WHY WE STILL NEED THE BALLOT INITIATIVE

by Paul Gibbs

So, the Utah State Legislature, after years of not passing a substantial Medicaid expansion (sorry, I appreciate the good that the micro expansion which came from the Utah House of Representatives has done, but it's too small and has been too increasingly chaotic and hard for even the most deserving to get coverage through for me to call it "substantial), the Utah State Legislature finally passed one. The new expansion is a big step in the right direction. It is not, however, a truly viable solution to the problem.

Why? Perhaps the biggest reasons is that there is almost no chance it will actually happen in its current form. The pared-down Medicaid expansion requires considerable waivers from the federal government, and one of the biggest things that made it acceptable to legislative Republicans will not get federal approval: the scaling back of the expansion to cover only up to 100% of federal poverty level. How do I know this? Simple: the recent Arkansas Medicaid expansion waiver was granted mulitple concessions by the federal government department of Health and Human Services, but not this one. If it it didn't fly in Arkansas, it won't fly in Utah.  This leads to the question of why the Utah State Legislature would even pass a bill for an expansion that it had just been established would not pass. In most years the Arkansas expansion decision would have killed this bill. However, in most years there isn't a looming ballot initaitive to let the people of Utah choose to accept the full Medicaid expansion. The simple reality is that there is no way a Medicaid expansion as substantial as this one would ever have made it to a vote in the Utah House of Representatives if it weren't for the fact that they were afraid of the ballot inititaive and trying to head it off. Make no mistake, credit for anything the sick and the poor do eventually get from this expansion (if indeed they get anything at all) goes not to the legislature, but to the healthcare advocates who have relentlessly pushed to keep this issue alive so long.

So, having now established that the new partial expansion can't get federal approval in its current form, let's talk about what's good and bad in it:

GOOD: It brings back federal tax oney Utahns are currently paying, and brings coverage to roughly 70,000 Utahns who don't currently have it. I openly and very happily acknoweldge that this is a considerable good, and I gratefully commend those legislators who genuinely supported it because they knew it was the best that would get passed in the Utah legilature.

BAD:  Aside from the aforementioned "Can't Get Federal Approval" problem (which is important enough that we need to keep coming back to it), there is the fact that this version of expansion includes a work requirment that can most diplomatically be reffered to as misguided. Endless studies show that 64% percent of those who would recieve coverage under full expansion already work. And the most diplomatic term to use for the argument legislators use about the rest being "able-bodied people who choose not to work" is "lie". The fact ois (and I've documented this in multiple states), many disabled people who need Medicaid coverage (whether traditional or expanded Medicaid) are not able to qualify as disabled to get the coverage. Why? Because they can't afford to see a doctor to get the diagnosis to qualify them as disabled. Free clinics and other currently available charity programs don't cover specialty care or expensive tests like MRIs. A poor person could rack up thousands of dollars of medical bills just trying to get qualified for Medicaid, with not certainty that they eventually will. SO the work requirement is bad solution to a problem that doesn't exist, and is only there to satisfy an ideological contingent that is more concerned with a fear that somebody else will get coverage they have to work for than with simple human decency or the moral imperative to care for those who legitimately can't care for themselves.

Additionally, this version of expansion includes caps on the number of people who can be covered and the amount of money that can be spent on it. This means when that point is reached, people get left out no matter how desrving or badly in need they are.

Then there is the issue of only covering up to 100% fpl instead of 138%: while legislative Republicans are techincally correct in their assertion that the people above 100% are eligibile for ACA subidies, the argument some of them like to make that this is giving them "double coverage" is flat out wrong. You can't reciveve both Medicaid and ACA subisidies, period. Besides that, there is a very sound reason for the overlap: hard lines inherently create cracks. And where there are cracks, people will fall through them. That's inevitable.

Finally, despite the Republican legislators continued use of their favorite catchphrase, "fiscally responsible", this expansion doesnt qualify as such in the way that the ballot initative does. The ballot initative includes a funding mechansim for the 10% of the costs Utah will have to pay, in the form of sa very small sales tax increase on non-food items, an increase which amounts to only 3 cents on every $20 spent. Surely this small increase is worth it to give people access to life-changing (or even life saving) healthcare, and to protect Utah's state budget into the bargain.

