SALT LAKE CITY — A bill replacing voter-approved full Medicaid expansion with a more limited and initially more costly plan passed a House committee Wednesday, but there may be some big changes before it hits the House floor.
The House Business and Labor Committee voted 9-6 to advance SB96 after members agreed unanimously to remove a provision that would have repealed any Medicaid expansion if the federal government rejects the new plan.
However, the chairman of the committee, Rep. Jim Dunnigan, R-Taylorsville, who sponsored the amendment and is the bill's House sponsor, voted against sending the bill to the full House.
Dunnigan offered no explanation for his opposition during the more than 1 1/2-hour long hearing and told reporters "no comment" afterward. He did, however, fist bump with SB96's sponsor, Sen. Allen Christensen, R-North Ogden.
Christensen told the Deseret News he expects more changes to SB96 before it comes up for a vote in the House.
"Why do you think Dunnigan voted no? They're disagreeing over the fallback plan," Christensen said, referring to what the state will do if the federal government doesn't approve the long-term plan.
"What happens if no secondary waiver comes through," the senator said, noting that under the amendment approved by the committee, Medicaid expansion ends "when we run out of money," about 18 months after the April 1 start date.
"That's what they're arguing about," Christensen said. He said he learned of the amendment just before it was posted during the meeting, but backed it anyway. "It's better than nothing, not as good as what I would have wanted."
An option expected to be considered in caucus is reverting back to full Medicaid expansion in a year if the waivers don't come through, basically implementing the Proposition 3 ballot initiative that passed last November.
House Majority Whip Mike Schultz, R-Hooper, declined to discuss the changes yet to be made to SB96 before it comes up for a vote on the House floor. He said those changes will be discussed in a closed House GOP caucus Thursday.
The House vote on SB96 won't come until Friday, Schultz said, and the bill will have to return to the Senate for action on any amendments. GOP leaders had said they wanted the bill on Gov. Gary Herbert's desk by the end of the week.
"The question is are there more changes? Obviously. The question is, how substantive are those changes. And that's a good question," Schultz said. "I hope we can get to the 50 votes."
That's a veto-proof majority in the House, and the number needed for the bill to take effect immediately, allowing the state to start working on the federal waivers needed.
Unlike SB96, Proposition 3 does not require approvals from the federal government to receive the 90 percent to 10 percent federal to state funding match available for full Medicaid expansion under the Affordable Care Act.
That's because Proposition 3 provides coverage to Utahns earning up to 138 percent of the approximately $12,000 federal poverty rate, while SB96 limits Medicaid expansion to those earning up to 100 percent of that rate.
While the waivers are being sought, SB96 establishes what's being called a bridge plan that extends coverage for up to 18 months at a higher 70 percent to 30 percent state to federal funding match that also requires federal approval.
Schultz said he doesn't believe a fallback plan will be needed.
"We're not just pulling this out of the sky," he said. "We truly believe we're going to get the waivers."
There was no talk of making additional changes to SB96 in the committee hearing.
Christensen said he's long opposed Medicaid expansion because he's "philosophically opposed to extending more government control over more lives," but was willing to "go along with what the public voted for," with some modifications.
"We're going to expand Medicaid. My bill does that," he said, but in a fiscally responsible way that includes enrollment caps, work requirements and other restrictions intended to help control costs.
He said the 0.15 percent sales tax increase in Proposition 3 isn't going to be enough to pay for the state's share of full Medicaid expansion, according to estimates predicting shortfalls reaching $65 million in four years.
SB96 has a $49 million price tag to help cover the more expensive bridge program.
For those Utahns earning between 100-138 percent of the federal poverty rate who won't receive Medicaid under SB96, Christensen said they can show "personal responsiblity" and buy federally subsidized insurance for as little as $22 a month.
He also said he expects the federal waivers to be approved, even though past efforts to obtain similar approvals from Washington by Utah and other states have been denied.
"I’m betting the farm we’re going to get it," he said. "It’s a matter of risk."
Jared Parker spoke in favor of SB96, calling Medicaid expansion a moral issue because of the impact on the budget. He asked lawmakers to be "morally responsible by being fiscally responsible."
Nate Crippes of the Disability Law Center, however, warned that the state will face legal challenges to SB96 because of some of the restrictions being put on Medicaid expansion.
House Minority Leader Brian King, D-Salt Lake, who along with the other two Democrats on the committee voted against advancing the bill, called the bill financially irresponsible.
"I don’t see the rush for pushing it through," King said. "There's a real significant downside."
Andrew Roberts, spokesman for Utah Decides, the group behind Proposition 3, said in a statement that now House members are following the Senate "in supporting a bill to overturn the will of Utah voters."
Roberts said "politicians risk bankrupting our state or kicking tens of thousands of Utahns off their health insurance. Either way, this isn't what voters asked for. Fully implementing Proposition 3 is the only responsible path."
Contributing: Emily Ashcraft