Thursday, November 20, 2014


by Paul Gibbs

If we're to subscribe to the idea that there is such a thing as "Utah Values", it's a no-brainer that nothing is more central to them than families. Even something as divisive as our state's same-sex marriage debate had both sides vehemently arguing their different views about what was good for Utah families.

How then can we ignore the impact delaying Healthy Utah has on Utah families? According to statistics I've taken from the wonderful local organization Voices For Utah Children, 85% of the families in the coverage gap have at least one working parent. While the children can receive coverage through CHIP, their parents can't, and many are not eligible for Medicaid. We're talking about 44,000 Utah families where the parents are uninsured, and at least one of them works. For those who don't work, the most common reason is that they're "taking care of family". Is anybody going to tell me that's "against Utah values"?

The logic is airtight: Parents who are able to take take of their own health will be better able to take care of the needs of their children. By helping these parents do so, we would be helping Utah children, and strengthening Utah families. Whether you're providing for the material needs of a family by working outside the home, or nurturing and taking care of the day to day needs of children at home, being a parent is hard work. Trying to do it while dealing with an illness or physical ailment is considerably more difficult. Trying to do it while dealing with an untreated illness or physical ailment is something I'd prefer not to think about. But we have to think about it. And when we can so clearly do something about it, we have to do that, too.

And Healthy Utah  would also provide help for older adults, including parents and grandparents. Low-income, near senior adults who are not yet eligible for Medicare coverage can get that coverage through Healthy Utah. We have the potential here to help, in some cases, three generations of Utah families. That certainly fits the "Utah Values" I grew up on.

The full details of the Healthy Utah plan will be reported to the Utah Healthcare Reform Task Force on December 4. That will leave a plan the Governor's office and federal government have agreed upon ready to go. All it needs is approval from our legislature. But now incoming House Speaker Greg Hughes is saying Healthy Utah is unlikely to be approved or shot down as is, but will be tweaked and reworked by 6 experts in the GOP caucus. I have to say, I've seen the work of some of these experts and I'm still waiting to be impressed. It's taken them two years to work toward a solution to a problem that already had a solution in place, and now they want to go back to square one? Any changes in Healthy Utah will have to be taken back to the federal government for approval. Utah families can't wait for another lengthy negotiation process. We need Healthy Utah now.


Monday, November 17, 2014


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 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

Friday, November 14, 2014


by Paul Gibbs

People have been asking me why a Florida-based outside group like the Foundation For Government Accountability would bother getting involved in the Health Utah discussion. How does it effect them? The simple answer is it doesn't. Sure, they're claiming they have a stake in this because Florida is paying ACA taxes, but if extremist groups like the FGA hadn't stalled Medicaid expansion in Florida, they'd be getting their tax money back for their own expansion. The fact that their state is throwing money away does not give them a stake in how Utah spends its tax payer money. That's a patently absurd argument.

The truth is, Utah isn't unique. The FGA has run ads attacking Medicaid expansion efforts in Indiana, Arkansas, Maine, and other states, using the same erroneous  points, stock photos and scare tactics. They haven't bothered to learn a single detail about Healthy Utah, or how it differs from traditional Medicaid expansion. And I don't think they care. The people of Utah matter so little to them that they keep ignoring my challenge that they meet with people in Utah's coverage gap and see how it effects them. And now they want Governor Herbert, who has important work to gaining the support of the legislature, to waste time debating them? We don't need to convince them, because this has nothing to do with them. Seriously, are we so short on stubborn, misinformed extremists in Utah that we need to bring some in from out of state? I'm here to tell you that is definitely not the case.

If our legislature wants to be true to their own stated goal of staying true to Utah values instead of letting outsiders tell us what to do, they need to ignore the FGA and listen to the people of Utah instead.

NEW VIDEO SEGMENT: Entitled to Life: Utah Values

Follow me on Twitter @entitled2life

Wednesday, November 12, 2014


by Paul Gibbs

On November 11, 2014, the Deseret News  ran an article called a Florida Group Targets Healthy Utah Medicaid Expansion Alternative, about the the Florida based Foundation For Government Accountability's campaign. I have no issue with article, which fairly reported a newsworthy story  and gave the good people at Utah Health Policy Project a chance to offer a rebuttal. But I have a big problem with the the things FGA says in the article, which quotes them as telling Gov. Herbert not to bring "D.C. values" to Utah, and charging that Healthy Utah puts "able-bodied people" on government assistance. 

