SALT LAKE CITY — The House voted 56 to 19 in favor of SB96 Friday, the GOP legislative leadership's alternative to the full Medicaid expansion approved by voters that now includes the possibility of reverting back to much of Proposition 3.
The vote came after a group of faith leaders chanted, "Do justice, love mercy," and prayed outside the House chamber for lawmakers to support the ballot initiative passed in November rather than a more limited and initially more costly plan.
There was brief cheering in the House gallery when backing the will of voters was mentioned during the debate, but House Speaker Brad Wilson, R-Kaysville, warned that the public seating area would be cleared if there was another outburst.
Despite the admonishment, a pair of banners — including one urging lawmakers to "Respect our vote" — were unfurled during the House vote. As a man who'd brought a banner was led away, he yelled, "Fight poverty, not the poor."
Outside the chamber following the vote, the four faith leaders who had been kneeling stood up but continued to pray. They vowed to continue their fight for Proposition 3, the ballot initiative that voters approved.
The Rev. Curtis Price, of the First Baptist Church of Salt Lake City, told reporters there is little left for the group to do now other than put their efforts toward convincing Gov. Gary Herbert not to sign SB96.
"It amounts to a war on the poor," he said. "I don't understand. It seems like every time they want to make a point, it's at the expense of the poorest. We really feel like there is a constitutional crisis happening right now, and we don't know what else to do."
The governor, who tried and failed in past years to win approval from the Legislature for a Medicaid expansion plan of his own, posted a long statement about SB96 on his website, saying the bill "balances Utah's compassion and Utah's frugality."
The bill, he said, provides coverage "in a meaningful, humane and sustainable way. It is now time to set aside differences and move forward to get those in greatest need enrolled on Medicaid and on the federal health care exchanges."
On the House floor, the bill's House sponsor, Rep. Jim Dunnigan, R-Taylorsville, told representatives that the cost of implementing Proposition 3 exceeds the money raised by the 0.15 percent sales tax increase in the initiative.
"Having enough money and being fiscally responsible, we should at least try," Dunnigan said, to get the federal approval needed for expanding Medicaid to only about two-thirds of those who would be covered under Proposition 3.
He said lawmakers can pursue what backers are calling a more financially sustainable plan knowing there is now a "backstop."
Several efforts to change the revised bill failed, including an attempt to replace SB96 with HB210, a bill that would allow Proposition 3 to take effect with some modifications while waiting to see if the more limited program would be approved.
But Dunnigan warned that could put the state in "legal jeopardy" because some people could receive Medicaid benefits but later lose them. He said he incorporated HB210, sponsored by Rep. Ray Ward, R-Bountiful, in the fallback plan.
Ward told fellow representatives during the SB96 debate he backed the revised bill.
"To me, it looks like we've done a very good job. It will be sustainable in the long run," Ward, a doctor and a longtime advocate of Medicaid expansion, said, allowing lawmakers to "keep our promises."
House Majority Leader Francis Gibson, R-Mapleton, assured representatives they'll be able to tell their constituents that "we covered the spirit of what that proposition was."
Proposition 3, Gibson said, "was asking for coverage for the most vulnerable in our society." He said by passing SB96, lawmakers will do that "in a way that is uniquely Utah."
Before the House convened, Dunnigan went over the proposed "fallback plan" that the House put in the bill to its Senate sponsor, Sen. Allen Christensen, R-North Ogden.
Christensen said he did not oppose a fallback plan because he believes it won't be necessary. He snapped his fingers when asked if the Senate would concur with the House changes, a vote that will come Monday.
"They want it done. They're happy the House is happy with it," Christensen said of the Senate. "They're all tired of the wrangling over it."
Asked if the Senate would support the changes made by the House, Senate President Stuart Adams, R-Layton, said, "Yes, I think so. We'll see on Monday." He said he believes the Senate "got a better bill back from the House."
Senate Minority Caucus Manager Derek Kitchen, D-Salt Lake City, said the Senate's six Democrats still have to review the changes. All of them voted against SB96 last week, along with a single Republican, Sen. Todd Weiler, R-Woods Cross.
"We'll be looking at it. We want to find common ground and some sort of agreement. Whether we'll get there, and whether this is the right bill, we're not sure yet," Kitchen said, adding that he feels "better about the bill going forward."
