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Healthcare providers voice opposition to tax during Medicaid expansion hearing

Healthcare providers voice opposition to tax during Medicaid expansion hearing

(Tom Smart/Deseret News)


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SALT LAKE CITY — A parade of health care providers opposed to a proposed new tax to pay for Medicaid expansion dominated the only public hearing scheduled on the plan from Gov. Gary Herbert and legislative leaders.

Most of those testifying before the Legislature's Health Reform Task Force on Tuesday said they favored expanding the federal program that will bring hundreds of millions of dollars to the state to provide coverage for low-income Utahns.

What they didn't like about the plan were new taxes on a long list of health care providers — including hospitals, doctors, nurses, pharmacies, insurers, social workers and optometrists — intended to raise more than $50 million by 2021.

The task force took no action at the end of the four-hour hearing on UtahAccess+, the product of months of private meetings that was unveiled a week ago in closed Republican caucuses in the House and Senate.

"We don't feel like we're ready," the task force's co-chairman, House Majority Leader Jim Dunnigan, R-Taylorsville, said. "It needs more time. We want a further incubation period so people can thoughtfully consider it."


I think many people are in favor of expanding if they don't have to pay for it.

–Jim Dunnigan, House Majority Leader


Dunnigan said caucus members are concerned about the unknown costs and whether the federal government will be able to pick up 90 percent of the price tag as called for in President Barack Obama's health care law.

"I think many people are in favor of expanding if they don't have to pay for it," he said after the task force heard from about 50 people, many representing health care provider groups.

Michelle McOmber, chief executive officer of the Utah Medical Association, said a recent survey of doctors found that while two-thirds support Medicaid expansion, 99 percent oppose a new annual tax, estimated to start at $800, to help pay for it.

Doctors want to see the money come from a broad-based tax, McOmber told the task force. She argued that taxing doctors and others providing Medicaid services would be like taxing developers to cover the cost of the new state prison.

Former Lt. Gov. Greg Bell, now president and CEO of the Utah Hospital Association, said the group could not support the current plan because it doesn't restrict how much taxes can climb to cover increases in enrollment.

The Health Reform Task Force meeting on Capitol Hill attempting to find a way to address the lack of adequate access to health care by those falling within the "coverage gap" created by the federal Affordable Care Act Tuesday, Oct. 6, 2015, in Salt Lake City. 
 (Photo: Tom Smart, Deseret News)
The Health Reform Task Force meeting on Capitol Hill attempting to find a way to address the lack of adequate access to health care by those falling within the "coverage gap" created by the federal Affordable Care Act Tuesday, Oct. 6, 2015, in Salt Lake City. (Photo: Tom Smart, Deseret News)

"Private business can't be at risk," Bell said. "There is a limit to what we can afford."

Some who testified, including Melinda Turner, of Provo, came to ask for help because they fall into the so-called coverage gap — poor but unable to qualify for health care subsidies unless Utah expands Medicaid.

"If it wasn't for my parents, I would be dead. I wouldn't have enough money to live," said Turner, 33, who spends all of her part-time earnings on health insurance and medication for her arthritis, fibromyalgia and other ailments.

She said her policy, purchased through the federal government's health exchange, costs $270 a month because without Medicaid expansion, Utahns earning less than the federal poverty level — $11,500 for a single person — must pay full price.

Turner asked lawmakers to support the new plan unveiled a week ago so she will be "able to have a life again instead of just staying home and paying everything" toward her medical care.

Another woman, Candace Salima, of Santaquin, who lost her insurance when her husband died, said she didn't want to see the state expand Medicaid because Utahns can't afford the cost.

"You and I both know the federal government never keeps its promises," Salima said.

Aimee McLean, vice president of the Utah Nurses Association, said nurses don't want to be taxed. The plan calls for them to pay $1.50 a year initially. But McLean said nurses also want health care coverage for Utahns.

"If this bill is how we get there, then we support it," she said.

Lawmakers also weighed in during the hearing.

Rep. Jake Anderegg, R-Lehi, said he can't back the plan because there's nothing to prevent the new provider taxes from being passed on to consumers, creating a "defacto tax on the back end."

Sen. Allen M. Christensen, R-North Ogden, and Rep. James A Dunnigan, R-Taylorsville, co-chair the Health Reform Task Force on Capitol Hill in an attempt to find a way to address the lack of adequate access to health care by those falling within the "coverage gap" created by the federal Affordable Care Act Tuesday, Oct. 6, 2015. 
 (Photo: Tom Smart, Deseret News)
Sen. Allen M. Christensen, R-North Ogden, and Rep. James A Dunnigan, R-Taylorsville, co-chair the Health Reform Task Force on Capitol Hill in an attempt to find a way to address the lack of adequate access to health care by those falling within the "coverage gap" created by the federal Affordable Care Act Tuesday, Oct. 6, 2015. (Photo: Tom Smart, Deseret News)

One of the lawmakers who helped put together the plan, Sen. Brian Shiozawa, R-Cottonwood Heights, said he would have preferred a different funding source but was willing to compromise.

"As an individual, I have some real concerns about the funding. It wouldn't be my first choice. It wouldn't be my second choice," said Shiozawa, an emergency room doctor.

He said he wants to see hospitals shoulder the bulk of the state's share of the costs because they benefit most from fewer emergency room visits by Utahns who are uninsured.

Dunnigan said adjustments have already been made in the proposed provider tax assessments, including raising the share paid by hospitals from $17.5 million to $23.5 million, which decreases what other provider groups would have to pay.

What's next?
The plan will next go before another House GOP caucus, set for Oct. 13. There, House Republicans, who hold a supermajority, will be polled to determine if the votes are there for a special session of the Legislature later this month.

House Speaker Greg Hughes, R-Draper, credited with coming up with the funding portion of the plan, did not attend the hearing. Senate President Wayne Niederhauser, R-Sandy, who was there, said other adjustments may be made.

The governor brought key lawmakers together after his Healthy Utah alternative to Medicaid expansion passed the Senate but stalled in the House in the 2015 Legislature.

Herbert has said he will call lawmakers into special session to consider the new plan, which, like Healthy Utah, helps low-income residents obtain private insurance coverage.

A timetable for UtahAccess+ distributed at the hearing shows the soonest the plan could be in place is January 2017, although some coverage could be available in July 2016. The plan will need federal approval, anticipated to come by May 2016 if lawmakers act this month.

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