SALT LAKE CITY — Utah lawmakers have been grappling since 2012 with solutions to avoid a full — and what many of them believe would be a costly — Medicaid expansion.
With already a few different bills filed to change what about 54 percent of Utah voters in the last election wanted, which was full expansion, it seems Utah legislators want to debate it all yet again.
If nothing happens, as has been the result for so many years, voters can be encouraged that Proposition 3 to expand Medicaid will stand, with eligibility starting April 1.
But lawmakers are saying something has to change.
Senate President Stuart Adams, R-Layton, said Monday that none of the bills that have surfaced so far have the backing of Republican legislative leadership. Instead, he said, they're working on an alternative with Gov. Gary Herbert's office.
Their goal, the newly installed Senate leader told reporters, is to provide coverage to the same population as called for by the ballot initiative also beginning April 1, but "in a fiscally prudent way."
Adams said that could mean implementing a hospital tax, as called for in the more limited Medicaid expansion bill passed in 2018 that never took effect because needed waivers were not granted by the Trump administration.
Senate Minority Whip Luz Escamilla, D-Salt Lake City, said Democrats are committed to "protect as much of Prop. 3 as possible," but are also looking at addition sources of funding. She said Democrats are being left out of the discussions.
Two bills, which are scheduled to be heard by the Senate Health and Human Services Committee Tuesday at 2 p.m., are already getting plenty of attention.
Sen. Allen Christensen's bill, SB96, aims to keep Proposition 3, but put enrollment caps in place to protect limited available funding, which would require waivers to be filed with the federal government and potentially delay the April 1 start date.
It would also only reach 100,000 of the 150,000 in need of access to health care.
The adjustments, Utah Health Policy Project Executive Director Matt Slonaker said, would leave tens of thousands of Utahns "who finally had a light at the end of the tunnel" still trapped in the coverage gap.
"(Christensen's) plan adds provisions that would indefinitely delay enrollment and risk legal challenge," Slonaker said. "Utah voters are smart, they are informed and they chose to support full Medicaid expansion without caps, red tape or delays."
Christensen, R-North Ogden, wants to implement a "bridge plan" that would cover up to 100 percent of the federal poverty level with the money that Utahns voted on, a 0.15 percent sales tax increase, to fund it, at least until the waivers are approved. The Legislature, he said, would provide "a cushion" to fund anything beyond what the tax increase would not.
The Trump administration, however, declined to address any waivers last year, which could be the case again, but Christensen said he has heard from Washington's Centers for Medicare and Medicaid Services that there's "an excellent chance" it will come through this time.
"I'm not an expansion fan. Never have been. I fought against it forever," Christensen said Monday, adding that he has legislative leadership support for his current proposal. But, he said, if "(voters) want it in and they want to tax themselves for it, we'll implement it. But we have to have some safeguards in there."
Sen. Jake Anderegg, R-Lehi, presented SB97, which would not only repeal Proposition 3, but also get rid of the limited expansion plan lawmakers approved last year. That plan was to cover about a third of childless and poor adults, who are mostly homeless, specifically to help with mental health and substance abuse disorders among that population.
His idea is to replace them with "nothing, because I don't know how we can afford it."
The latest projections show that the cost of full Medicaid expansion as approved by voters would reach $400 million in five years, so the $92 million raised by the sales tax increase that was part of the ballot initiative "just isn't going to cut it," Anderegg said.
He also questioned whether voters knew there was a tax increase in the ballot initiative.
"I think voters didn't realize they were raising the tax," he said. And even if they did, Anderegg said, "they had no idea it was only covering a quarter of the total expense. According to projections."
Anderegg said colleagues in the House and Senate encouraged him to present his bill to repeal expansion, but didn't suggest he had enough support to get it passed this session.
"I will live with that. But the reality is, I just don't know how we can pay for this. It's not that I hate poor people or sick people or old people," he said. "This is going to bury us. I don't know how to get around that."
Advocates see it another way.
I fear for my son. He can’t live a normal life. – Mary Ann Ericksen, a single mom in West Valley City
"These bills that would repeal Proposition 3 are harmful to Utahns and run contrary to the will of the people," Slonaker said. His nonprofit group has long been an advocate of the uninsured, pushing for expansion every year since it was an option. It also helps Utahns apply for limited coverage under the federal health care exchange.
Mary Ann Ericksen, a single mom in West Valley City who has been waiting for years for coverage options to help her grown son with his debilitating post-traumatic stress disorder issues, doesn't want to get her hopes up that the voters' will will stick, but really needs the coverage.
"I fear for my son," she said. "He can't live a normal life."
Ericksen works at and attends Salt Lake Community College and is also without health care. She and her son are two of an estimated 140,000 Utahns who do not have health insurance, either because they make too much to qualify for state programs or not enough to get subsidies to help pay for insurance offered on the federal health care exchange that was created when the Affordable Care Act was passed in 2010.
Every day spent waiting, Ericksen said, she fears the worst.
"When you're dealing with PTSD … it paralyzes you, not only physically, but mentally and emotionally to where you can't function," she said, adding that her 32-year-old son, who was severely abused as a child, has obtained some mental health counseling. But it wasn't enough.
"Without dealing with the issues for so long, he's right back where he started from," she said. "The majority of the time, he just sits in his room."
Sen. Gene Davis, D-Salt Lake City, has been a proponent of full Medicaid expansion since it was first offered to the states by the federal government in 2012. For the past three years, he's run the same bill to offer health care benefits to every Utahn who qualifies with full expansion.
He's disappointed it hasn't happened.
"We've lost billions of dollars in the state of Utah over the years," Davis said.
The federal government promised to pay 100 percent of the cost of expanding Medicaid up until 2017. Utah lawmakers said they couldn't trust the money to come through, and the match rate has now dwindled to 95 percent. It will get to a 90-percent match rate, where it will stay, in 2020.
"I think it is really necessary," Davis said. "This will take care of those folks who can't get coverage, can't get benefits at work and can't get the services they need."
Utah Decides Healthcare, which backed Proposition 3, released a statement saying Utah's voters need to be respected and repealing "the will of the people" would harm "hardworking families who are expecting access to lifesaving care."
"We can do better than this, and we look forward to working with lawmakers to support the implementation of Medicaid expansion in a way that is consistent with the intent of Utah voters," the nonprofit group stated Monday.
A recent UtahPolicy.com poll found that 47 percent of voters want the Legislature to leave Medicaid expansion alone. About 41 percent say some amendments are necessary, according to the website's pollster, Dan Jones & Associates, which doesn't give the Legislature much to go on, UtahPolicy.com states.
"I don't want to see any changes," Davis said. "I believe the people got it right, following what was put in place by federal law. Let's make sure that the voters of Utah, who have voiced their compassion for people who don't have access to what they need, get what they voted for."
All but one of the many, many iterations of partial expansion plans presented by Utah lawmakers over the years, including one presented by Utah Gov. Gary Herbert, have failed to get the necessary votes to pass.
The plan approved last year never came to fruition without a federal decision on a waiver.
It could be that nothing happens and Ericksen, who isn't getting her hopes up, said she will continue doing what she can to help her son on the very limited budget that they have.
"It's been trying, but it's made me strong," she said. "I'm fighting for my son. It's all for him."