Herbert signs bill scaling back Utah’s Medicaid expansion ballot initiative
February 12, 2019
Gov. Gary Herbert signed a bill modifying the state's voter-approved Medicaid expansion plan Monday after a bitter fortnight on Capitol Hill.
S.B. 96, sponsored by state Sen. Allen Christensen, R–North Ogden, became a flashpoint from day one of the 2019 legislative session. Originally, it represented a more drastic return to the Republican-majority Legislature's partial Medicaid expansion plan passed last year, which voters rejected by approving a ballot measure for full expansion in November. Proponents of the bill said it was necessary to keep the expansion in good financial shape, while opponents pointed to other states' successful rollouts of full expansion.
The proposal, which lawmakers said was hurried through to meet an April 1 deadline for federal government waivers to be granted, underwent multiple major revisions. It's receiving backup in the form of H.B. 210, sponsored by Rep. Ray Ward, R–Bountiful, which provides a backstop in case the Trump administration doesn't grant the waivers.
One of the key differences between S.B. 96 and Proposition 3, the voter-approved plan, is a narrowing of eligible adult patients from those living on up to 138 percent of the federal poverty line to 100 percent. People in the resulting coverage gap will have an option to enroll in Affordable Care Act benefits, though many will pay monthly premiums. A work requirement equivalent to the one in place for SNAP benefits was also included in the bill. S.B. 96 is estimated to cover up to 90,000 new patients in Utah, down from 150,000 under Prop 3.
Rep. Tim Quinn, R–Heber, who opposed the Legislature's partial expansion last year on the basis of opposing all Medicaid expansion, said that he was initially against S.B. 96, but that the final product was an acceptable compromise between Prop 3 and what conservatives said were necessary amendments to the plan. Prior to its fourth and final substitution, the bill included effectively a kill switch for Utah Medicaid expansion as a whole if the federal government did not approve the necessary waivers by July 1, 2020.
"Whether you agree with expanding (Medicaid) or not, once you do something it's very difficult and not morally right to take that coverage back from people you had covered for the 15 previous months," said Quinn, whose district includes Park City. "We worked for days and days to come up with a solution that many of us felt satisfied the requirements for the voter will of Proposition 3, if you will, while maintaining the ability for the state to pay for it."
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On the other side of the House aisle, House Minority Leader Rep. Brian King, D–Salt Lake, lamented the Legislature stepping in to alter a plan that 53 percent of Utah voters approved in November. He opposed the plan the Legislature passed last year because, he said, it didn't go far enough. King's district includes Summit Park and parts of Pinebrook.
"What the Legislature has done is to say, 'We're going to come in and make some significant changes that are substantive,'" King said. "I'm sorry to see Prop 3 diluted and changed in a way that is not good for the people of the state of Utah generally."
Beth Armstrong, executive director of the Park City-based People's Health Clinic and a prominent advocate for Proposition 3, watched the proceedings with dismay.
"My disappointment is mostly with the process itself; just the enormous waste of human effort from the very beginning of proposing the initiative, to pushing the initiative to getting the signatures, getting 113,000 to sign it in order to get it onto the ballot," Armstrong said. "If they are so much smarter than we are, then why didn't they come up with this and get something passed without us having to do all of that work?
While the clinic, which cares for uninsured patients, would continue operating as normal, Armstrong said the passage of S.B. 96 was a blow to voters.
"(Legislators have) been successful at one thing, and that's discouraging anyone that thinks differently than they do from doing the work to change things," she said. "They've discouraged change by showing us that we really do not have a voice in this state."
Roughly 65 percent of Summit County voters supported Prop 3, and every state legislative district that stretches into the county voted in favor of it as well. Aside from King, every legislator representing Summit County — Christensen; Sen. Ron Winterton, R–Roosevelt; Quinn; and Rep. Logan Wilde, R–Croydon — voted to pass S.B. 96.
In the end, it all comes down to the federal Centers for Medicare & Medicaid Services (CMS). Christensen, Quinn and Republican leadership have stated they're betting on the Trump administration's approval for partial expansion. King and Armstrong don't share their confidence — Utah would be the first state to have such a waiver approved.
As the deadline for approval approaches, it appears that 150,000 Utahns will have to wait and see.