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Latest Medicaid expansion plan 'incremental'

The state senator behind the new, limited Medicaid expansion plan sought by GOP legislative leaders to replace a compromise proposal rejected by lawmakers said he's finally been proven right.
The state senator behind the new, limited Medicaid expansion plan sought by GOP legislative leaders to replace a compromise proposal rejected by lawmakers said he's finally been proven right.
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SALT LAKE CITY — The state senator behind the new, limited Medicaid expansion plan sought by GOP legislative leaders to replace a compromise proposal rejected by lawmakers said he's finally been proven right.

"How many times do you have to get a 'no' until you believe it? We have to try a different approach," Sen. Allen Christensen, R-North Ogden, said. "We need to drop it or start someplace. This is a start someplace."

Christensen, who tried to unsuccessfully get the 2015 Legislature to consider a plan expanding Medicaid only to the medically frail living in poverty, said this time he'd like to see that limited even more to just those with several mental illnesses.

Over time, he said, coverage could be extended first to everyone considered medically frail and eventually to all of the 63,000 low-income Utahns who currently don't receive any assistance under President Barack Obama's health care law.

"It's not going to be a full-blown program. It's going to be kind of an incremental thing," the senator said, estimating that only as many as 5,000 people would receive help with their health care needs initially.

The compromise proposal that resulted from months of private meetings between Gov. Gary Herbert, House Speaker Greg Hughes, R-Draper, and Senate President Wayne Niederhauser, R-Sandy, would have covered 95,000 low-income Utahns.

That proposal, which mustered only a handful of supporters last Tuesday in a closed-door House GOP caucus and a poll of Senate members, also would have brought hundreds of millions of dollars in federal funds to the state annually.

That's because the proposal, dubbed UtahAccess+, would have covered Utahns earning up to 138 percent of the federal poverty level and qualified for what will decrease to a 90 percent funding match by 2021.

Only a 70 percent federal funding match is available for a plan that limits coverage. That makes it more expensive to provide coverage to fewer people. But the House speaker and Senate president still want to scale back.

Niederhauser said even though some estimates put the state's price tag at least $50 million higher for a plan limited to those in the coverage gap, most lawmakers see too much risk associated with full expansion since enrollment can't be capped.

"I'm willing to look at different options, especially for those who need it the most," the Senate president said. "Hopefully, over some time, we'll get the whole gap covered."

The governor, however, isn't interested in a limited plan. He wants lawmakers to look again at his Healthy Utah plan offering help obtaining private insurance that passed the Senate in the 2015 Legislature but stalled in the House.

Like the short-lived UtahAccess+, Healthy Utah would qualify for the maximum federal match. UtahAccess+, however, depended on new taxes on a long list of health care providers to raise more than $50 million annually by 2021.

Herbert's plan was presented last session as a two-year pilot program that did not require tax increases. However, there were discussions about imposing a $25 million assessment on hospitals and taxing e-cigarettes.

The governor said recently any new plan has to bring back some of the hundreds of millions of dollars Utahns pay in taxes related to the Affordable Care Act, as well as provide "access to health care for those who are most vulnerable in our society."

He said Utahns can do better than "spending a lot more money and getting a lot less benefit" and expects the Legislature's leaders to find a way to avoid that and still get something passed.

"The governor still maintains that his Healthy Utah plan was the most responsible and cost-effective way to resolve this difficult issue," Herbert spokesman Jon Cox said. "If someone else has a new idea, the governor is always willing to hear them out."

Still, Cox said, "with every new proposal that comes out, Healthy Utah looks better and better."

Don't expect the governor to simply try to push through his plan by executive action. That's not an option, Cox said. A bill passed by the 2013 Legislature limits the governor's ability to act without the approval of lawmakers.

But Cox doesn't rule out the Legislature coming around on Healthy Utah.

"The Legislature can always be counted on to do the right thing. After they have exhausted every other option," Cox said, citing a quote attributed to British statesman Winston Churchill about Americans.

Kirk Jowers, the former head of the University of Utah's Hinckley Institute of Politics and an adviser to Herbert, said the governor may end up having to accept a more limited plan.

"I honestly don't think he's posturing. But at the end of the day, I do think he has no choice but to be pragmatic," Jowers said. "We have people with real needs, and we're losing a lot of taxpayer dollars."

Christensen, who said he's also looking at taxing hospitals and e-cigarettes along with other potential revenue sources to pay for his new plan, said the governor isn't going to get anywhere with Healthy Utah.

"Push all you want," the senator, co-chairman of the Legislature's Social Services Appropriations Subcommittee, said. " I mean, it got killed. Are you going to bury that thing or just keep doing CPR on it forever?"

Christensen said his new plan should be ready in time for a hearing during November's interim legislative meetings and a vote by the 2016 Legislature that begins in late January.

"I would say I've got a 60 percent chance of getting it through," he said.

Christensen's effort last session to limit Medicaid expansion, often referred to as "Frail Utah," never made it to the Senate floor.

The five Democrats among Utah's 29 state senators aren't likely to be on board.

"This idea that they're promoting now goes back to square one," Senate Minority Leader Gene Davis, D-Salt Lake City, said. "Most of it is just the rhetoric that's going on against the Obama administration."

Davis, who wants the state to just accept full Medicaid expansion rather than trying to fashion a new plan, said Democrats in the Senate opposed UtahAccess+ because they saw it as set up to fail to win federal approval.

"They may be able to get the votes to be able to get this watered-down version through," Davis said, adding that he'll oppose it. "I've never believed that my position as an elected official should be to kick sand in the face of poor people."

A Republican House member who has supported Medicaid expansion, Rep. Ray Ward, of Bountiful, said he'd prefer the governor's Healthy Utah plan over what's being proposed.

But Ward, a doctor who has seen a number of patients in the coverage gap including a woman who died after not being able to afford a colonoscopy to diagnose her cancer, said he'll take what he can get.

"If my choice is between this (new) plan and nothing, it will have my wholehearted support," he said. "I'm very happy to do something than to keep doing nothing."

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