SALT LAKE CITY — Gov. Gary Herbert wants to know who will occupy the White House before making any decisions about expanding Medicaid in Utah.

"I think it's prudent to wait and see what happens in November," he said Tuesday.

"If President Obama is re-elected that will tell us one thing about the direction of health care in this country. If Gov. Romney is elected — and I'm an unabashed supporter of Gov. Romney for a lot of reasons — it will change the direction of health care and hence, Medicaid as we go forward for the next four years."

Under the controversial Affordable Care Act, states may extend the government-run insurance plan to those currently ineligible starting in 2014.

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Although the U.S. Supreme Court upheld the requirement that individuals either have insurance or pay a fine, the justices ruled that states can opt out of the expansion of Medicaid. People earning up to 138 percent of the federal poverty level qualify for Medicaid under the health care law, except in states that reject the expansion.

Herbert told the KSL editorial board that there are too many uncertainties and questions that the state needs answered before a decision could be made.

Ultimately, he said his office in conjunction with the Utah Legislature will decide whether to expand the program.

Herbert said although the federal government has made it clear it wants states to join in, there may be opportunities for flexibility and doing things differently.

"I want to keep the door open for negotiation, and the Legislature, I think they're very concerned that somehow we're going to empower the Affordable Care Act, which they don't like."

Covering Utahns eligible for but not currently enrolled in Medicaid will cost the state $940 million over the next decade. Expansion tacks on another $240 million in that time period, he said.

Herbert called Medicaid the "budget buster of all budget busters" and said costs are growing dramatically. The portion of the state budget going to Medicaid has gone from 9 percent to 21.8 percent the past 10 years, the governor said.

If that continues, he said, Utah would have to raise taxes, stifle the economy or take money from places such as human services, education, roads and water development to fund it.

"We're putting excessive amounts into Medicaid," Herbert said.

But Voices for Utah Children contends the true costs of the national health plan are often overstated.

“If Utah’s budget is stretched short, don’t blame Medicaid,” said Allison Rowland, Voices director of research and budget. “Only 8 percent of state resources go to Medicaid, and Utah receives two additional dollars on average for each one it spends."

The difference between her figures and the state's is that Herbert includes federal Medicaid dollars flowing to the state, which he said is tax money just the same.

A new Voices report attempts to put state spending on Medicaid into perspective by comparing it with other priorities. It shows public education, higher education and transportation all receive substantially larger shares of state dollars than Medicaid.

The report further shows that Utah actually gets more health care bang for the buck due to Medicaid. Increased efficiency in the program allowed 108,000 additional Utahns — two thirds of them children — to receive coverage. Medicaid spent 18 percent less per enrollee than in 2007, according to the report.

“Medicaid did exactly what it was meant to during the toughest economic downturn in a generation," Rowland said.

Herbert said he supports the idea of a safety net for the most vulnerable members of society but "can we afford the good program?"

The governor disagrees that the costs to maintain Medicaid are overstated. He said he recently spoke with a liberal Democratic governor who told him that Medicaid is killing her state's budget.

"I think everybody acknowledges that this is causing our budgets to dramatically increase, and is not sustainable," Herbert said.

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