SALT LAKE CITY — State Sen. Jim Dabakis wants Utah to reconsider large-scale Medicaid expansion, saying the Affordable Care Act is "here to stay" after a second effort in the U.S. Senate to replace the law failed this week.
Dabakis, D-Salt Lake City, has taken to Twitter urging Gov. Gary Herbert to hold a special legislative session to discuss accepting federal Medicaid funding.
The timing is right, he told KSL on Thursday, because Senate Republicans failed to secure enough supporters to pass the Better Care Reconciliation Act, which beginning in 2020 would have rolled back states' expanded Medicaid programs.
Under the Affordable Care Act, 31 states accepted federal funding to expand who is eligible for Medicaid and what medical services qualify under the program.
Dabakis, who is a member of the Senate Health and Human Services Committee, said state Republicans justified not expanding Medicaid in Utah because of uncertainty over whether the funding would continue, particularly under a Republican president.
But, he said, that funding source looks much more secure now that the Better Care Reconciliation Act is presumed failed.
The Affordable Care Act "is not going to be repealed, it's not going to be replaced in the near future," Dabakis said. "For us not to take our share is doing an astonishing injustice to so many people who are in desperate need of this insurance."
Dabakis believes state Republicans' distaste for the Affordable Care Act blinded them to the opportunity to insure more Utahns.
"It's very smug for legislators to kick their feet up on the desk and say we're going to teach Washington a lesson, we're going to show them, (when) it's with somebody else's health care that they're making this ideological message," he said.
But state Rep. Brad Daw, R-Orem, who is chairman of the House Health and Human Services Committee, said Republican legislators have opposed Medicaid expansion not because of the possibility of Affordable Care Act repeal, but rather due to the financial unsustainability of expanding.
"We opposed Medicaid expansion before there was any hint that the ACA might be repealed," Daw said.
Multiple attempts to reach Hebert for a response to Dabakis were unsuccessful Thursday. The governor in recent years has been a proponent of full Medicaid expansion. But state lawmakers only passed a minor Medicaid expansion in 2016.
After some delays associated with the handing of the baton between presidential administrations, the Utah Department of Health confirmed in February that between 3,000 to 5,000 poor Utah parents will be made eligible for Medicaid this year due to the expansion, at the expected cost of $5 million to $7 million per year.
Another subset of Utahns — 6,500 childless adults who are either homeless, need addiction or mental health treatment or are in the criminal justice system — were also a part of the expansion approved by the state Legislature. But federal approval of that expansion component remains in limbo.
The fact is, Medicaid expansion is fiscally unfeasible and we don't want to go down that road.
–Rep. Brad Daw
State Democrats have repeatedly said they are upset that more robust expansion, bringing in $530 million in federal funds to cover 90,000 additional Utahns, was rejected.
Asked what he thought of Dabakis' renewed call for Medicaid expansion, Daw said it was a nonstarter.
"I don't see the House changing its stance. The fact is, Medicaid expansion is fiscally unfeasible and we don't want to go down that road," he said.
Under current law, 2016 is the last year for which the federal government provides 100 percent of Medicaid expansion funding to states. It is scheduled to taper down to 90 percent by 2020. The U.S. Department of Health and Human Services finalized a rule in 2013 mandating that the federal matching rate not dip lower than 90 percent after 2020.
Despite the application of that rule, Daw said he and other state legislators believe "it's almost a guarantee" that federal lawmakers will one day drop the matching rate below 90 percent.
"The state ... (would be) completely at the mercy of whatever the Congress decides to hand out,' he said.
Even if the matching rate dropped only to 85 percent, he said, it would devastate the state budget. What is a 5 percent decrease in federal help would still balloon the state's obligations by 50 percent, Daw said.
"When you're on the margin like that, a little move becomes very painful," he said.
Dabakis said the GOP's reluctance to pay a small portion of a vast monetary gift from the federal government amounts to "lunacy."
"It doesn't boil down to what's reasonable. It doesn't boil down to what's sensible," he said. "It boils down to what will the extremists in the caucus say about it.
"Ideology has stepped up ahead of logic and common sense. It's not the Utah way. We believe in common sense, we believe in helping our neighbors, we believe in doing what's right (and) we believe in helping the least of these."
Daw insists the Republican-controlled Legislature worked diligently to find creative solutions making Medicaid expansion fiscally doable, including the consideration of a tax on health care providers to help pay for the state's 10 percent burden.
But those efforts fell apart because of intense opposition from those providers, many of whom supported expansion.
"As soon as they were on the hook ... they changed their tune dramatically," Daw said.