Utah Republicans curtail voter-approved Medicaid expansion

Posted at 6:57 PM, Feb 11, 2019

What Utah voters expanded, GOP lawmakers are curtailing.

Utah Gov. Gary Herbert, a Republican, signed a bill Monday that would limit the expansion of Medicaid that voters approved in November.

The move, which has sparked days of protests at the statehouse by advocates for the poor, is expected to deny 48,000 low-income residents access to Medicaid and cost Utah nearly $50 million over the next two years, according to a recent state legislative analysis.

The Utah ballot measure, which garnered 53.3% of the vote, was set to go into effect April 1 and was projected to cover as many as 150,000 residents. Herbert and GOP lawmakers say the changes are needed because the voter-approved 0.15 percentage point increase in the state sales tax won't cover the costs of expansion by the third year.

"I do not accept the characterization that SB 96 ignores the will of the people," Herbert said about the bill in a blog post Friday. "I see this as a thoughtful effort to implement the will of the people to care for the poor with quality health care with the added benefit that it can be sustained over the long term with no reduction in other important social services."

The new Republican-backed law restricts coverage to those at or below the poverty line, instead of up to 138% of that threshold, as is standard under the Obamacare provision to expand Medicaid. The poverty line is roughly $12,000 for an individual and $25,000 for a family of four.

GOP state officials argue that residents with incomes above the poverty line can get subsidized policies on the Obamacare exchanges, though many advocates argue that coverage can still be too pricey for the poor, which is why they remain uninsured.

The new law also mandates that beneficiaries work, places a per-capita cap on spending and imposes a lockout period for those who violate certain requirements. And it closes the program to new enrollees if costs are projected to exceed the funds the Legislature appropriated, said Republican state Sen. Allen Christensen, who sponsored the measure.

The law requires a federal waiver that may be tough to get. The federal government covers at least 90% of the costs of the expanded Medicaid population in states that broaden their programs to 138% of the poverty level. Unless it is granted a waiver, Utah will receive only its current 70% match rate for the new enrollees.

Last year, the Trump administration failed to rule on a similar Utah proposal to broaden Medicaid only up to the poverty level before voters embraced a much more comprehensive expansion plan.

Herbert said he has been encouraged by recent conversations with the federal Department of Health and Human Services. And, he noted, if the waiver isn't granted, the state will fully expand Medicaid.

The battle over expansion in Utah is reminiscent of the fight in Maine, the first state to pass expansion at the ballot box in 2017. Former Maine Gov. Paul LePage refused to implement expansion for more than a year, defying state court orders. His successor, Janet Mills, quickly moved to expand Medicaid after taking office last month.

Republicans in Idaho, where voters also approved expansion -- by nearly 61% -- in November, are also considering whether to place restrictions on the program. A conservative group, the Idaho Freedom Foundation, recently lost a court challenge to the law.

Reclaim Idaho, an advocacy organization that pushed for expansion, held a rally at the statehouse last week to press lawmakers to implement the ballot measure with no changes.

"We continue to fight for funding and implementation without barriers to coverage and remind the legislators that their job is to represent their constituents, not their own interests," said Emily Strizich, co-founder of Reclaim Idaho.

In Nebraska, GOP Gov. Pete Ricketts has long opposed broadening Medicaid, but said in his State of the State address last month that his budget "reflects the vote of the people of Nebraska" and that officials are working to implement expansion. State Sen. Adam Morfeld, a Democrat, said the deadline to introduce legislation has passed for this year. Expansion is expected to go into effect in 2020.