SALT LAKE CITY — House Speaker Greg Hughes says GOP legislators might be willing to pass Medicaid expansion under the Affordable Care Act during the 2018 legislative session if the bill meets a slew of requirements — including a work requirement and a cap on spending.
Rep. Robert Spendlove, R-Sandy, has opened a file for a Medicaid expansion bill, and while he says the bill hasn't been drafted yet, he expects it to meet those requirements.
But a Senate Democrat plans to sponsor a full Medicaid expansion bill — saying anything less would be a "joke" to Utahns. And backers of the initiative to put full Medicaid expansion on the 2018 ballot say they're not going to back down.
The initiative to let voters decide whether Utah should expand Medicaid coverage using a sales tax increase came amid frustration after years of tense debate on Capitol Hill, until in 2016 state lawmakers settled on a more limited Medicaid waiver package. Utah leaders then waited more than a year until President Donald Trump's administration approved the waiver in November.
Republican legislators in the House — Hughes in particular — have long been reluctant to adopt full Medicaid expansion, arguing it would place Utah in a fiscally irresponsible position with open-ended and uncertain costs. Because of those concerns, the House killed Gov. Gary Herbert's Healthy Utah expansion plan in 2015, even though it passed in the Senate.
Previously, Spendlove has sponsored Medicaid expansion bills to address Republicans' concerns, but they hit dead ends because the Obama administration wouldn't allow some of Utah's requirements. Now, Hughes said, Utah has a new opportunity to pass its own tailored version under a more "flexible" administration.
Hughes said Republican lawmakers could support expansion under the following requirements, which he expects would be accepted under the current administration:
- Including only up to 100 percent of poverty, not 138 percent.
- A cap on how much the state would spend.
- Paid for under a 90-10 split, where the federal government would start out paying 90 percent of the cost, where the state would pay 10 percent before the state's share would grow over time.
- Eligibility would hinge on some sort of work requirement
Hughes, R-Draper, said the GOP is "not a party of 'no' and is "looking to help people in need" in a fiscally responsible way.
"These are good conversations worth exploring, and I think we owe it to everyone to explore those options," Hughes said.
Sen. Jim Dabakis wants to push another option. The Salt Lake Democrat said he plans to sponsor a full Medicaid expansion bill, adamant that Utah should take its "full share" of Medicaid dollars — and it shouldn't take a ballot initiative to do it.
"In 2014, 2015, 2016, 2017, we lost billions of dollars while those guys just sit around trying to think up the latest scheme — it's really taking the lives out of so many Utah family's hands while they play these political games, and it's shameful," Dabakis said.
He said anything less than full Medicaid expansion would be "preposterous" and "no solution at all."
"It's a joke on the people of Utah," he said. "I think these guys are making contortions to avoid doing the right thing."
Full Medicaid expansion would draw down matching funds of roughly $800 million from the federal government to expand coverage to all Utahns whose income is 138 percent or less than the federal poverty level, making insurance available to Utahns who make too much to qualify for Medicaid but not enough to be eligible for tax credits toward any coverage plans on the federal health exchange.
Matt Slonaker, executive director of Utah Health Policy Project, one of the advocacy groups backing the ballot initiative, said their campaign to gather signatures is "full steam ahead."
"We support getting coverage to folks in the coverage gap, and we would prefer the mechanism to be traditional Medicaid expansion," he said, though he added it's too early to either support or condemn any legislation because no bills have been filed yet.
"We're still tentatively watching, but certainly focusing in on the citizens initiative is the more practical alternative at this point," Slonaker said.
Supporters will need to collect 113,000 signatures by April 15, meeting certain thresholds of signees in 26 of Utah's 29 Senate districts in order to get the initiative on the ballot.
Slonaker also wondered if Republicans' willingness to pass a Medicaid expansion bill may have surfaced from the "pressure" from the ballot initiative.
"We knew it wouldn't be outside the realm of possibility that a citizen initiative would sort of impact the Legislature and perhaps they would want to act before the citizens," Slonaker said.
But Hughes said the effort has not been driven by the ballot initiative — but rather by the new administration's willingness to consider custom requirements.
Herbert spokesman Paul Edwards said the governor looks forward to seeing the proposals that come forward from the Legislature, though he added it's difficult to comment on bills that have not yet been filed. He also said "we'll have to see" what will come of the ballot initiative.
However, Edwards said "a lot of policymakers were very heartened" by Centers for Medicare and Medicaid Services Administrator Seema Verma's visit to Utah in November.
"At the time we had some very positive discussions about the kind of flexibility that we are likely to expect from this administration," Edwards said.
He added: "I think we will see the stars align" for a possible Medicaid expansion bill with requirements House Republicans are jockeying for.
"We look forward to working with the Legislature on addressing this serious gap in our safety net," Edwards said.
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