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Latest version of Medicaid expansion fails to win House, Senate support

The latest version of Medicaid expansion, crafted by Gov. Gary Herbert and GOP legislative leaders, failed Tuesday to muster more than a handful of votes among House Republicans and members of the Senate.
The latest version of Medicaid expansion, crafted by Gov. Gary Herbert and GOP legislative leaders, failed Tuesday to muster more than a handful of votes among House Republicans and members of the Senate.

SALT LAKE CITY — The latest version of Medicaid expansion, crafted by Gov. Gary Herbert and GOP legislative leaders, failed Tuesday to muster more than a handful of supporters among House Republicans and members of the Senate.

Only seven House Republicans voted in favor of UtahAccess+ during a closed caucus meeting that lasted more than four hours, House Speaker Greg Hughes, R-Draper, told reporters.

That straw vote, along with a poll of both Republican and Democratic senators, leaves little hope of action on a plan to provide health care to some 95,000 low-income Utahns before the 2016 Legislature.

The governor's spokeswoman, Aimee Edwards, said in a statement that Herbert "stands by" his plan for Medicaid expansion, known as Healthy Utah, that was defeated in the House last session.

"The poorest among us will continue to struggle until Utah leaders can find agreement on this difficult issue," Edwards said, while the House "continues to push back against other proposals, even those crafted by their own legislative leadership."

The governor had hoped to call lawmakers into special session next week to approve the plan unveiled two weeks ago that would have imposed new taxes on health care providers, adding up to more than $50 million by 2021.

Some $450 million is available to Utah under President Barack Obama's health care law to expand Medicaid, including to the 63,000 Utahns earning below the federal poverty level who currently don't qualify for any health care subsidies.

Hughes called the caucus vote a "gut check" for Republicans, who hold 63 of 75 seats in the House. He and House Majority Leader Jim Dunnigan, R-Taylorsville, both said they were among the seven votes in favor of the new plan.

"The glass half full is this: I do believe there is political will to provide care for the needy," the speaker said. But he said future plans are likely to be scaled back and not qualify for the maximum federal funds available.

House Republicans saw too many risks in accepting the larger Medicaid expansion program that they had no way of controlling, Hughes said, citing as an example the Obama administration's reluctance to allow enrollment caps.

Hughes is credited with coming up with the funding portion of the plan, strongly opposed by hospitals, doctors and other health care providers because not only would they be paying new taxes, those taxes would increase as the program grew.

"Everybody loves expanding Medicaid until they have to pay for it," he said.

Senate President Wayne Niederhauser, R-Sandy, said the result of the poll taken over two days was "not even close," with the plan failing by a signficant margin. He declined to be more specific.

"My feeling is this plan brought in too many providers. There's some complexity to that," the Senate leader told the Deseret News. He said no one expected the health care providers to be so adamantly opposed to the new taxes.

"I thought there would be some groaning," Niederhauser said.

That, as well as the campaign targeting lawmakers in their districts launched by the Utah chapter of Americans for Prosperity, a group affiliated with the nationally influential billionaire Koch brothers, spelled doom for the plan.

Niederhauser said he and Hughes are scheduled to meet with the governor Wednesday to talk about what's next. He offered advice to those Utahns waiting for Medicaid expansion.

"Keep the faith," Niederhauser said. "And make sure you're working with your legislators to make sure they know how you feel about it."

The Senate had backed the governor's Healthy Utah plan last session, but the House offered its own more limited proposal from Dunnigan that had a higher price tag and covered fewer people.

UtahAccess+ was the result of the governor bringing together Hughes, Niederhauser, Dunnigan and the sponsor of his Healthy Utah plan, Sen. Brian Shiozawa, R-Cottonwood Heights, at the end of the session.

The group worked in private, originally with the goal of having a plan ready for a special session by the end of July. Had UtahAccess+ been able to win approval later this month, it still would have taken until January 2017 to put in place.

While House Republicans were meeting behind closed doors, several Utahns in the coverage gap gathered at the Capitol to tell their stories to members of the news media, including Stacy Stanford, of Salt Lake City.

Sitting in the wheelchair she uses to deal with chronic pain, Stanford said she doesn't understand why lawmakers can't agree to extend Medicaid coverage to her and other low-income Utahns.

"Maybe there's a gap in compassion. I don't know," the Westminster College student and online business owner said.

For her, Medicaid expansion would mean finally being able to afford the expensive tests needed to diagnose her condition.

House Democrats have also been left out of the discussion.

House Minority Leader Brian King, D-Salt Lake City, accused Republicans of "political incompetence."

King said the plan put together by Republican leaders "aggravated divisions among their own ranks." The closed caucus meetings to hash out those differences, he said, "have literally closed the door on the opinions, on the needs of the people of Utah."

House Republicans held their caucus in a remote committee room guarded by the Utah Highway Patrol, and reached a decision on Medicaid expansion in less than two hours.

Afterward, they sang "Happy Birthday" to Hughes and then took a brief break before taking up other issues. Cartloads of sandwiches, birthday cake and soft drinks had been delivered to them earlier in the afternoon.

The leftover birthday cake still contained part of a message wishing the speaker "Good luck with UtahAccess+."


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