UPDATED: Summit County’s senators spearhead push to tweak voter-approved Medicaid expansion
January 30, 2019
SALT LAKE CITY — State Sen. Allen Christensen's proposal to cap the number of eligible recipients under a voter-approved Medicaid expansion plan is undergoing maintenance after an initial burst of activity in the first week of the 2019 legislative session.
S.B. 96 has prompted a firestorm of debate over the role of elected officials in modifying laws passed via statewide ballot initiative. Among other changes to the plan voters approved as Proposition 3 in November, the North Ogden Republican's sponsored bill would move the current number of eligible patients — people living on up to 138 percent of the federal poverty line — back to the 100 percent figure included in a plan passed by the majority Republican Legislature last session.
The bill possessed initial momentum as it cleared a procedural hurdle in front of the full Senate Wednesday and was set to receive final Senate approval as soon as Thursday, but adjustments to the bill's mechanics have delayed further action. Republican leadership had planned to fast track the bill onto Gov. Gary Herbert's desk in order, they say, to meet an April 1 deadline to implement expansion. GOP modifications would require the Trump administration to approve waivers for aspects of the plan that fall outside of the Affordable Care Act.
Christensen said Wednesday in a press conference that he was betting on the expansion being put in place by the deadline, while critics say the Republicans are pushing through the bill and getting the final say on a voter-endorsed law that ultimately amounts to a gamble.
Sen. Ronald Winterton, a Republican from Roosevelt who represents parts of Summit County and chairs the Senate Health and Human Services committee, made his presence felt on the second day of the session in Salt Lake when the committee voted to send Christensen's proposal to the full chamber. Winterton campaigned partly in opposition to a full Medicaid expansion plan, though his emphasis was on transportation rather than his health care credentials.
"Having the Medicaid bill on there first thing was somewhat intimidating," Winterton, a freshman senator, said Thursday. "I feel like we did justice to that one. … Christensen hasn't taken anything out that was in the original proposition but enhanced it."
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Every state legislative district that covers Summit County voted in favor of passing the full expansion (though by a narrow margin in House District 53). That includes Winterton's massive Senate District 26, where Wasatch County and the Uintah Basin join Summit County as population centers.
Prop 3 called for a hike in the sales tax to help the state fund a full expansion of Medicaid, directly competing with the lawmakers' earlier plan that required the federal government's stamp of approval. Aspects of Christensen's proposal stand in direct opposition to the ballot initiative in other ways, such as a requirement that Medicaid recipients prove their employment. Supporters of changing Prop 3 say that, in the long run, a stricter cap will be better for Utah patients by ensuring the system remains fiscally stable. Critics say, however, that Republican lawmakers are usurping the will of the people, since the ballot initiative was, in essence, a choice between the GOP plan and full expansion.
Winterton said he has mixed feelings on the ballot initiative process because voters were misled on the viability of Prop 3 and because legislation passed via that route skips the Legislature and the governor.
"In some regards I feel like there should be restrictions on (ballot initiatives)," Winterton said. "If it gets to the point where we're going to legislate everything with ballot initiatives and propositions, then there's no sense to have a legislature. … A ballot initiative forces it through without any checks or balances."
Sen. Jacob Anderegg, R-Lehi, fired back at the opposition during debate on the floor Wednesday, saying that the U.S. is a "republic, not a democracy," and specifically called out news media coverage of the issue as contributing to the unpopularity of the Legislature's efforts to tweak Medicaid expansion. Earlier in the week, hundreds gathered in the Capitol rotunda to rally in support of keeping Prop 3 untouched. On Thursday, a digital billboard truck was spotted circling the Capitol grounds bearing pro-Prop 3 messages.
Democratic Sen. Luz Escamilla on Wednesday proposed compromise legislation that aimed to bridge the two sides, citing studies of other states that have adopted full Medicaid expansion without going bankrupt. Her proposal failed.
Only one Republican, Sen. Todd Weiler, voted against the measure on Wednesday. Gov. Gary Herbert, in his State of the State address later that evening, indicated he would be open to signing such a bill if it made it onto his desk. Christensen said before the Wednesday meeting that he is confident that the bill will find enough House support to get there.