by Paul Gibbs
I get asked a lot of questions about Healthy Utah. Despite the length and intensity of Utah's Medicaid expansion/Healthy Utah debate, a lot of people still don't really know what's going on here. I've put together some quick answers to basic questions about the issue. Of course you should keep in mind that I'm just a blogger/activist, and you shouldn't take my word as definitive. I strongly suggest checking out other sources such as
Utah Health Policy Project or
Voices For Utah Children for further information.,
What is the coverage gap?
Essentially, the people who make too much money to qualify for traditional Medicaid but not enough to qualify for assistance through subsidies under the Affordable Care Act (ACA).
What is Medicaid expansion?
In order to allow for those who don't qualify for Medicaid or ACA subsidies, the ACA has a provision which expands Medicaid coverage to include those in that category. The intention was for it to be mandatory, but the same 2012 Supreme Court ruling which upheld the individual mandate determined it was unconstitutional to force states to expand Medicaid. Therefore, it became the decision of individual governors whether or not to accept federal funding for Medicaid expansion. The program allows states to take back their own ACA taxes to pay for Medicaid expansion. Starting in 2013 it would have paid 1100% of the costs for the first 3 years, and never more than 90% after.
Who decides whether we accept the federal money?
The original federal law said it was up to the governors. Gov. Gary Herbert could have made the decision to do so, until in the 2013 legislative session the Utah legislature passed a resolution requiring they sign off on any expansion. While some maintain that Herbert still has the choice to accept expansion on his own, state law makes it clear that he does not, and governors such as Virginia's Terry McAuliffe have failed spectacularly at trying to go around their legislature. At this point, anyone pushing that we have to accept the original Medicaid expansion instead of Healthy Utah is being as much of an ideological obstructionist as the legislators who don't want to accept anything. Getting the original ACA Medicaid expansion past them has considerably less chance than the proverbial snowball in Hell.
So what is Healthy Utah, and how is it different from Medicaid expansion?
Healthy Utah is a plan developed by Gov. Herbert and his administration which will take back the ACA tax money, but instead of expanding traditional Medicaid it will provide subsidies for people in the coverage gap to obtain coverage through the commercial market. It has other provisions Medicaid doesn't, such as co-pays and a voluntary work effort which helps unemployed Healthy Utah patients find work.
Which is better, Medicaid expansion or Healthy Utah?
That depends to a large degree on your political ideology. Liberals tend to prefer Medicaid because it doesn't reauire co-pays or premiums for people who have difficulty affording them and has fewer hoops to jump through. Conservatives tend to see Healthy Utah as an improvement, because it emphasizes "personal responsibility" through the premium co-pays and.work efforts, and benefits the insurance market.
In the most important respects, the two pland accomplish essentially the same things. They both give roughly 111,000 Utahns in need access to healthcare coverage (those who say Healthy Utah would cover fewer people than Medicaid are merely stuck on a different set of numbers. One estimate is based on now, another is based on the the future. It works out the same). While whether those in the gap can afford premiums is a very valid concern, care has been put into keeping the premiums very low, $15 for the first adult in a household and $10 for each additional adult covered (children are covered by CHIP or Medicaid and do not pay premiums).
What are people against this?
There are a variety of reasons given. Some have a degree of legitimacy and others, frankly, are merely ideologically based paranoia. Arguments include:
It costs Utah money.
Yes, that is true, and of course expenditure of tax payer funds should never be taken lightly. But the simple reality is that Utah can afford this. No less than 90% will always be paid by federal tax money, and the costs won't bankrupt or harm our state. Through wise financial management and prioritizing, we can afford them. Priorities must be established and difficult choices must be made, and that's what we elect our legislature to do.
The federal government can't be trusted to live up its end of the bargain, and they'll make cuts.
This one is pure politics with no evidence to back it up. The federal government has never made cuts to Medicaid, and the idea of President Obama undercutting his signature legislation by making those cuts is laughably absurd.
It will breed dependence.
Again, pure politics. As popular as this argument is with conservatives, there has never been real evidence to support it. The majority of people who receive Medicaid only do so for about 1 year, which shoots down that argument quite nicely. And once people make too much for Healthy Utah they become eligible ACA subsidies. When they make too much for that, they no longer need help. If anything, closing the gap reduces dependence by eliminating the incentive and creating a clear path away from dependency.
We shouldn't be paying for able bodied people who don't work.
This one is just an absurd distortion of what Healthy Utah does. According to studies by the University of Utah, 66% of those is the gap already work, and 85% of families in the gap include at least one working adult. 15% are disabled or otherwise unable to work. Are there people who could be working but aren't? Probably. But they clearly constitute such a small minority that denying access to healthcare to tens of thousands of others just to avoid helping them can't be seen as reasonable or moral.
Take a look at some of the so-called "able-bodied people who don't work" in my film
Entitled to Life.
Sometimes access to healthcare can kill people.
Yes, somebody actually said this. Rep. Mike Kennedy made the argument in reference to Doctor errors which in some cases result in death. While this certainly occurs, this has to be the most specious argument I've ever heard. By this logic nobody should be getting health care (only poor people are subject to Doctor errors?), and we should stop wearing seat belts, looking while crossing the street, exercising, etc. One of my most beloved family members died because of a Doctor error. At no point did I ever think "maybe that means I'm safer not going to a hospital" because of that, because it's simply a ridiculous thought.
There no evidence this will save lives.
Well, a study by Harvard University estimates that roughly 316 people in Utah per year will die due to lack of care without the program. I think that's pretty good evidence.
There are other options for people who need help (free clinics, etc).
Perhaps (in some cases) for basic care, but not specialty care such as MRIs and CT scans, or more advanced care. And representatives of Utah's charity care network have spoken up in favor of Healthy Utah, saying charity care can't do this on its own.
This is a job for churches and charities.
Providing coverage for what is estimated to range from 45 to 77,000 people? The charity argument is covered above. Simple logic says churches can't cover this. For example, I belong to the LDS Church, which is well known for looking after its members. And I received a great deal of help from charity fundraising for my kidney transplant. That still would have left me paying about $145,000 out of pocket, which I couldn't possibly have done. The Archie Bunker
Employers will drop thousands of people from their coverage plans because they can just put them on Healthy Utah.
This is another piece of speculation that isn't backed up by evidence. The conservative Sutherland Institute and former Utah State legislator Dan Lilljenquist love to make this claim, and their projected numbers keep changing dramatically. But it hasn't happened yet in any of the 28 states (or Washington D.C.) which have expanded Medicaid, and ADP, America's largest payroll company, has stated that none of its thousands of clients has any plans to drop healthcare coverage. Not to mention that the ACA includes substantial financial penalties to employers who do this.
We can just expand to cover up to 100% of the poverty line, not the 130% Healthy Utah requires.
Yes, we can, but it's a bad idea. We'd get substantially less of our own tax money back and a lot of people struggling to stay just barely above poverty level would be without affordable insurance.
The federal government is behaving like a schoolyard bully, forcing Utah to do things its way.
When you consider the
polls which show that an overwhelming majority of Utahns support Healthy Utah or would choose Medicaid expansion over doing nothing, our legislature looks like the bullies.
The President is a Democrat, and I don't like him.
Most opponents aren't actually saying this, but it's what their objections rare really about. Okay, it's true, but is that really a good reason to throw away tax money and deny people access to healthcare?
So, there's basic rundown of the debate. Again, it's not exhaustive or authoritative, and I encourage you to read further.
Watch the
An America Plea Healthy Utah Music Video
by Paul Gibbs