The Utah Decides Healthcare ballot intitiave closes the coverage gap with an overlap to make sure people don't fall through the cracks. It leaves out ideologically appealing but pointless and harmful hoops for people to jump through. It has a mechanism to pay for it. And it requires no special waiver to be implemented. None of those things can be said about the bill passed by the Utah State Legislature.

So, while I sincerely appreciate the good that will be done  IF the legislature's plan somehow manages to secure federal approval (in whatever form it would have to take to get that, because the current one can't get it), the job isn't done and the problem isn't solved. The ballot initiative is the only way to do that.

CHECK OUT THE WEBITE FOR THE BALLOT INTIATIVE AND FIND OUT WHERE TO SIGN

In Presidential Election, There Is Only One Choice For Healthcare

by Paul Gibbs

I dread presidential election years, and Facebook has made it so much worse. It used to be easier to get away from the vitriol and avoid political tension with friends. And this year it got very intense very early, as the primaries were more heated than usual. I found myself in the position of staying fairly quiet about my preference, and doing my talking mostly with small monetary contributions. But with the primaries over and our choices narrowed, I feel I can't do this anymore in good conscience, because not only are we in danger of not moving forward with any improvements in health care, most of the candidates would destroy any and all progress that has been made in recent years (and both the numbers and the personal experiences of people like me and many others I've encountered as an activist show we have made considerable progress). As a health care advocate, there is only one possible choice I can make for my vote, only one candidate who shows both an understanding of healthcare issues and a longstanding desire to improve America's health care system. Only one who won't throw away all of the work we've all been doing. And that candidate is Hillary Clinton. 

It's obviously not Donald Trump. Trump doesn't have a realistic, solid or detailed proposal for anything. He tells us his healthcare plan would be great, it would be wonderful, it would do everything for everybody. But he's given us next to nothing in terms of details. And there's not a consensus among Republicans to accept a Trump plan, especially with House Speaker Paul Ryan having proposed his own plan. Both Trump and Ryan want to repeal the Patient Protection and Affordable Care Act, and with a Republican president and congress, it would happen. The exchanges would close, causing tens of millions to lose their healthcare coverage.  Pre-existing conditions would again block people from being insured, which would have a devastating effect on people like me with chronic conditions (while I could theoretically fall into Ryan's "except for those with continuous coverage" exemption, there are any number of ways my coverage could get interrupted, and the lack of online exchanges would make getting new coverage that would count as "continuous" much harder.). This, of course, doesn't even go into the myriad of other problems with Trump, an unambiguous racist who has been caught in more lies than all other 2016 presidential candidates combined, and whose dangerous views on foreign policy have caused former officials from Republican administrations to endorse his Democratic opponent.  

What about Libertarian Gary Johnson? Sorry, but Johnson, while seemingly a solidly honest and upstanding guy, shows a frightening lack of understanding of healthcare issues. He even wants to abolish most forms of health insurances, relying on an absurdly naive and unsupported belief that the free market would drive prices down to an affordable range. As an activist who's been working with people who in some cases can't afford the possibility of $10 co-pays or other such expenses but are suffering from devastating ailments, I find this to be the most ridiculous statement on healthcare I've heard in recent years. This is based on an ideological deification of the free market, not on any kind of logic or evidence. He also favors making huge cuts in Medicare and turning Medicaid into a block grant program which would allow states to cover fewer people than they are now, anathema to a Medicaid expansion supporter like me. Johnson seems to me to be a far better human being than Trump, but on the issue of health care, he's not a better candidate. 

And Green Party candidate Jill Stein? While she's a physician, she's also an advocate for fringe pseudo-science and panders to the anti-vaccination crowd. I don't trust someone with such a questionable grasp of medical science to take care of healthcare issues. Besides, while she supports universal health care, any progress that is going to be made on proposals like a "Medicare for all" single payer program would require a huge majority of votes in congress, one which seems incredibly unlikely to happen no matter who wins. And since a third party candidate can't carry down ballot votes with them, any third party candidate inherently helps the "repeal Obamacare" status quo. I find many supporters of Stein or Johnson seem to be voting that way as a moral stand against two major party candidates they see as corrupt or embarrassing.  Sorry, but I cannot let my vote contribute to the risk of taking health care access from tens of million of people so I can feel pure or stick it to the establishment.  I see no morality in that. 

