Imagine you’ve decided to make a necessary major household purchase, such as a new car. Let’s say you find a vehicle that suits your family, so you sit down with the dealer. You ask the total price, how much the payment will be and for how long. The dealer says he cannot tell you an exact price or a precise monthly payment, but the term of the loan will be “from now on.” Would you buy that car?
Last session, the Utah Legislature passed a Medicaid expansion measure that includes cost controls and allows enrollment limits. It establishes clear and reasonable eligibility rules and gives us options should the costs exceed our means.
For the out-of-state funders of Proposition 3, this was insufficient. So Utah voters will vote in November on whether to enact full Medicaid expansion under the “Affordable Care Act,” or Obamacare, instead of the Legislature’s Utah-centered approach.
Obamacare Medicaid expansion includes no cost or enrollment circuit breakers, and once we are in, we will never get out. The payment is undetermined and “term of the loan” is indefinite. Our decision will determine our future ability to fund vital state needs such as education, transportation and public safety.
Our “Utah style” limited Medicaid expansion is designed to help those truly in need while protecting taxpayers from excessive, budget-breaking costs. Under Proposition 3, all that flexibility vanishes in favor of a “top-down, one size fits all” Washington-style plan.
Since 32 states have chosen to expand Medicaid under federal mandates, we can examine their track record. Here’s what we know:
- In every expansion state, enrollment and cost estimates have been way off; reality has sometimes doubled projections, thus doubling the costs.
- Eighty-two percent of new enrollees are childless, able-bodied adults, mostly unemployed; 55 percent do not work at all.
- The promised benefits — fewer uninsured, less uncompensated care, reduced emergency room utilization, vastly improved health outcomes — materialize marginally or not at all.
- Because of federal reimbursement formulas, the very people most of us really want to help — the chronically ill, seniors in need of long-term care and individuals with physical or developmental disabilities — actually end up at the back of the line behind thousands of unemployed adults. Nationally, more that 600,000 such people are currently denied the care they need in favor of millions of new, able-bodied adult enrollees.
Medicaid is broken; doubling down on a broken system is foolish. Utah’s share of expenditures will only grow. In 2000, Utah spent $774 million on Medicaid; $127 million of that was Utah’s share, or 11.8 percent of Utah’s budget.
In 2016, the most recent year for which we have complete data, Utah’s total Medicaid expenditure was $2.5 billion, a whopping 229 percent increase in Medicaid alone. Utah’s share increased to $893 million, a 603 percent increase since 2000. And that was without Medicaid expansion under Obamacare as proposed in Proposition 3.
Medicaid currently absorbs 18.7 percent of Utah’s General Fund budget. How much more can we afford without more tax hikes or major cuts in services? That is happening in other states. So what are we willing to cut, or which taxes are we willing to raise, to pay for it?
Utah's Legislature has sometimes been criticized for its reluctance to grow state government, for demanding that we “pay as we go.” But as a result, Utah is among the most fiscally sound states. It’s been said, “It is easy to identify the blue states — just look for all the red ink.” Utah has avoided that pitfall by adhering to fiscal prudence.
Our Legislature acted wisely on expanding Medicaid — the full Obamacare Medicaid expansion proposed in Proposition 3 is bad policy and potentially devastating for Utah.