders of Proposition 3, this was insufficient. So Utah voters will vote in November on whether to enact full Medicaid expansion under the “Affordable Care Act,” or Obamacare, instead of the Legislature’s Utah-centered approach.

Obamacare Medicaid expansion includes no cost or enrollment circuit breakers, and once we are in, we will never get out. The payment is undetermined and “term of the loan” is indefinite. Our decision will determine our future ability to fund vital state needs such as education, transportation and public safety.

Our “Utah style” limited Medicaid expansion is designed to help those truly in need while protecting taxpayers from excessive, budget-breaking costs. Under Proposition 3, all that flexibility vanishes in favor of a “top-down, one size fits all” Washington-style plan.

Since 32 states have chosen to expand Medicaid under federal mandates, we can examine their track record. Here’s what we know:

  • In every expansion state, enrollment and cost estimates have been way off; reality has sometimes doubled projections, thus doubling the costs.
  • Eighty-two percent of new enrollees are childless, able-bodied adults, mostly unemployed; 55 percent do not work at all.
  • The promised benefits — fewer uninsured, less uncompensated care, reduced emergency room utilization, vastly improved health outcomes — materialize marginally or not at all.
  • Because of federal reimbursement formulas, the very people most of us really want to help — the chronically ill, seniors in need of long-term care and individuals with physical or developmental disabilities — actually end up at the back of the line behind thousands of unemployed adults. Nationally, more that 600,000 such people are currently denied the care they need in favor of millions of new, able-bodied adult enrollees.

Medicaid is broken; doubling down on a broken system is foolish. Utah’s share of expenditures will only grow. In 2000, Utah spent $774 million on Medicaid; $127 million of that was Utah’s share, or 11.8 percent of Utah’s budget.

In 2016, the most recent year for which we have complete data, Utah’s total Medicaid expenditure was $2.5 billion, a whopping 229 percent increase in Medicaid alone. Utah’s share increased to $893 million, a 603 percent increase since 2000. And that was without Medicaid expansion under Obamacare as proposed in Proposition 3.

Medicaid currently absorbs 18.7 percent of Utah’s General Fund budget. How much more can we afford without more tax hikes or major cuts in services? That is happening in other states. So what are we willing to cut, or which taxes are we willing to raise, to pay for it?

15

comments on this story

Utah's Legislature has sometimes been criticized for its reluctance to grow state government, for demanding that we “pay as we go.” But as a result, Utah is among the most fiscally sound states. It’s been said, “It is easy to identify the blue states — just look for all the red ink.” Utah has avoided that pitfall by adhering to fiscal prudence.

Our Legislature acted wisely on expanding Medicaid — the full Obamacare Medicaid expansion proposed in Proposition 3 is bad policy and potentially devastating for Utah.

DMU Timestamp: November 02, 2018 17:13





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