So that leaves us with the much-maligned former Secretary of State. I could go into why I think she's the best candidate on foreign policy and overall economic issues, and at very least the best middle ground on social issues,  but that's not the subject of this blog. So I'll stick to why I believe she's the only reasonable choice for a healthcare activist like me: with Clinton in the White House, the ACA will not be repealed, but it will likely be improved. Those of us who support and defend the ACA are well aware that it's a flawed piece of legislation, and there are problems that need to be fixed. But tell the millions of people who suffer from chronic or potentially deadly illnesses who can now get insurance they couldn't get before that it's not helping anyone. Tell the tens of millions of people who are now insured and weren't before. All credible evidence supports the idea that millions of people have been helped by this law.

Hillary Clinton supports reducing the cost of insurance plans on the healthcare exchanges by extending tax credits up to $5,000 to help families struggling with premiums and and deductibles. And reviving the "Public Option" through an optional state by state process that would not require passing congress.  Through these provisions she'd improve the "Affordable" part while preserving the "patient protection" part.

For me, choosing a president is first and foremost about what they'll do and whether they're qualified and capable to do the job. The only candidate I feel has good ideas on health care and is capable of implementing them is Hillary Clinton. I believe the other three would set us back in ways I can't accept. And that's why, from my healthcare activist perspective, she's the only candidate I can choose.

NEW SESSION, NEW PLANS

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.

DUNNIGAN'S BILL

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.

CHRISTENSEN'S BILL

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.

 


DAVIS' BILL

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.

WARD'S BILL

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.
 

CHAVEZ-HOUCK'S BILL

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.

SHIOZAWA'S BILL

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.

SPENDLOVE'S BILL

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

THE TROUBLE WITH SECRECY

by Paul Gibbs


If there are two things which kind of define my personality these days, it's that I'm a healthcare activist and a film geek. As such, a lot of my attention is divided between two different approaching events: the unveiling of the new Gang of Six Medicaid expansion alternative plan and likely subsequent vote in a special legislative session, and the release of Star Wars: The Force Awakens. I mention these two unrelated topics because the people behind them are approaching them in surprisingly similar ways: under a protective layer of secrecy, revealing only as much as they have to every now and then. This approach works for Star Wars. J.J. Abrams knows the anticipation and surprise are half the fun, and keeping us hooked with a little bit of information but leaving the big questions unanswered will help us enjoy his film all the more. But with the Gang of Six, I'm concerned that this approach leads to serious and negative consequences.

Because the gang of Six is playing their cards so close to the chest, it's very easy for opponents to jump in and fill in the information gaps. The problem is that the groups who are doing this organizations like the Koch brother's Americans For Prosperity, the Sutherland Institute. the Foundation For Government Accountability, and the Libertas Institute, or  pundits or former legislators who share their ideological outlook. These groups have two things in common: they're all very far to the right, and they all vehemently oppose any Utah healthcare expansion which accepts federal funding. Let make sure I'm being clear on the emphasis of the word any. They don't oppose the Gang of Six plan because they're afraid it won't do what Healthy Utah or straight up expansion of traditional Medicaid will. They oppose it because they're afraid it will. This leads to a situation most of us would never see coming: proponents of expansion, including Democrats and other progressives, are buying into Koch brothers propaganda, because for once the people they're bad mouthing are Republicans.

As I said before, a big part of the responsibility for this comes from the frustrating lack of information coming from the Gang of Six. It's understandable that expansion proponents are wary of a plan coming from a group which includes such notable Healthy Utah opponents as House Speaker Greg Hughes and House Majority Leader Jim Dunnigan. And the lack of inclusion of any Democrats, liberal, moderate or otherwise, in any part of the negotiation, also invites distrust. It's not a matter of partisan pride or ego, it;s just not a good approach to public policy. It wasn't a good approach nationally when a Democratic super majority pushed through the Affordable Care Act unilaterally, and it's not a good approach for Utah now. I've chosen my comparison here very deliberately: I may not be the biggest fan of the way the ACA was passed, but while the ACA is imperfect, it's a huge improvement on the way things used to be, and I support the law. What I'm hearing from non-Koch related sources on the Gang of Six plan tells me that, while imperfect, it also offers a great deal of good.

