Medicaid expansion inches along as deadline passes
This Friday, July 31, is Gov. Gary Herbert’s deadline for his "Gang of Six" Republican lawmakers to come to an agreement on a plan to accept hundreds of millions of federal dollars annually to provide health care to low-income Utahns. That deadline is widely expected to come and go without any action.
On July 17, the Gang announced that it had come to an agreement on a "framework" for a Medicaid-funded expansion.
"The framework of this proposal provides coverage for a population up to 138 percent of the federal poverty level utilizing the greatest return of Utah taxpayer dollars through the ACA," a press release stated. "It protects the State from cost overruns through a formulaic funding model allowing providers and benefactors of Medicaid dollars to pay their share."
A spokesperson for the governor said Tuesday that those details are "pretty much it for now." She said the governor had been out of town last week and that she expects the Gang to begin meeting again in the coming weeks.
The Gang said it planned to "meet with stakeholders and policy makers in the coming weeks" as a "draft" of a plan is produced. Public hearings on the plan would follow.
"We’re getting closer all the time, and I hope in the next three or four weeks we’ll have this thing resolved," Herbert said Monday.
As the current plan is only a very broad framework, many steps remain before a health care expansion could actually take place. The framework calls for health care providers such as hospitals and doctors to pay a share of the annual costs of any expansion, so those groups will need to provide some level of "buy-in."
If and when those groups offer support for a plan, the Utah House of Representatives will need to be convinced.
RyLee Curtis, senior health analyst at Utah Health Policy Project, said that while the announced framework is light on details, the fact it would be a "full" expansion, meaning it would cover the most people and accept the most federal dollars, is significant.
"The House has never been at that place before and so that’s a huge breakthrough," she said.
The House has been the legislative body most resistant to any form of Medicaid or Medicaid-funded expansion. It refused to hold a full vote on Herbert’s Healthy Utah plan in the last legislative session after the plan passed the Senate.
"A majority of the House allowed their loathing of all things Obama to supersede Medicaid progress, and rejected the deal, offering a piddling alternative ironically dubbed Utah Cares," said the Standard-Examiner editorial board Monday. "We’re not at all surprised at the cypher of a Medicaid deal that a six-member group has ‘reached’ to expand Medicaid in Utah. No one really expected the group to accomplish much," it added.
The Salt Lake Tribune and Deseret News editorial boards have also been critical of the glacial progress on expansion.
"In order to drag the matter out for three years, the blockade in the Utah House had to willfully ignore two facts," a July 20 Tribune editorial read. One, that delay "would leave tens of thousands of Utah residents without access to health care." Two, that "[a]ccepting Medicaid expansion, or some alternative, could not be anything but a net financial benefit, both to government and to the state’s overall economy."
"As long as Utahns are required to shoulder hundreds of millions of dollars of new Obamacare taxes, rejecting a cost-sharing plan that address the unmet health needs of the poor does not make sense," wrote the Deseret News in February 2014.
The Affordable Care Act’s Medicaid expansions are 100 percent paid for by the federal government in the years 2014-2016, before that number winnows down to an ongoing 90 percent. Those years aren’t up for negotiation, so if Utah is going to take advantage of the final year of basement-bargain prices, it will need to have a program in place prior to 2016.
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