The two-part fallback plan that kicks in only if the more limited coverage sought in SB96 is rejected by the federal government is similar to the full Medicaid expansion in Proposition 3.
However, the first step of the plan that would take effect Jan. 1, 2020, does attempt to keep in place what Dunnigan called a "work effort" that requires recipients to try to find employment.
If the work requirement doesn't fly with Washington, then the final version of Medicaid expansion in SB96 would be put in place on July 1, 2020, along with a $15 million annual hospital tax.
Unchanged is Christensen's original proposal to provide Medicaid coverage only to Utahns earning up to 100 percent of the approximately $12,000 federal poverty rate.
The full Medicaid expansion approved by voters provides Medicaid for Utahns making up to 138 percent of that rate. SB96 proponents have said federally subsidized insurance will take care of those in that category.
Christensen's bill would start coverage April 1, as would Proposition 3, but at a more expensive 70 percent to 30 percent federal to state funding match rather than the 90-10 split offered for full expansion.
The so-called "bridge" plan would be in place for 18 months as the state seeks permission from President Donald Trump's administration to extend Medicaid to the smaller population at the higher funding match.
While the Senate passed SB96 last week 22-7 without a fallback plan, enough House Republicans balked at the bill to jeopardize the supermajority needed to ensure the bill could take effect quickly with the governor's approval.
Following a closed-door House GOP caucus Thursday, Dunnigan went to work on changing the bill. Sen. Dan Hemmert, R-Orem, said legislative analysts worked past midnight to ready the substitute for Friday's vote.
'Do the moral thing'
Groups on both sides of the SB96 debate assembled at the Capitol to lobby House members, while faith leaders from several Salt Lake churches prayed, sang and chanted, kneeling directly in front of the doors leading to the House floor.
House security kept a watchful eye but didn't intervene.
The Rev. Price, in prayer, called on God to "soften (legislators') hearts and turn their hearts to the poor."
"Lead them away from this war on the poor they are exhibiting right now," he said. He called on lawmakers to "do the right thing, do the moral thing … and take care of the citizens of Utah as the people have asked them to do."
The Rev. Monica Dobbins, of the First Unitarian Church of Salt Lake City, and the Rev. David Nichols, of the Mount Tabor Lutheran Church, knelt with Rev. Price, elbows locked.
Supporters of SB96 from Americans for Prosperity, the flagship organization of the political network backed by industrialist billionaires Charles and David Koch, gathered among the crowd, at times arguing with Proposition 3 supporters. The demonstration, though at times tense, remained peaceful.
As the vote neared, faith leaders backed up and knelt closer to the House doors, blocking them. When House security asked them to move, they began singing, "We shall not be moved." One woman shouted, "We are not blocking health care!"
As they sang, SB96 supporters stood in front of the banner that read "Respect democracy, our vote matters." Proposition 3 backers moved the sign, pulling it in front of the Americans for Prosperity supporters, but they moved again to block it.
One woman starting singing "Row row row your boat" in an attempt to drown out the singing.
But the chants continued: "The people have decided."
Ward said he'd tell Proposition 3 supporters, "I can easily understand why you're mad. That's not hard to understand at all." He added, however, that he hopes they'll feel differently once an ongoing coverage plan is in place under SB96.
Other Republican lawmakers have made it clear that had Proposition 3 not passed, they wouldn't be talking about Medicaid expansion.
"I never voted for any kind of an expansion bill," Senate Majority Leader Evan Vickers, R-Cedar City, said, comparing his support for SB96 to backing the Legislature's actions in special session last year on the medical marijuana initiative.
"My message is, 'Thank you. Thank you for bringing it forward.' It forced us to take action," Vickers said of Medicaid expansion. "Quite frankly, if it hadn't have been brought forward through that proposition, I would not be voting for it."
Karina Andelin Brown, a former Democratic House candidate from Cache County and one of the original backers of Proposition 3, said she's happy with the changes made to SB96.
"I think that Proposition 3 supporters should be encouraged. All of the results that have come about show our voice matters," she said. "Sometimes, compromise is what we have to do."
Contributing: Emily Ashcraft