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SALT LAKE CITY — Republican lawmakers are already trying to sell the Obama administration on their limited plans for Medicaid expansion, even as Gov. Gary Herbert continues to push his Healthy Utah alternative.
House Speaker Greg Hughes, R-Draper, said Monday he participated in a conference call late last week between lawmakers and representatives of the U.S. Department of Health and Human Services.
While the speaker said “nothing concrete” came of presenting several proposals to the federal department, “we didn’t hear any cursing on the other end of the line, so we felt pretty good.”
Hughes said the call wasn’t intended to compete with the GOP governor's efforts on Healthy Utah, which would provide health care coverage to low-income Utahns using the Medicaid expansion money available to the state under the Affordable Care Act.
“We’re not doing this in an adversarial way,” he said. “We know we need to work with the governor.”
The discussion between House and Senate members and Washington came as a surprise to Utah Health Department Executive Director David Patton, who has played a key role in the governor’s attempt to win federal approval for Healthy Utah.
Those efforts are nearly wrapped up, Patton said, but are on hold as Herbert attempts to reach an agreement with lawmakers on the best approach to Medicaid expansion.
Patton said he still hopes lawmakers will come around to Healthy Utah.
“We’ve tried to have open communications with them. I think, for the most part, they’ve been open to that,” Patton said, adding he was “not faulting them” for not letting the governor’s office known about the Washington call.
Healthy Utah would use the nearly $300 million available to help low-income Utahns obtain private health insurance, including those in the so-called coverage gap who otherwise would not qualify for any subsidies under President Barack Obama’s signature health care reform law.
But the governor’s fellow Republicans in the Legislature have balked at making what they believe will become a costly long-term commitment.
So lawmakers are looking at limiting coverage to only the medically frail earning less than 100 percent of the federal poverty level, about 10,000 people compared with nearly 100,000 under the governor’s plan.
Sen. Allen Christensen, R-North Ogden, said the state’s price tag for covering just that group under his proposed legislation would be $28 million in 2021, based on a 70 percent match from the federal government. That’s compared with $68 million at that time for Healthy Utah.
Because the governor’s plan complies with the requirement that coverage be available to anyone earning 138 percent or less of the federal poverty rate, the federal government would initially pick up all of the cost, a match that would drop to 90 percent in 2021.
Christensen said because Healthy Utah is more expensive, his plan “becomes the most plausible alternative” for lawmakers, especially those who would prefer not to deal with Medicaid expansion at all.
But the governor’s office is expected to come up with revenue sources to offset what will be a $78 million cost starting in 2021, based on a 90 percent federal match because more people are covered.
Those sources reportedly including a tax on electronic cigarettes already in the governor’s budget and expected to raise $10 million annually, as well as an assessment or tax on hospitals that would be saving money through the extended coverage.
Christensen, who participated in the conference call, said the federal officials “were absolutely elusive. Man, you couldn’t pin them down on anything.” He said lawmakers realize there’s no point in passing a plan that won’t be approved by Washington.
Senate Majority Assistant Whip Pete Knudson, R-Brigham City, said the discussion was actually helpful.
“We were given some things to contemplate on how our legislation would be drafted and whether it would be accepted,” Knudson said, including guidelines from similar plans aimed at the medically frail in two other states.
Still, Knudson wasn’t optimistic lawmakers would be able to put together a plan acceptable to the federal government before the session ends in mid-March.
“The good news is we don’t have a deadline — and maybe that’s bad news, I don’t know,” he said. “It may just carry on for a while.”
Contributing: Katie McKellar
