Utah House passes replacement for voter-approved Medicaid expansion amid protests

SALT LAKE CITY — The House voted 56 to 19 in favor of SB96 Friday, the GOP legislative leadership's alternative to the full Medicaid expansion approved by voters that now includes the possibility of reverting back to much of Proposition 3.

The vote came after a group of faith leaders chanted, "Do justice, love mercy," and prayed outside the House chamber for lawmakers to support the ballot initiative passed last November rather than a more limited and initially more costly plan.

There was brief cheering in the House gallery when backing the will of voters was mentioned during the debate, but House Speaker Brad Wilson, R-Kaysville, warned the public seating area would be cleared if there was another outburst.

During the vote, banners urging lawmakers to "Respect our vote" were unfurled. As the man with a banner was led away, he yelled, "Fight poverty, not the poor."

The bill's House sponsor, Rep. Jim Dunnigan, R-Taylorsville, told representatives that the cost of implementing Proposition 3 exceeds the money raised by the 0.15 percent sales tax increase in the initiative.

"Having enough money and being fiscally responsible, we should at least try" to get the federal approval needed for expanding Medicaid to only about two-thirds of those who would be covered under Proposition 3, Dunnigan said.

He said lawmakers can pursue a more sustainable plan knowing there is a "backstop."

Several efforts to change the revised bill failed, including an attempt to replace SB96 with HB210, a bill that would allow Proposition 3 to take effect with some modifications while waiting to see if the more limited program would be approved.

But Dunnigan warned that could put the state in "legal jeopardy" because some Medicaid recipients could lose their benefits. He said he incorporated parts of HB210, sponsored by Rep. Ray Ward, R-Bountiful, in the fallback plan.

Ward told fellow representatives during the SB96 debate he backed the revised bill.

"To me, it looks like we've done a very good job. It will be sustainable in the long run," Ward, a doctor and a longtime advocate of Medicaid expansion said, allowing lawmakers to "keep our promises."

House Majority Leader Francis Gibson, R-Mapleton, assured representatives they'll be able tell their constituents that "we covered the spirit of what that proposition was."

Proposition 3, Gibson said, "was asking for coverage for the most vulnerable in our society." He said by passing SB96, lawmakers will do that "in a way that is uniquely Utah."

Before the House convened, Dunnigan went over the proposed "fallback plan" the House is putting in the bill to its Senate sponsor, Sen. Allen Christensen, R-North Ogden.

Christensen said he did not oppose a fallback plan because he believes it won't be necessary. He snapped his fingers when asked if the Senate would concur with the House changes. He said that vote would likely come Monday.

"They want it done. They're happy the House is happy with it," Christensen said of the Senate. "They're all tired of the wrangling over it."

The two-part plan that kicks in only if the more limited coverage sought in SB96 is rejected by the federal government is similar to Proposition 3, the ballot initiative for full Medicaid expansion passed in November.

However, the first step of the plan that would take effect Jan. 1, 2020, does attempt to keep a work requirement in place. If that doesn't fly with Washington, then a $15 million annual hospital tax would be put in place July 1 of that year.

Unchanged is Christensen's original proposal to provide Medicaid coverage only to Utahns earning up to 100 percent of the approximately $12,000 federal poverty rate.

The full Medicaid expansion approved by voters provides Medicaid for Utahns making up to 138 percent of that rate. SB96 proponents have said federally subsidized insurance will take care of those in that category.

Christensen's bill would start coverage April 1, as would Proposition 3, but at a more expensive 70 percent to 30 percent federal to state funding match rather than the 90-10 split offered for full expansion.

The so-called "bridge" plan would be in place for 18 months as the state seeks permission from the Trump administration to extend Medicaid to the smaller population at the higher funding match.

While the Senate passed SB96 last week 22-7 without a fallback plan, enough House Republicans balked at the bill that the supermajority needed to ensure the bill could take effect quickly with Gov. Gary Herbert's approval was in jeopardy.

Following a closed-door House GOP caucus Thursday, Dunnigan went to work on changing the bill.

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