SALT LAKE CITY — The debate over whether to replace voter-approved Proposition 3 Medicaid expansion with a plan that at least initially costs more and covers fewer Utahns appears to be headed for changes in the House.
A day after the Senate gave final passage to SB96, House Speaker Brad Wilson, R-Kaysville, met with the bill's House sponsor, Rep. Jim Dunnigan, R-Taylorsville, and the sponsor of an alternative proposal, Rep. Ray Ward, R-Bountiful.
There was new talk Tuesday that the bills could be combined in the House, possibly allowing the Medicaid expansion passed by voters last November to take effect while waiting for federal approval for a more limited program.
"All options are on the table," House Majority Whip Mike Schultz, R-Hooper, told the Deseret News. "We can argue different ways of how to get there, but most important is, let’s find the bridge."
Neither Dunnigan nor Ward were willing to discuss the meeting.
"Some meetings are good. Some meetings are not good," Dunnigan said, deferring other questions about any potential changes to SB96 in the House to the Republican leadership.
Ward said only that he did not expect a hearing on his bill, HB210.
Last week, House Majority Leader Francis Gibson, R-Mapleton, told the Deseret News that Ward's bill would not advance and that he anticipated getting SB96 through the House and on Gov. Gary Herbert's desk by Friday.
SB96 is set to be heard by the House Business and Labor Committee Wednesday at 2 p.m. House Republicans are expected to discuss Medicaid expansion during their Thursday caucus, which is likely to be closed to the press and the public.
The bill, sponsored by Sen. Allen Christensen, R-North Ogden, replaces full Medicaid expansion that provides coverage to Utahns earning up to 138 percent of the approximately $12,000 federal poverty rate first with a "bridge" program.
That program would limit Medicaid coverage to Utahns earning 100 percent of the poverty rate. Those earning 100 percent to 138 percent of that rate would have to purchase federally subsidized insurance policies.
The bill anticipates permission to start that program April 1, at a 70 percent to 30 percent federal to state funding match, which approval is sought for long-term coverage at the same 90-to-10 match available for full Medicaid expansion.
Ward's bill, HB210, basically puts in place Proposition 3 while going after federal waivers to receive the higher federal funding match to cover only Utahns earning up to 100 percent of poverty.
"We have to pass something that forces the waivers with the federal government," Schultz said. "But we also have to have a fallback position because what if the federal government doesn’t. Everything is talking about the bridge."
The price tag to taxpayers for what could be up to an 18-month bridge program in SB96 was dropped from $72 million to $49 million in a last-minute adjustment to the fiscal note put together by legislative analysts.
But that's still more than the cost of the full Medicaid expansion available under the Affordable Care Act, which also does not require waivers from the federal government to implement.
Similar waivers requested by Utah and other states have not been granted.
Schultz said while there's a high level of confidence this time will be different, the question is, "What happens if we don’t get the waivers? That's where all the discussion is right now. You have Ray Ward’s bill. You have the Senate’s bill."
Former Republican state Sen. Brian Shiozawa, who now works for the Trump administration as a regional director in the Denver office of the U.S. Department of Health and Human Services, is meeting with Utah officials this week and next.
Shiozawa, who four years ago carried the governor's "Healthy Utah" alternative to Medicaid expansion that passed the Senate but failed in the House, is expected to attend the Senate GOP caucus on Feb. 14.
He also has a meeting this Thursday with Lt. Gov. Spencer Cox.
Senate Republicans are waiting to see what changes the House makes to SB96.
"They gotta do what they gotta do to get the votes," Senate Majority Whip Dan Hemmert, R-Orem, said. He said he did not believe starting with full Medicaid expansion was as good as the bridge program in SB96.
"Our fear is, you can't put someone on with full Medicaid expansion and pull them off," he said. "To have them come over and say, six months later, nine months later, 'Oh, by the way, you've' got to go back.' That's much more disruptive."
Asked how such a proposal might fare in the Senate, Hemmert said the GOP supermajority "hasn't done any sort of vote-counting on this side for any new Medicaid ideas."
Those ideas could also include removing a provision added to SB96 just before Monday's 22-7 vote in the Senate that would repeal all Medicaid expansion if the necessary federal waivers aren't granted.
Dunnigan had no comment on that provision.
"I've got to look at the version of that bill that passed the Senate," he said.
Schultz said he couldn't speak to that provision "at this point in time."
Hemmert said the repeal provision was put in the bill to pressure the federal government to act on the waivers. "That's important for our negotiation position," he said. "That's why I think it's important that it is the way it is."