ObamaCare’s Medicaid Expansion supported by Summit County Council
Ryan Summerlin March 5, 2013
The Summit County Council is throwing its support behind ObamaCare’s Medicaid Expansion.
Following a straw poll on Feb. 27, the council said they plan to sign a resolution in favor of the expansion bill, H.B. 153, during the next County Council meeting Wednesday, March 6.
"This is a no-brainer," Councilmember Claudia McMullin said.
Governor Gary Herbert is still deciding whether Utah will opt for the expansion.
The expansion would provide health insurance to anyone making up to 133 percent of the federal poverty line.
A family of three making about $25,000 would qualify under the expanded program.
"Medicaid is a program that covers folks who meet two requirements: have a certain income level and be either a child, have a disability, be elderly or pregnant," said Matt Slonaker, Utah Health Policy Project (UHPP) Medicaid Policy and Collaborations Director. "The Medicaid expansion essentially says, you’ve got to raise your limit for poverty a little bit higher and you have to get rid of the categorization."
Medicaid Expansion is an optional program states can choose whether or not to participate in.
"Do we want to expand to that greater income level with a broader basket of people?" Slonaker asked. "That’s the question currently before the governor and before the Legislature. Across the nation, governors have been taking the lead on whether or not to do the expansion. A lot of Republican governors have been going for it. But Governor Herbert has been thinking its better timing to go after the legislative session is over."
Currently, the federal government matches state funds for Medicaid 60/40. If Utah passes the expansion, the federal government has offered to pay the full cost of the program for three years, then phase down to 90 percent.
"That’s a significant deal," Slonaker said. "That doesn’t happen very often when the federal government is kicking in that much money."
It is projected Utah will save $4,549,200 in 2014 and $13,024,700 in 2015, according to the bill’s fiscal note. The expansion is also expected to generate 5,000 Utah jobs.
Costs to the federal government would be $245 million in fiscal year 2014 and $521million in fiscal year 2015, according to an economic impact analysis by Families USA and the UHPP.
"If we don’t do the expansion, the money goes to other states," Slonaker said.
However, Slonaker said he has heard a lot of legislators worry that the federal government won’t keep up their end of the bargain.
"But if we look at Medicaid as a program, with it’s integrity and position as a solid funding source for state programs, its one of the most reliable," he said. "If you go off history, we probably have a very stable funding source."
According to Nann Worel, People’s Health Clinic Executive Director, between 16 to 18 percent of Summit County residents are uninsured. This is higher than the state average of 14 to 15 percent, she said.
The People’s Health Clinic serves only uninsured Wasatch and Summit County patients.
"Our patients are really struggling to making ends meet," she said. "Oftentimes they work two or three jobs. But if they aren’t healthy, they can’t be productive at work."
Worel added that 91 percent of the clinic’s patients are employed.
"They aren’t looking for a handout; they are looking for a hand up," she said. "It’s not like they people who are not doing anything. Our system just doesn’t accommodate that there is no insurance offered by the employer."
Worel said that expanding Medicaid eligibility to 133 percent will help the people they serve receive the help they need.
"Our patients tend to be sicker than those with insurance," she said. "They delay care because of lack of access or the costs involved, so by the time they get to us, they often have chronic illnesses that are way out of control."
Summit County is legally responsible for providing mental health and substance abuse services for all patients, regardless of their ability to pay, according to Summit County Health Director Richard Bullough.
"But most counties across the country, including Summit County, are struggling to meet those obligations," he said.
About 98.7 percent of those receiving substance abuse treatment in the county are uninsured, Bullough said.
"It’s estimated that about 50 percent of the individuals receiving the treatment would be eligible for Medicaid under the proposed expansion," he said.
Many who go through substance abuse treatment cycle in and out of the courts and jails, Bullough added.
"It’s pretty clear there are certain standards of care that are effective in keeping them out of the courts and jails, and it’s questionable whether or not we are delivering those levels of service at this point in time," he said. "From the perspective of the Health Department and Summit County, we would have increased opportunity to not only stretch our limited resources but, more importantly, provide long-term care so they are not cycling through our system."
County Manager Bob Jasper related a story from when he served as Assistant County Manager for Washoe County, Nev. about a woman with a bipolar son.
"When he would be in his manic phase, it was pretty crazy," Jasper said. "We had that kid in our county jail at least 30 times over a two or three year period. She spent every penny she had on him and was constantly bailing him out of jail. It was a big jail with a mental health facility, but jail is a terrible place to treat mental illness."
Jasper said the son would be given enough drugs to temporarily treat his mania and then discharge him from jail.
"And two weeks later he’d be back," he said. "That’s the cycle were dealing with. And it’s an expensive and rotten way to treat people."
The state has commissioned a study from an independent consultant to look at the cost-benefit of Medicaid expansion in Utah.
"So then we’ll have state-specific data," Slonaker said. "A lot of legislators up on the Hill are waiting for this study to come out. But the study was delayed twice, so now we’re in this predicament with two weeks of session left. There’s not enough time to get it through the session, so we’re hoping the governor can take the initiative shortly after the session. Maybe he’ll call a special session to get this issue through the Legislature."