Friday, December 19, 2014


by Paul Gibbs

December 18 was a spectacularly bad day for both compassion and common sense in Utah. In its final meeting for 2014, the Utah Healthcare Reform Taskforce chose to exclude Healthy Utah from their list of recommendations to the legislature for providing health care to people in the coverage gap. The options they did choose don't even accomplish the logical minimum goal of closing the gap. They help only a small percentage who qualify as "medically frail", leaving out tens of thousands of the working poor and throwing away huge amounts of Utah tax dollars. It would easily qualify the members of the committee who voted this way for the bad judgment hall of fame, yet co-chair Sen. Allen Christensen describes it as the "glass half full" approach. I would argue that the glass doesn't count as half full when you started with a full glass and poured out half of it out of it out of ignorance and spite.

Fortunately, this doesn't kill Health Utah. This was only a recommendation made by the task force, and we saw willingness from two Republicans  (Sen. Becky Edwards and Sen. Brian Shiozawa) to fight for what is morally and fiscally responsible. But it's a big setback, especially considering the crucial role Rep. Jim Dunnigan, the new House Majority Leader and co-chair of the taskforce, is expected to play in legislative process. Dunnigan is an insurance agent who is being called an "expert" by the legislature, and many have said they would go by what he supports. He has been working on the issue of healthcare in Utah for 10 years. Well, frankly, I'm not impressed with an "expert" who takes 8 years to work on an issue, gets a workable solution from the federal government, takes 2 more years to watch it get watered down, then chooses to take less money to help fewer people. This is a guy who has used the campaign slogan "Get it done again with Dunnigan"? Up until recently I thought Dunnigan would act as a moderating influence on the more extremist members of the task force. I thought he was essentially reasonable, and he seemed to be headed toward reluctant acceptance of Healthy Utah. I don't know if I was wrong, or if getting the House Majority Leader position made a change for the worse, but if this is the kind of leadership we can expect, he's going to be a crushing disappointment.

The two approaches suggested by the task force would cover between 12 and 20 percent of those below the poverty line, such as those who are mentally ill, addicted, or disabled, or too sick to work. While covering these people is of course necessary, it leaves out the majority in the gap. 66% of those in the gap work and can't get health insurance. Those people are left with no options. How does this accomplish the goal of encouraging "personal responsibility"? The task force is suggesting we punish people for working. This blatantly commits the Medicaid opponent's avowed cardinal sin of "encouraging dependence", because it leaves people no help once they're able to work. And, as suggested by stalwart supporter of the poor Rep. Rebecca Chavez-Houck, we'll be adding to the "medically frail" by preventing those on the edge from getting preventative care.

I pray that you're shocked and outraged by this. I pray that you'll send and email to Rep. Dunnigan telling him how strongly you oppose this decision. I pray that compassion and wisdom will prevail. Because we just took a serious hit, and we need people to stand up, or tens of thousands of Utahns will be left out in the cold, betrayed by their own legislature.


Friday, December 12, 2014


by Paul Gibbs

I believe in self-reliance. Both morally and as a matter of practicality, I don't being overly dependent on others is a good thing. It's not fair to them, and it's not good for you. But any good concept can be distorted. The distortion of the concept of self-reliance is the basis for one of the most common arguments used by opponents of Medicaid, Healthy Utah, or any government program of that nature, that it "promotes dependence". While there is no legitimate proof of or even evidence of this concept, it continues to be treated as if it were established fact by its adherents. And I'll admit there's at least a specious logic to part of it: the idea that once you get past a certain income level, you become ineligible for that kind of assistance, which motivates you not to get ahead. But if one is going go along with that thinking, it's inescapable that Healthy Utah, by eliminating the coverage gap, eliminates that motivation.

Let me explain this as a Q and A

Q: How are people dependent now?

A: Currently, a person who does qualify for Medicaid can lose that coverage by moving just slightly over the limit. It doesn't have to be enough to allow you to afford health insurance, mind you, just enough to go over an arbitrary limit on a piece of paper.

Q: What would Healthy Utah do about tto change that?

A: It would raise the income level required to get people off of coverage.

