SALT LAKE CITY — Until Wednesday, there has been little public discussion during the 2015 Legislature related to covering Utah's uninsured population, but lawmakers maintain that the pressing issue remains one of their top priorities.
"I think legislators are well aware there are people that need coverage and demand for medical services. We work on this every day, and we know it's important, and we know there are people that can't wait," Rep. Jim Dunnigan, R-Taylorsville, said Wednesday. "Frankly, we're trying to find a solution that will help people, but also something that is sustainable so we don't give them something and then have to take it away."
So far, despite no consensus on any specific program, lawmakers are faced with a decision of enacting full expansion of the Medicaid program as set forth by the Affordable Care Act (SB83), pursuing an alternative to expansion that Gov. Gary Herbert has negotiated with the federal government (SB164), insuring the most needy or medically vulnerable of the uninsured population (SB153), or doing nothing.
The majority of residents who spoke at various legislative committee meetings Wednesday support the governor's Healthy Utah plan, including doctors, business leaders, social workers and people who are uninsured.
"We need to do more for those who cannot help themselves," said Thomas Rich, a small-business owner who spoke during the Senate Health and Human Services Committee meeting Wednesday afternoon. "As a person drawing Social Security and still working in order to take care of my sons, I can't afford a bill for a surgery that my son who dropped out of school is in need of."
Rich said something has to be done to help Utahns who don't qualify for coverage under the Affordable Care Act.
Former Lt. Gov. Greg Bell, president of the Utah Hospital Association, said hospitals across the state are on board with Healthy Utah, even though it is a complex issue.
"It makes the most sense for the 70,000 Utahns caught in the coverage gap, who live below the poverty line and have cultural challenges," he said. "They are struggling to make it work, and they can't live without medical care. They just can't."
Bell said that by the time the federal government pulls back to fund 90 percent of the program in 2021, as it has promised, Utah will have received about $3 billion for a state investment of $240 million to implement Healthy Utah.
He said churches and charitable organizations can't provide the care that is needed, specifically specialty care.
"These people are citizens of our state. We need to reach out and give them the dignity and same kind of care that we all want and regard as part of a quality life," Bell told the committee.
A couple of dissenters told the committee that the costs of implementing the program could unexpectedly grow and that physicians might not receive a good enough reimbursement rate to make it worth their while to treat newly enrolled patients.
Michael Hales, deputy director at the Utah Department of Health, said the program would be driven through private insurance companies, to protect the market, which would likely keep reimbursement rates fair.
SB164 sponsor Sen. Brian Shiozawa, R-Cottonwood Heights, said Healthy Utah is the "most efficient plan to cover the most patients with the best care at the lowest cost."
"As you look at the options, it really comes down to the Healthy Utah bill and almost doing nothing in the state in terms of practical bills that can go forward," Shiozawa said. "I think our committee members are realizing that one-by-one, in terms of what are the realities and what's the best way to leverage our monies and take care of our people."
Dunnigan and other lawmakers have been meeting behind closed doors to find a compromise to Herbert's Healthy Utah plan, which seems to some lawmakers to be too much for the state to take on financially.
The program is projected to cost the state $20 million from the general fund in 2017 and $78 million by 2021, when the federal government will drop its match rate to 90 percent. The only variable is how many people will enroll, which could be more or less than projected, according to Hales.
"We continue to work and are in communication with the executive branch and our colleagues in the senate," Dunnigan said. "We are trying to find something that is affordable, sustainable and addresses the uncertainty" that comes along with a very fluid promise of federal funding.
Shiozawa said his bill is gaining support. It passed through the committee meeting Wednesday with only one dissenting vote, from Sen. Evan Vickers, R-Cedar City.
Vickers, who serves as a chairman of the committee, told its members that Medicaid expansion is one of the more "weighty issues" of the session and is "one of the most important topics we'll discuss this session."
Sen. Allen Christensen, R-North Ogden, was not present at the meeting, but has said he does not support expansion, except to the state's most medically frail.
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