Legislature Approves Changes to Voter-Approved Medicaid Expansion

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Back in 2014, after several years trying to expand Medicaid in Utah, the Most Rev. John C. Wester, then Bishop of Salt Lake City, penned an opinion piece challenging legislators to make the right and moral choice to expand Medicaid under Governor Gary Herbert’s Healthy Utah proposal.

Legislators refused.

The Catholic Diocese of Salt Lake City continued to advocate for the next four years for Medicaid expansion, finally finding some success as part of the many entities and individuals supporting Proposition 3 fully expanding Medicaid.

We supported the initiative  with our eyes wide open to the realities of Utah politics. Having fought legislative inaction for years, we had no reason to expect that legislators would view the voter-approved initiative as sacrosanct. There was no reason to suspect that legislators, having vocally and repeatedly expressed their determination to avoid any expansion, other than a very limited increase to cover about 6,000 chronically homeless or criminal justice-involved individuals, would suddenly see the light.

Nor should any initiative be untouchable. There was at least one significant flaw in the proposition related to automatic payment increases to match the Consumer Price Index. This provision was a leading contributor to projected cost overruns, so fixing it was necessary to ensure the fiscal sustainability of the expansion.

Legislators, of course, went far beyond that simple fix. This week they enacted SB 96, which will provide more coverage than what is available now, but less than voters approved, and which contains several problematic provisions.

SB 96 does not change the effective date of Medicaid expansion. If you think you might be eligible for Medicaid, you can apply for coverage during the first half of March and start receiving care April 1. Visit takecareutah.org to talk to an enrollment specialist.

Unfortunately, with SB 96, fewer people will be eligible for Medicaid than under the initiative. Voters approved Medicaid for people living between 100 percent to 138 percent of the federal poverty line, but SB 96 stops Medicaid at 100 percent, leaving those in the gap with their current option of finding health care coverage on the federal exchanges. Exchange-based plans can be very good, but all have costs. Legislators insist those costs are minimal, thanks to deep federal subsidies, but for people struggling to get far enough ahead to be able to cover rent, food, medical care, transportation and other daily living expenses, a spike in any one cost can be an economic catastrophe.

The new law requires several waivers from the federal government, including to impose a work requirement and to cap how many people can participate. The most problematic waiver request, however, arises from the failure to fully expand coverage. The Affordable Care Act offered to pay 90 percent of Medicaid costs for states that expanded access for people living up to 138 percent of the federal poverty line (a little less than $17,000 per year for a single person). Utah hasn’t expanded to 138 percent, but is asking the federal government to pay the full 90 percent anyway. This is the waiver request that seems to have the least chance of being granted, though Gov. Gary Herbert and legislators are optimistic in this regard.

If the waivers aren’t granted, then the best part of SB 96 kicks in and the voter-approved full expansion goes into effect, at least until legislators can change the law again. This is a significant change from the original version of the bill, which would have repealed the initiative entirely if the waivers don’t come through.

The bill is not what the Diocese of Salt Lake City and others advocated for during the past year. However, for the thousands of Utahns who have been suffering without health care all of these years, it is a significant victory. As voters have fought for six-plus years to expand Medicaid, low-income individuals have been left to rely on expensive emergency room care. Worse, these same individuals lacked real options for consistent and long-term care for chronic illnesses and preventative care to maintain their health, and thus their ability to work and attend school. SB 96 helps end that unconscionable situation.

Jean Hill is director of the Diocese of Salt Lake City Office of Life, Justice and Peace.