80,000 patients hang in the balance as Utah voters consider Medicaid expansion
October 24, 2018
As if redistricting reform and medical marijuana weren't big enough topics on their own, voters on Nov. 6 will also determine who has the final say on Medicaid expansion in the Beehive State.
Proposition 3, formerly known as Utah Decides Healthcare and backed by a group of the same name, offers a more liberal dose of Medicaid expansion than the plan passed by the Utah Legislature that Gov. Gary Herbert signed this spring. The ballot item proposes a 0.15 percent sales tax increase to help fund an expansion of Medicaid coverage to Utahns under 65 living on up to 138 percent of the federal poverty line — about 150,000 eligible patients making at or under $16,643 individually or $33,948 for a family of four — with no stipulations.
The proposal more than doubles the number of people projected to benefit under the existing expansion plan passed by the majority-Republican legislature. Currently, 70,000 people in the state under 65 living on up to about 95 percent of the federal poverty line will become eligible for Medicaid. The plan would also nix the legislative solution's requirements that eligible residents work, volunteer or undergo an educational program to receive benefits.
The outcome of the vote could have consequences far beyond the state's borders.
Utah is among a quartet of conservative-leaning states to put Medicaid expansion to a vote this year, alongside Idaho, Montana and Nebraska. As of now, 18 states have not yet expanded the program; Montana is voting on whether to lift a 2019 expiration date on their policy.
The rest of the states have undertaken Medicaid expansion since the Affordable Care Act (ACA), which enabled them to do so, passed in 2010. According to polling by the Salt Lake Tribune and the Hinckley Institute of Politics, a 59 percent majority of Utahns favor the Prop 3 alternative, the Tribune reported last week.
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Among the 607 voters surveyed, 89 percent of Democrats either strongly or somewhat favored the ballot item, while 64 percent of unaffiliated voters signaled their approval.
Only 44 percent of Republicans polled said they supported Prop 3, while 9 percent said they didn't know how they felt and 24 percent marked "strongly oppose."
While the current Medicaid expansion plan was passed on bipartisan grounds in the heavily Republican Legislature, many of the GOP members who supported the partial expansion oppose the alternative offered in Prop 3.
Rep. Logan Wilde, a Republican from Croydon representing parts of Kimball Junction and eastern Summit County in the Utah House, voted in favor of the partial expansion but doesn't support Prop 3 — not because of its policy goals, but because of the math involved.
"Not that I don't support the program or idea," said Wilde, who is running for reelection. "The problem I have is, do we make a program that has the potential of collapsing on itself, and we have to come back and install limitations on it. … We are seeing a dwindling of the sales tax, which is where that $92 million comes from. With the erosion of that sales tax base, is it a dependable mechanism to fund such a much-needed program?"
Wilde says he has spoken with officials in Colorado concerned about the instability of expansion as the neighboring state has expanded Medicaid to the 138 percent mark since 2009. He is wary of inviting similar challenges in Utah. Since beginning its Medicaid expansion, Colorado has seen a 29 percent drop in the number of rural residents who are uninsured, the largest in the nation according to a recent study by Georgetown and the University of North Carolina.
Park City's other candidates for the statehouse have also stated their positions on the issue. Chris Neville, Wilde's Democratic challenger for the House District 53 seat from Park City, fully supports the ballot measure.
Incumbent Republican Rep. Tim Quinn, who represents Park City in House District 54, voted "no" on House Bill 472, the partial expansion legislation, and has stated his opposition to Prop 3. Senate District 26 candidate Ron Winterton, a Republican, has also voiced his concerns about the policy.
Both Meaghan Miller and Eileen Gallagher, the Park City Democrats challenging Quinn and Winterton, respectively, work in healthcare and have made their support of full Medicaid expansion key parts of their platforms. Miller has long studied healthcare policy and works at the People's Health Clinic, while Gallagher is a physician.
Prop 3 also gets around an uncertainty inherent to the Legislature's plan. The federal government will need to approve the H.B. 472 plan, said Utah Department of Health spokesperson Tom Hudachko. The plan outlined in Prop 3 would not need federal approval, as it is in line with ACA standards. While Washington has indicated it would wait until after the midterm to take action on the existing plan, the Trump administration has quietly chipped away at ACA provisions after Congress failed to repeal it last year.
The 2018 midterm elections take place on Nov. 6. Voters may register online at vote.utah.gov until Tuesday, Oct. 30. Same-day registration is available on Election Day.
Editor’s note: A previous version of this article incorrectly stated that Utah’s Medicaid expansion plan would need federal approval regardless of whether Prop 3 passes.