What do these people know about "Utah values"? They  haven't been to Utah and have done nothing to learn about the actual people involved in this. I have lived in Utah since i was 1 year old, and as an activist and as a citizen I have spent a lot of time learning about and being with these people, in Utah and in other states. So called "able-bodied" people like:

Who is in a wheelchair because of a neuro-degenerative condition caused by a car accident, and yet still runs her own small business, and goes to college on a scholarship and is about to start offering tutoring services to help keep up her cognitive function.

Who works 3 jops  are working 3 jobs while struggling with multiple types of cancer and trying to raise children.

Who  spent a lifetime working and serving his country as a Marine in Vietnam. and then couldn''t get coverage for his wife spouse when she had a stroke.

A Flordia woman who suffers from lupus and kidney failure, and many other issues.

A North Carolina woman who lost her insurance and suffers from cancer.

Who has two children and lost her job as CEO of a company because of illness.

And another gentleman I go to church with (he hasn't done any media and I don't feel comfortable using his name without him giving anyone permission to put his story out there) who worked as a security guard, but lost that job due to suffering from liver failure. He can't work at all now and has been bankrupted by medical bills. 

These are all people who are in or effected by the coverage gap. And they are just seven of many examples  They are not "able-bodied" people looking for a handout. In all my searching and experience which has taken me across the country I haven't run into anybody like that who is looking for help from Healthy Utah or Medicaid expansion. Do they exist? Probably. Are they the majority? No. And that's not just my experience or my emotions talking, it's the facts/ 

 I've studied the numbers and research, and learned froma  study by the University of Utah that 66% of the people in the gap already work, and another 15% are disabled or otherwise unable to work. For groups like the FGA or the Sutherland Institute this to claim some sort of moral high ground while denying the most basic needs of human beings who are suffering is evil. I realize that's a harsh word, and I don't use it lightly. I'm not saying these are mustache twirling villains who are tying women to railroad tracks. Evil doesn't work that way in the real world. Most of the time, evil takes the form of selfish concerns overcoming basic decency and empathy. And sometimes it take the form of putting loyalty to ideology ahead of clear evidence of suffering people in need. And this most definitely qualifies as such a situation.

If you want the real facts, go to a legitimate organization like Utah Health Policy Project, or even a nobody like me who isn't an expert and doesn't work for a "think tank" but actually thinks experience and facts matter and bothers to accumulate them. And who is willing to listen to and consider things which challenge my own ideas. For example: I adamantly opposed Healthy Utah at first, because it wasn't the straight up Medicaid expansion I was fighting for, and because it came from a Governor and didn't (and still don't) like. But I listened and learned the facts, and became convinced that it's the best option with a chance of passing.

When I went to Florida to fight for their expansion, I met with actually people who are effected by this and learned about what they're going through. I have publicly challenged the FGA to make the journey in reverse, and come from Florida to Utah. Will they do it? I doubt it. 
The FGA cares nothing about Utah, and they aren't experts in anything, they're just ideologues who want to promote an ideology and agenda no matter who it hurts.

Watch the new video segment: Entitled to Life: UTAH VALUES

Friday, November 7, 2014


by Paul Gibbs

The 2014 mid term election wasn't good for anybody who believes in health care as a human right, or really even anyone who believes in human rights as a concept. Let's look at the ups and downs.


Most of the strongest Healthy Utah or Medicaid expansion advocates in our legislature were re-elected. Rebecca Chavez-Houck, Jim Dabakis and Brian King easily cruised to victory. All Democratic incumbents in the state legislature won, and they are joined by the return of Republican supporters like Peter Knudson and Craig Hall. We also gained a new Republican supporter in Raymond Ward of Bountiful. I know Dr. Ward and I expect him to fight as hard for this as any Democrat.

We also have a new Speaker of the House, Greg Hughes, who has the huge virtue of not being Becky Lockhart. Hughes hasn't come out directly in support of Healthy Utah, but it's reasonable to be optimistic that he'll at least be more reasonable than his predecessor. In his words, "We’re really going to drill down on [Medicaid] with the guiding principle being that we do right by our constituents."

 It remains to be seen exactly what Hughes means by that, or what his approach will be. He vows to work with new Majority Leader Jim Dunnigan (an insurance executive), and 4 physicians in the legislature to solve the problem. Dunnigan has is hardly one of our biggest supporters, and the physicians could range from the eminently reasonable Sen. Brian Shiozawa to Rep. Mike "Sometimes healthcare kills people" Kennedy. And if he's planning on supporting alternate solutions to Healthy Utah, that could involve going back to square one in negotiations with the federal government.

