Medicaid Expansion: Power to the People

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The People of Utah are empowered on policy issues like never before. In November, Utah voters passed three citizen initiatives on issues where the Utah Legislature had refused to act: medical cannabis (Prop 2), Medicaid expansion (Prop 3), and non-partisan redistricting (Prop 4). With the backing of the Mormon Church, the Utah Legislature was able to undo much of Prop 2 after the vote. (For now. Stay tuned.). Without the backing of that 600-pound gorilla on the other 2 initiatives, however, the Utah Legislature has run into choppy waters (a.k.a., people power) as it seeks to undo the vote of the People.

The Utah Bee previously helped untangle the Legislature’s scheme to undo Prop 3, detailing how SB 96 intended to spur federal action on a waiver by threatening to harm Utah citizens. The legislative scheme to completely undo Prop 3 is flagging a bit. As the Utah Bee previously reported, the Legislature had intended to ram through a repeal before the public could comprehend the scheme and mount an informed opposition. However, the communication tools of 2019 might beat that go-to, anti-democratic legislative tactic. Already, the Utah House of Representatives has backtracked and passed out a Fourth Substitute of SB 96 that will offer full expansion after Utah's waiver request is inevitably denied by the federal government. That bill moves to the Senate. We'll see whether the Senate feels the People Power.

On Prop 3, I’ll add 3 observations to Ben Wood’s latest article. First, Speaker Brad Wilson’s comment that the Legislature is acting on Prop 3 based on a concern that the law as written and approved by voters would run out of money and strip Utahns of their health-care coverage is a false. That supposed concern could be addressed through the normal appropriations process; if fiscal analysts forecast a shortfall, the legislature could simply appropriate part of the huge surplus to cover it, without amending the law.

Second, Speaker Wilson’s comment, “We, in fact, are going to be ensuring that people have coverage that don’t have it now,” also is false. If the Legislature does nothing, current law specifies that all Utahns eligible for full Medicaid expansion under the Affordable Care Act will be covered. Nothing is fuller than full. Exactly contrary to Speaker Wilson’s statement, all the Legislature is now doing is working to see if it can cover fewer people than Prop 3 specifies, not more. In fact, on April 1st, the Fourth Substitute of SB 96 that the House just passed will strip coverage away from 50,000 Utahns who would be had coverage under Prop 3. That is not more. That is fewer people. Simple math.

Third, contrary to almost all public dialogue, the Legislature does not need to pass a bill with an immediate effective date—which requires a 2/3 majority—to quickly submit a waiver request to the federal government. The Legislature wants the 2/3 majority vote for the sole reason that a 2/3 vote would block a citizens referendum that might overturn its actions. So, the push for a 2/3 majority vote translates to: “Dear Citizens: Kindly shut up.”

Don’t accept any waffle explanation your legislator gives you about voting for a Medicaid bill to give it the 2/3 vote so a waiver (to help the citizens, of course) can be promptly submitted. That explanation would just mean your legislator (a) isn’t honest or (b) isn’t smart. Utah could submit a waiver application today—without amending a word of Prop 3. That is exactly what Governor Herbert previously did—without Legislative action—on a prior waiver request that was denied. In the present case, if a waiver request were to be submitted and granted, then the Legislature could amend Prop 3 to incorporate the provisions of the waiver.

Let’s stop believing those 3 myths. Honest, grown-up conversations are needed to set good Medicaid policy in Utah. As the Senate now takes action on SB 96, let's insist that the debate is honest and factual.

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