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SALT LAKE CITY — Gov. Gary Herbert has taken tax increases for his Healthy Utah alternative to Medicaid expansion off the table and cut the number of years he wants to try the program from three to two, but House Republicans still may not be sold.
The changes to the GOP governor's plan for using the federal funds available for Medicaid expansion under the Affordable Care Act were announced Thursday by Lt. Gov. Spencer Cox.
Cox said they "are a direct result of conversations we’ve had with multiple House members. We’re trying to respond to their concerns about long-term sustainability, really, the unknown about what happens."
The lieutenant governor spoke to reporters shortly after a closed-door meeting of the House GOP caucus on Medicaid expansion, the second time this week majority Republicans have talked about the issue.
House leaders said no decision was reached by the caucus among three options — Healthy Utah; a Senate alternative limited to the medically frail now called Utah Cares; or taking no action this session.
House Majority Leader Jim Dunnigan, R-Taylorsville, said the caucus has concerns about setting up a Medicaid expansion program to help low-income Utahns obtain health care coverage and then taking it away.
Dunnigan said the newest version of Healthy Utah does little to address that concern.
"We have a reluctance to start this program, put 60,000, 70,000 Utahns on it, and just tell them in two years, 'Oops. Just kidding. It didn't work out,'" the majority leader said.
Cox had a different perspective.
"Let's set up the program to do the best with what we have right now for these two years and then we can decide how we’re going to move forward at that point," the lieutenant governor told reporters.
Now, instead of being a three-year pilot program, Cox said Healthy Utah would be a "true two-year program so everyone who signs up knows it’s a two-year program going into it."
That will enable the state to use existing funds to pay for both years, he said, and the governor to abandon plans to ask for an assessment on hospitals, a tax on e-cigarettes and an increase in physician licensing fees to cover the cost.
Herbert's office was still working on the price tag for the new program, which is expected to help provide private insurance coverage to Utahns earning up to 138 percent of the federal poverty level.
Previous estimates put the price tag at $16.3 million for two years. As many as 126,500 low-income Utahns are expected to enroll, including those earning less than 100 percent of the federal poverty level who are in the so-called coverage gap.
Those Utahns in the coverage gap do not qualify for any subsidies under President Barack Obama's signature health care law unless the state adopts some form of Medicaid expansion.
Cox, who was serving in the Utah House when Herbert named him lieutenant governor, said he was not surprised the caucus hasn't taken a position on Medicaid expansion.
"I'm not surprised because it is a very complicated issue. It is a very big issue. We understand that. Having served in the House, I know how that process works," he said.
Senate Republicans also have yet to decide what they want to do about Medicaid expansion, but are seen as leaning toward supporting the governor's Healthy Utah option.
Sen. Brian Shiozawa, R-Cottonwood Heights, is sponsoring SB264, a bill that would establish the governor's Healthy Utah plan. The bill is expected to be substituted to reflect the changes announced Thursday.
Another senator, Allen Christensen, R-North Ogden, is sponsoring the "Utah Cares" compromise to assist the medically frail earning below 100 percent of poverty in SB153.
Both bills have won committee approval and are expected to be considered by the full Senate early next week.
Senate President Wayne Niederhauser, R-Sandy, said the changes to the governor's plan, especially limiting the program to two years, were sought by senators who backed Healthy Utah.
"Part of the difficulty with us coming to some kind of a conclusion, at least here in the Senate, is: What are the outcomes? How many people are going to show up?" Niederhauser said.
Not knowing exactly how much the plan could cost over time is one of the biggest problems senators have had with Healthy Utah, he said. So ending the program after two years unless lawmakers choose to renew it could win them over, he said.
"We're going to fund it all this year," Niederhauser said, then come back in two years with a better idea of how the program will work and decide whether to continue it, replace it or end Medicaid expansion.
"We're going to have to make some very difficult decisions at that time. It isn't just, 'Let's reauthorize it.' We're going to have to fund it also," he said. "I wouldn't consider it putting the decision off." Email: lroche@ksl.com Twitter: DNewsPolitics