Q: But won't they just be able to move to move up a little higher, then still be stuck either making less money or giving up their insurance?

A: N
o, because then they can get coverage under the ACA.

Q: The what?

A: Obamacare.

Q: But Obamacare is bad.

A: Well, that's debatable, but love it or hate it's there and it's not going away. Because of Obamacare, when somebody makes too much to qualify for Healthy Utah they become eligible for subsidies that help them pay premiums, so there's no motivation not to move head.

Q:  But then won't they just want to stay where they are and not move off of Obamacare?

A: No, because to lose eligibility for that, it means they make enough to afford health insurance on their own. Healthy Utah completes a bridge that eliminates any need to avoid moving ahead just to keep what you have. It eliminates the motivation to be dependent.

Q: But if we didn't have these programs, people would just want to move ahead in the first place and we wouldn't need programs at all. Isn't that  the way to discourage dependence?

A: Uh . . . No. If that were the case we wouldn't have over 45,000 people in the coverage gap, they'd all have good jobs with good insurance. Motivation doesn't help much when there's no way to get what you need.

Q:  Huh.  But if you're already getting a free ride why move ahead?

A:  It's not a free ride. You pay small premiums, even with Healthy Utah. Besides. Healthy Utah and Obamacare don't buy your groceries, pay your rent or utilities, buy your clothes, your car, gas, or anything like that. It doesn't give you a free ride, it's just a safety net that gets people access to something they can't make it without.

Q:  Then how come I hate it so much?

A: I have no idea.

If anything, Healthy Utah (and yes, the big bad Affordable Care Act) help encourage and provide ways for people to be less dependent. There is a bridge to self -reliance, and right now that bridge is unfinished, with a huge gap in the middle. Let's close the gap and finish the bridge.

Saturday, December 6, 2014


by Paul Gibbs

As a lifelong member and returned missionary of The Church of Jesus Christ of Latter-Day Saints, I was overjoyed by the presence of Presiding Bishop Gary E. Stevenson at the press conference announcing Utah governor Gary Herbert's Healthy Utah plan, and by the following statement issued by the Church:

"We recognize that providing adequate health care to individuals and families throughout Utah is a complex and weighty matter. It deserves the best thinking and efforts from both the public and the private sectors.
"While the economic and political realities are being debated, we hope the discussion and decisions taken in this matter will be consistent with the God-given principles regarding care for the poor and the needy that in the end benefit all of His children. We reaffirm the importance for individuals and families to be as self-sufficient as their particular circumstances allow and recognize that the lack of access to health care can impair a person's ability to provide for self and family.
"We commend public officials for their efforts to grapple with these difficult issues and pray for their success in finding solutions that reflect the highest aspirations of society."
Of course this doesn't constitute an official endorsement of Healthy Utah by the LDS Church, and it would be wholly inappropriate for me, as a member, to present it as such. It's a declaration of the LDS Church's beliefs and standards of caring for those in need, very much in line with the recent General Conference talk by Elder Jeffery R. Holland of the Quorum of the Twelve, in which he charged members to do what they can to help. But, speaking only for myself, I believe that the only plan for closing the coverage gap currently under consideration by the Utah legislators that is consistent with these principles is Healthy Utah. In my opinion, the "Do Nothing' option of rejecting all federal funding (which thankfully Gov. Herbert and House Speaker Greg Hughes consider unacceptable) blatantly violates all of them. The alternative proposals fall short on at least some levels. Let me explain how by running down the principles discussed:
Healthy Utah is a public program which benefits and utilizes the private sector by giving those in the coverage gap access to insurance from the private insurance market.
Healthy Utah benefits the poor by giving them access to insurance coverage, and respects the taxpayer by bringing back to Utah the maximum possible amount of our taxpayer dollars. Alternative proposals fall short of both of these goals, bringing coverage to fewer people and rejecting huge amounts of Utah taxpayer money.
Healthy Utah included reasonable co-pays and premiums which encourage personal responsibility, but do not as people to metaphorically "run faster than he has strength" (The Book of Mormon, Mosiah 4:27). Alternative proposal do not respect circumstances and ask exactly this. By reducing the coverage to only those at 100% of the coverage gap, these proposals force those at 101-138% to pay higher premiums and deductibles, with the only help coming from ACA subsidies that were never intended to be enough for people at this income level. 
This one is obvious: all proposals other than Healthy Utah leave a large number of people without reasonable, affordable access to healthcare. Healthy Utah even helps people to become more self-sufficient through the much discussed Work Effort which helps those who are unemployed or underemployed find employment or gain employable skills.
Again, I wish to stress that the conclusions drawn here are entirely my own. I'm not suggesting the LDS Church endorsed Healthy Utah, or that Mormons are obligated to support it. merely that, fortunately, Healthy Utah fits all of the principles they did endorse. And unfortunately, the other proposals do not.