Here are a few genuine facts we know about the new plan:

-It covers up to 138% of federal poverty level the same as Healthy Utah or expansion of traditional Medicaid.
-It returns the maximum available amount of Utah tax payer money.
-It will reimburse providers and hospitals at private market rates, which are higher than traditional Medicaid rates, which is beneficial to hospitals and providers.
-The coverage benefits would be required to be Medicaid equivalent (Silver Level)
-There would be no new caps, no coverage gaps, or reductions in benefits as long as the federal funding remains intact.

If this doesn't sound much like the horrible scenario we're hearing from opponents, it's because it isn't. The doomsday scenarios are at best based on wild speculation, and it's important to reiterate that they're coming from those who want to stop any kind of expansion, not from people looking for the best way to do it to benefit the poor. As frustrated as I frequently get with Utah's legislature and other leaders, these ultra ideological groups are the ones we should be seeing as inherently and eternally untrustworthy. I don't believe that we should or can afford to stubbornly and blindly stick to the idea that a plan supported by Greg Hughes and Jim Dunnigan has to be a bad one. But I believe we can and should inherently question any "information" which comes from these groups.

In the coming weeks, as details of the new plan are unveiled first behind closed doors to the House GOP Caucus, and then publicly to the Healthcare Reform Task Force, we should learn a lot more about it. It's very possible that we'll learn things we don't like. But I strongly suspect that we'll also learn things we do. Based on what we already know, I'm prepared to support and even fight for the new plan. Because, as I've said again and again, it's absurd for us to keep clinging to the notion that defeating a more conservative friendly compromise is going to get us straight up Medicaid expansion (or even Healthy Utah at this point). At best it keeps stretching out and slowing down the process while legislators come up with new plans that will keep moving us further away from what we want, not closer to it.

I understand if some expansion supporters aren't as eager to support the new plan as I am.  But don't jump to opposing it. That's exactly what the Koch brothers and like-minded groups want us to do, and we can't let them control this debate.

OUTSIDE GROUPS ATTACK UTAH HEALTHCARE EXPANSION WITH FALSE ARGUMENTS

by Paul Gibbs

As we get closer and closer to the possibility of a special legislative session to resolve the Medicaid expansion issue in Utah, opponents of expansion are getting increasingly desperate. And they're relying on outside groups that are making the same misleading, cookie-cutter claims to fight expansion in all states. Instead of looking at the reality of Utah's situation, they're simply tossing out the same silly and paranoid claims

Despite what groups like the Libertas Institute and the Koch brothers Americans For Prosperity claim,  refusing federal Medicaid expansion money in Utah will do nothing to decrease federal spending. The money the people of Utah are already paying in taxes will go toward Medicaid expansion in other states. It will still get spent,just not to help people in Utah.  Opponents are also using inflammatory and inaccurate terms such as “sick tax” to describe the proposed tax to be paid by healthcare providers.  This is a ridiculously misleading term, as no proposal has been made to tax "sick" people, only the healthcare industry which will benefit from the expansion. Their argument is misleading and leaves out important facts.  The new plan would reimburse providers at a higher rate than traditional Medicaid, and the financial benefit of the revenue coming in would outweigh any expenditure from the tax.  What rejecting healthcare expansion in Utah will do is leave 53,000 people with no reasonable access to necessary healthcare coverage, and keep Utah taxes going to the federal government without us receiving anything in return. 

 The stories of Utahns like Carol Frisby show us just how serious this issue is. The only way to get these people the help the need is to implement a plan which will return the maximum possible federal funding by covering up to 138% federal poverty level. Don't believe the propaganda coming from these groups that are willing to let people die just to score some points against Barack Obama. These groups don't represent Utah or its values, and they simply aren't telling the truth.

Still Waiting

A TIME FOR UNITY

by Paul Gibbs

When I first decided to make Entitled to Life, I started to meet with people who were working to support Medicaid expansion or what was just then becoming known as Healthy Utah. The 2014 Utah general legislative session had just ended, and a straight up Medicaid expansion hadn't even made it to a vote. One of the first people with whom I met asked me a question that took me completely by surprise: "What's the purpose of your documentary? Is it to express angry at the legislature for not passing Medicaid expansion? Or is it to raise awareness and try to support getting the best possible plan through?" I had to do some serious thinking about that. But I decided that the second option was by far the more productive. That's what I've tried to stick to since.