We also, of course, saw a lot of our stronger opponents (including Kennedy) re-elected. And the national Republican majority in both houses essentially guarantees more bone-headed and harmful attempts at repealing the ACA. Might our legislature use this as an excuse to delay again?  While the Republicans don't have a big enough majority to make an outright repeal of the ACA likely, any progress on healthcare over the next two years will be a gargantuan task, and that includes Medicaid expansion and variations thereof. We're extremely lucky that negotiations over Healthy Utah are complete, because those states who aren't that far along are in huge trouble. And, sadly, Utah contributed to the added majority by sending Tea Party extremist Mia Love to congress. Ouch.


Local voter turnout was rather low, only 24%. And our opponents had a much better election than we did. This really speaks to something I've been saying for a while: liberal apathy is as big a threat as conservative extremism. We could have made an impact just by having a half-decent turnout, but we couldn't be bothered.

To be honest, this week has been my lowest point with this cause. I'm scared about where we'll go from here. I'm beyond devastated.


Every single supporter has to step up. Clicking "like" on a Facebook status doesn't make you a supporter, and it certainly doesn't make you an activist. We need you writing emails, going to events, everything you can do. No excuses. It's all on the line. We can still do this, but EVERY SINGLE PERSON who supports this has to act in some way.

Email Hughes and Dunnigan. Tell them you supporter Healthy Utah, not any alternate plan that covers fewer people. Because if we don't fight this with all we have, it's over.

Greg Hughes: 
Jim Dunnigan:

Monday, November 3, 2014


Paul Gibbs

Most people who read this blog are probably aware that I have an identical twin brother, Patrick.  Some will know that Patrick and I were both born with serious medical problems. By the time we were 5 years old, I had 9 major surgeries, and Patrick had 17. Obviously this placed a huge financial burden on my parents, even with ths insurance they had through my Dad's employment. Family was only able to do so much. Our church was only able or willing to do so much. An attempt to get help from charity failed when the money raised to help us was embezzled. It was a near impossible situation, and when it reached the point where Patrick was in serious danger of dying, some suggested my parents just accept that there was nothing they could do, and that after all, that still left one of us alive. Of course no parent would accept that, and ours didn't. The debt caused by all of these medical bills is the reason my Mother died poor 5 years ago.

Had my parents chosen to exercise the sort of "fiscal responsibility" that far right members of our legislature are advocating, they would have just let Patrick die. I realize that's an inflammatory analogy, and Healthy Utah opponents would argue that the two things are not comparable. They would say one falls under personal responsibility, and one doesn't. And I would reply that's a self-serving load of crap.  We as a society do have a responsibility to each other.  It is not morally acceptable to let people suffer or die because they're not out problem. Especially when there so clearly is something we can do about it. As LDS apostle Elder Jeffrey R. Holland so eloquently put it, "I may not be my brother's keeper, but I am my brother's brother."

In no way is it fiscally responsible to to turn down $258 million of our own tax money, or the 3,000 healthcare sector
jobs Healthy Utah will bring to our state. Yes, there will be costs to Utah beyond that. But they won't bankrupt or harm our state. Through wise financial management and prioritizing, we can afford them.  And if we choose not to accept that responsibility, we're not choosing freedom or personal responsibility or anything lofty or noble like that. The only thing we're choosing is to apathetically shrug and say "It's not my problem." The rest is empty rhetoric and rationalization.

On of the legislature's most staunch opponents of Healthy Utah responded to those trying to appeal to his Christian values that Jesus said as much about justice as He did about mercy. Ignoring the fact that he and I apparently have been taught very different version of the scriptures despite belonging to the same church, there's the simple fact that it just doesn't apply to this situation in any logical fashion. It is not justice for people to suffer or die from treatable illnesses just because they are poor. That's not a consequence of their actions, it's simply an unfortunate circumstance. Justice and mercy both demand that we help those who cannot help themselves, and study after study after study has shown it's a matter of cannot not will not, so that kind of flat-earth denial is not a reasonable argument.

After months of negotiation, Healthy Utah is ready to go at our upcoming general legislative session. Any "alternative plan" by members of our legislature (which would almost certainly cover fewer people) would take us back to square one in negotiations with the federal government, and would make people who need healthcare now go without it. And, because of the supreme court decision, this comes down to our state exercising its freedom to make a choice, through our elected representatives. While we have the right to make either choice, there is still a right choice and a wrong choice. We can choose both just and mercy, or we can choose to walk away and let others deal with it. But to pretend those are not the only two choices is absurd and wrong. We've put off our responsibility long enough.