by Paul Gibbs
With the 2016 Utah General legislative Session about to begin, the debate over whether Utah will implement a form of Medicaid expansion to cover the 44,000 Utahns in the coverage gap rages on, and less clearly than before. Because unlike 2014, this isn't a debate over a straight-up expansion of traditional Medicaid under the Affordable Care Act. And unlike 2015, it's not about Gov. Herbert's Healthy Utah plan. Both of these unfortunately failed to pass our legislature (and for about the 50 billionth time, no, Gov. Herbert can't just unilaterally pass either one without the legislature. Railing against Herbert on this is a waste of time, effort and breath that we can't afford). What we have now is multiple different potential bills which attack the problems from different directions. Some of these have the potential to be effective. Some, frankly, don't.
We'll learn more about each of these proposals as the session progresses, but here's a preliminary rundown of what we do know, who is sponsoring them, and their respective pros and cons. Along with the basic facts of each bill, I've offered my personal opinion of it's potential effectiveness. While these opinions are admittedly subjective, I hope you'll notice that they're non-partisan. My support or opposition for these or any other proposals is based on their effectiveness in providing much-needed healthcare coverage to people who can't get it somewhere else. not on which party it comes from.
House Majority Leader Jim Dunnigan, architect of the failed "Utah Cares" plan and a member of the Gang of Six who devised the failed "Utah Access +" plan, is proposing a partial expansion which would cover a very small percentage of the gap population, 0-10%.
I've disagreed with Rep. Dunnigan more often than not in this debate but unlike some of his colleagues further to the right, he seems to recognize that there is a serious problem here in need of a solution, and I believe he sincerely wants to solve it. But this plan doesn't even come close to doing that. When Dunnigan acknowledged to a house committee that the coverage provided under "Utah Cares" wasn't "a Cadillac plan", I expressed the opinion that it wasn't even a "Pinto plan". This new plan is one roller skate with a broken wheel. It leaves tens of thousands of Utahns without insurance access and leaves millions of dollars of our tax payer money going elsewhere instead of helping Utah citizens in need. And the promised potential to put higher income people in the gap on PCN (Utah's Primary Care Network) doesn't make it better. PCN offers very limited coverage with no specialty care at all. My aunt who was on PCN had to wait over a year to even get the necessary tests to diagnose an illness that turned out be cancer of the esophagus. She passed away in late 2015.
The bill from Sen. Allen Christensen (R-Ogden) looks to make Dunnigan's look good by comparison. It also only covers a small percentage of those in the gap, and only if they qualify as "medically frail". Aside from fitting the same problems of leaving far too many uninsured and not bringing back tax payer money, it does nothing to address one of the current problems faced by many in the gap who face serious problems: inability to get the healthcare needed to diagnose them as qualifying for help. Christensen has long been one of the most staunch ideological opponents of Medicaid expansion/Healthy Utah/Any version of expansion that uses federal funding, and this bill caters to that ideology, not to fixing the problem. This is the weakest of the plans being proposed.
Sen. Gene Davis (D - Salt Lake City) is again proposing the straight-up expansion of traditional Medicaid provided under the ACA. This certainly would accomplish the goals of providing quality coverage to all those in the gap, and bringing back the maximum amount of tax dollars. The is problem is, it just doesn't stand a realistic chance of going anywhere. The straight expansion has failed in the legislature for three consecutive years and is anathema to the far-right legislative contingent that has stalled previous efforts to cover the gap. Nothing has changed over the past year to give us any reason to believe the result will be any different. I've met personally with Sen. Davis before to discuss the coverage gap situation and the various plans to address it. I appreciate his commitment to providing quality healthcare coverage to those in need, and I certainly don't oppose this bill. But I feel that in this case idealism has to be tempered with practicality in order to achieve results, and that efforts are better spent on plans which would offer comparable coverage (Healthy Utah, for example, would have covered the same number of people and brought back as much federal funding) but stand a greater chance of passing a vote. I'd love to be wrong and see this go further than I expect it to, but I'm not holding my breath.
Rep. Raymond Ward (R-Bountiful), a physician who has dealt with many patients in the coverage gap, plans to propose a plan which has been described by some as a mix between Healthy Utah and Utah Access +, bringing back the maximum federal funding and covering up to 138% of the federal poverty level. Of all of the proposed bills, this is the one which has me most optimistic. Rep. Ward has been one of the most tireless supporters of helping those in the gap since before he was even elected to the House of Representatives, and this sounds like potentially the best deal in terms of providing real coverage, returning tax dollars, and actually having a chance of going somewhere. The downside is that since Ward is in the house, that's where the bill will start, and opposition to expansion in the house is strong to say the least. I'm afraid it may take quite a bit of pressure to convince Speaker Greg Hughes to even give this one a fair chance, and we need to make sure that pressure is there.
Rep. Rebecca Chavez-Houck (D-Salt Lake City) is another legislator I greatly respect, and if we can't get something like Rep. Ward's bill passed in this session, her proposal to put the issue on the 2016 General election ballot (the result would be a recommendation to the legislature, not a binding decision). This would be a full expansion which, like Ward's bill, would cover up to 138% fpl and bring back the 90/10 match rate from the federal government. If it passes, it will be interesting to see if the staunch ideological expansion opponents in the legislature will exceed my expectations and put the will of their constituents ahead of their agenda.
Sen. Brian Shiozawa (R-Cottonwood Heights), last year's sponsor for the healthy Utah bill, plans to introduce a message bill, telling the federal government Utah would implement a partial expansion of of up to 100% fpl if the government were to extend to us the 90/10 match rate, instead of the 70/30 that would normally come with such an expansion. While I'm in favor of a full 138% fpl expansion, I certainly understand where Sen. Shiozawa (who as much as anyone is responsible for keeping the idea of a from of Medicaid expansion in Utah alive and is one of my favorite Utah elected officials of either party) is coming from. Expansion opponents or doubters have frequently expressed that they would be willing to support or at least consider such a partial expansion, therefore this one might have a chance of passing if the federal government would approve it, which they have previously refused to do. Even if this one does manage to get over its many hurdles it's not the best plan, but it's far superior to Dunnigan or Christensen's, and I hope expansion supporters don't mistakenly turn against one of our biggest allies for trying to do the best he can under very difficult circumstances.
The bill proposed by Rep. Robert Spendlove (R-Sandy) is similar to Shiozawa's, but adds a purely ideological requirement that people receiving benefits would work. I, like all expansion supporters, am exhausted by now of pointing out to opponents that the data clearly establishes that the majority of people in the gap already work and most of those who don't are disabled or otherwise unable to work. A work requirement serves no legitimate purpose and would make the plan less likely to get federal approval, as the federal government has already refused to accept a work requirement.
With 45 days to go in the legislative session, it's difficult to predict which, if any, of these potential solutions or non-solutions will gain gain support. But it's certain that tens of thousands of Utahns will suffer needless until a solution is found. Contact your legislators and tell them you support a real and substantial Medicaid expansion plan.
Watch ENTITLED TO LIFE and learn about the people in the coverage gap