The reason I tell this story now is because we're at a very important turning point. A week ago statements from House Speaker Greg Hughes and House Majority Leader gave most of us the impression that a plan which would cover up to 138% of the poverty level and bring back the maximum possible amount of Utah tax money from the federal government was no longer a serious possibility.  Now, the so-called Gang of Six (including Hughes and Dunnigan) has announced an agreement for the "framework" of a plan which does just that. We don't know much about the details at this point, and a lot of questions have to be answered. But there's no denying this is a huge step in the right direction. Now, pending those details,  we have to ask ourselves some important questions as well.

The plan isn't going to be a straight up expansion of traditional Medicaid. It's not going to be exactly the same as Healthy Utah. But from what they're telling us, it's closer to both than I frankly thought had any chance of happening at this point. Real coverage for up to 138% fpl and getting back the maximum federal funding has always been the goal. That's what the "Utah Cares" plan we so disliked failed to do. And they can't exactly bring back the controversial work requirement that's already by rejected by the Obama administration. And with the support of Hughes and Dunnigan,  this plan has a real chance of passing. I've made my frustrations with Hughes and Dunnigan very clear in the past. I couldn't have much more strongly disagreed with their approaches during the 2015 legislative session, and nothing I was seeing or hearing from them between now and then changed my mind. But if the details of the new plan are workable (and I join most of my fellow activists in being optimistic that they are), I'll happily consider the two of them allies. Anger over past issues will serve no purpose and distrust and antagonism will be counterproductive.  If we're working toward the same goal, I'm happy to work with them.

At this point there will be no purpose served by dividing into camps and opposing each other to fight over the plan which best suits our respective pure ideologies, or in worrying about what we call the plan or who gets credit. It is necessary to unite in the common effort to get this past both houses of our state legislature,  where the Allen Christensen's and Jake Anderegg's are likely to be no more friendly than before . Any confusion or disunity will be potentially disastrous. But by working together, we can help influence compromise and positive change. It's important that we remember that neither Dunnigan or Hughes have stated an absolute ideological refusal to accept federal funding, and therefore this doesn't constitute an out of character change of position from them which would give reason to be suspicious. If they really have found a solution that silences their fears about sustainability while bringing back the federal funds and providing quality coverage, that will be hard for House Republicans to fight against, especially with the backing of Dunnigan and Hughes. The people many of us thought of us as the biggest obstacles a week ago may very well turn out to be crucial to getting this through. The irony may be equally poetic and frustrating, but what really matters is getting this passed.

For anyone who wonders why, given what I'm saying here, I didn't join with those who supported Utah Cares as "better than nothing" or "the best we can get", the reason is that plan plain and simple didn't get the job done. But in 2014,  I moved from holding out for straight expansion to supporting Healthy Utah because it did, and it appears now that this plan may very well do the same.  And if burying the hatchet with Jim Dunnigan and Greg Hughes helps that happen, then I won't give it a second thought. If the details bear out that this plan offers quality, comprehensive coverage to up to 138% fpl, we need to support it and get the job done. What we needed to do now is push the Gang of Six to give us those details, to be sure that this is real and comprehensive coverage that doesn't fall back on PCN or some other weak and inadequate form of coverage. And, as they've given us no timeline for announcing these details or calling a special session, we need to keep up the pressure that this be done quickly. As we just saw with the untimely death of Carol Frisby, a cancer patient who didn't get the care she needed soon enough, people waiting for this don't have the luxury of time, and therefore these legislators have no right to ask for it either. That's how we can stay involved, and where continued pressure serves a purpose. We don't have all the answers yet, and just as legislators kept insisting they needed to know the details of Healthy Utah, we need to know the details of this. But it's crucial that we
hear them with clear and open minds, not a cynicism that tells us this plan is bad just because of our past feelings toward or experiences with some of the legislators who support it. Some people are going to feel I'm being naive for even considering the idea that Dunnigan and Hughes may now be allies. But all that kind of thinking has the potential to do is kill a solution before it even comes to a vote. I'll take bipartisan hope over partisan cynicism any day.

As I've said in the past concerning Governor Herbert, there will be a time and place to hold people accountable for not acting sooner. But just as we've been asking our opponents to choose between their politics and the needs of tens of thousands of people, we need to be prepared to the same thing. It doesn't matter whether this is victory for Democrats or Republicans.  What matters is a victory for poor and sick people.