It will come as no surprise to the readers of this column that I have strong opinions about the Medicaid expansion debate in Utah. I have worked on Medicaid policy issues for nearly seven years, observing firsthand the overwhelming needs and tenuous financial situation of the existing Medicaid program. I have worked with health-care providers and advocates to reform Medicaid, to curb runaway costs and to improve health care outcomes for Medicaid recipients. While it should be 100 percent state run, Medicaid is a core safety-net program that lifts the burdens of hundreds of thousands of Utahns.

I am opposed to a broad expansion of Medicaid, in part, because I am certain that expanding Medicaid to 138 percent of the federal poverty level to chase a better federal matching rate will, in the end, critically injure the core Medicaid program we have worked so long to reform and ultimately harm Medicaid recipients. I, and many others, have expressed these concerns multiple times to our elected leaders over the last two years. Unfortunately, if news reports are to be believed, our concerns have been overlooked.

According to recent reports, the self-styled “Gang of Six” has apparently agreed upon a policy framework that will “fund” full Medicaid expansion by taxing health care providers. This conclusion was reached behind closed doors and apparently with little input from Medicaid providers themselves. And it is catastrophically bad policy.

According to my contacts who are close to the negotiations, the proposal would impose a Medicaid tax on physicians that would start at around $3,000 per year but could easily reach $10,000 per year depending on actual Medicaid enrollment. The Gang of Six is apparently under the illusion that all Medicaid providers will reap windfall profits from Medicaid expansion. That is simply not the case.

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Doctors already subsidize the costs of Medicaid. Not only are Medicaid reimbursement rates abysmal, Medicaid patients typically present complex health care challenges that often require much more intensive care. Sadly, they are also more likely to sue. We already have a physician access problem in our Medicaid program. Currently, 60 percent of Utah doctors refuse to accept more Medicaid patients into their practices. For those doctors who are still willing to see Medicaid patients, taxing them to recoup non-existent windfall profits to “fund” Medicaid expansion is a slap in the face.

On top of this, there is a nationwide shortage of doctors, particularly among primary care providers. Primary care providers are the backbone of the Medicaid program, providing the basic services that keep Medicaid recipients healthy and out of our emergency rooms. Primary care physicians are the lowest paid of all doctors, and the vast majority of new primary care physicians are struggling to pay off massive student loan debts. How do we expect to recruit and retain primary care physicians when our physician “licensing fees” are 10 times higher than neighboring states? Any student of macroeconomic policy knows that when you tax something you get less of it. That applies to physicians like anything else. Imposing a physician tax will exacerbate physician shortages and impact access to physicians for all Utahns, not just Medicaid recipients.

If the governor and the Legislature are intent on expanding Medicaid, then they should pay for it through a broad-based tax increase. Their primary objective for the Medicaid program should be to “first do no harm.” Instead, they appear to be trying to cobble together just enough money to make the first down payment on the largest entitlement expansion in 50 years, knowing that costs will double and most likely triple within the next five years. These costs cannot be absorbed in the Medicaid program. To make such a leap is political malpractice.

Dan Liljenquist is a former state senator and former U.S. Senate candidate.

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