Friday, December 5, 2014


by Paul Gibbs

Yesterday, Governor Gary Herbert held a press conference to announce the details of the Healthy Utah plan. Gathered with him were local business and religious leaders (including Bishop David Wester of the Catholic Diocese of Salt Lake and Gary E. Stevenson, Presiding Bishop of The Church of Jesus Christ of Latter-Day Saints) showing their support. It's exciting to be at this point, with a workable plan in place, one which makes big compromises to fit the values of Utah's conservative majority while maintaining the core benefits and compassion of Medicaid expansion. In any part of the real world this would be hailed as a win-win situation on all sides. But this isnt the real world, it's politics. And that means some people aren't content to win unless they can see their opponents lose.

Members of Utah's legislature have unveiled their alternate proposals, which still include their visionary "do nothing" plan (in fairness, I am encouraged by the fact that incoming House Speaker Greg Hughes doesn't consider this an option, and House Majority Leader Jim Dunnigan has also indicated his belief that we can consider this off the table). I'm unable to make any logical sense out of the alternate proposals, which still involve taking back less of Utah's tax money and providing coverage to fewer Utahns in need. Again, in any real world scenario these options would be considered lose-lose, but here they serve the entirely ideological and impractical purpose of taking a stand against the federal government even though it hurts us. Nobody would be hailing those who had participated in the Boston Tea Party if they had thrown the Tea overboard then volunteered to pay for it. But that's essentially what is being proposed here. 

For my part, I really don't care about winners or losers or egos or saving face or who gets credit or what message is sent. Healthy Utah is no ideological victory for an Obama supporter like me. When it turns out to be a huge success the very conservatives who have been blocking it will be the ones taking the credit because it comes from a Republican Governor in a red state. And it's no a personal feather in my cap, either. I'm just one of many cogs in the machine of people fighting for this.  Within a month of Healthy Utah passing I predict not much of anybody outside of a few people I worked directly with will remember that Entitled to Life ever existed, and I'm more than fine with that. All I care about is that there are tens of thousands of Utahns who are just as good as anybody struggling to be healthy or stay alive, and every delay makes their situation worse. Talk of "taking the time to do this right" ignores common sense and medical science by pretending people won't get sicker the longer they don't have access to care, and that losing health or lives now won't impact generations to come.  These other so-called plans are not effective, fiscally responsible or very helpful to people in need. Even those who would be eligible for ACA subsidies under the plans that only cover up to 100% of the poverty level can't afford the higher premiums and co-pays required. That's why the ACA didn't put them in that category to begin with.  Figuring people on the edge will be fine is transparently short-sighted and trades the long term good of Utah and its people for short term ideological victory.  It's a perfect example of the sort of "rationing" of which healthcare reform opponents seem to be so afraid.

But the contradictions get even more baffling: in the past Healthy Utah opponents have responded to suggestions that we take the money now and then cut off the program if it doesn't work out with cries that at that point we'd have a moral responsibility to these people (we don't have one now?) and can't do that. Now we're hearing some essentially propose doing this as a planned strategy, with the idea being that we take the 100% federal funding while it's there, then when it's time to scale back to a 90-10 scenario we cut off everybody over 100% of the poverty level. Wow. This idea may be the ultimate triumph of reducing the equation to merely being about money and completely ignoring that, lost in the rhetoric about taxes, are tens of thousands of Utahns who won't make it without our help.