SALT LAKE CITY — To Leonard Bagalwa, Utah's replacement of the voter-approved Proposition 3 to expand Medicaid is like a bad April Fools' joke.
Before the Legislature passed a more limited plan to replace Proposition 3, Bagalwa said he was looking forward to April 1, believing he would finally have affordable health care under Medicaid.
But Monday came, and Bagalwa said he's among many other Utahns who continue to fall in the health care coverage gap, now forced to purchase private insurance from the federal marketplace. The cost, even with a federal subsidy? About $250 a month, he said.
"That is too much when we are trying to take care of our children and make our lives better," Bagalwa said.
Bagalwa's wife, who recently had a baby, now stays home with their four children, meaning their income is even lower, but still above the federal poverty level, he said.
As an immigrant from the Democratic Republic of Congo, Bagalwa said he was "excited" to vote and campaign for Proposition 3, but now he's left "disappointed."
"To see my voice have no meaning to the Legislature reminds me of my native home country where democracy is not respected," he said.
Bagalwa said he's enthralled in the complicated world of health care coverage every day as a navigator for Health Access Project.
"I do this every day, enrolling people," he said. "And we shouldn't be fooled by our politicians."
Bagalwa was among a group of health care advocates who Monday — the day Utah's limited Medicaid expansion opened for enrollment to between 70,000 to 90,000 Utahns who earn up to 100 percent of the federal poverty level — gathered at Liberty Park to outline the shortfalls of Utah's expansion.
Stacy Stanford, policy analyst with the Utah Health Policy Project, called Utah's so-called "bridge plan" a "broken bridge" with "missing planks" that still leave Utahns falling through the gaps.
Those missing planks are work reporting requirements, enrollment caps, per-capita caps and open enrollment "lockouts" for people like Balgalwa who earn just over the federal poverty line, Stanford said.
Proposition 3 would have covered people earning up to 138 percent of the about $12,000 federal poverty level.
"This is really affecting people, the people who are falling through these gaps have very real issues right now, and they can't wait for a fallback plan that might come 18 months from now," Stanford said
She referred to a provision of SB96 that expands Medicaid fully in the event the federal government doesn't approve Utah's other waivers.
Stanford said there will be Utahns "calling our office today because they see the headlines and they think they get coverage," but instead they'll "find out that they should have signed up for the Affordable Care Act market last year."
"Now they have to wait until next January because they're falling through that plank," Stanford said.
Under a federal waiver approved Friday, Utah is paying for 30 percent of the cost of the plan. The state's other waiver request to move to a 90-10 split is pending.
"We'll be spending more of Utah's hard-earned taxpayer dollars, yet covering fewer people," said Jessie Mandel, senior health policy analyst for Voices for Utah Children. "That should give us all pause."
Utah's federal approval came after a judge struck down Medicaid work requirements in Kentucky and Arkansas, leading critics to ponder whether Utah's program could be legally challenged. Proponents of the plan say Utah's program is different from those states because it requires applicants to show a work "effort" and includes exceptions.
But Nate Crippes, an attorney with the Disability Law Center, said Utah's requirements add extra red tape that acts as an unnecessary "barrier" to an already complex system.
'A day to celebrate'
Also on Monday, Utah Decides, the group behind Proposition 3, announced in a news release the launch of a campaign to "unseat the politicians who turned their backs on democracy" and sponsored the bill replacing Proposition 3.
The campaign targets Sen. Allen Christensen and Rep. Jim Dunnigan.
"The decision made by politicians to choose profits for insurance companies over the wishes of Utah voters and the health care needs of families cannot and will not be forgotten,” Utah Decides organizer Dawn Le said. “There is no point in having a democracy if the votes of its citizens are ignored."
In response, Dunnigan, R-Taylorsville, said critics of SB96 are "missing" an important point.
"This should be a day to celebrate," he said, noting up to 90,000 Utahns now have coverage when they previously didn't.
Dunnigan also said Proposition 3 included a "guaranteed pay raise" for drug companies and hospitals. "I don't think many of the voters who supported Proposition 3 understood that of the $100 million tax increase to pay for the expansion, $30 million of that goes to pay drug companies and hospitals," he said.
To claims that now 50,000 Utahns still fail in the coverage gap, Dunnigan said that's "not factual." He said people can still apply for subsidized health coverage on the federal market place.
"I would say there are no gaps," he said. "I think Utahns are well-served with the plan that we're on."
Asked about Bagalwa's situation, Dunnigan questioned whether Bagalwa was on the most affordable planned he was eligible for. Dunnigan, an owner of an insurance agency, then searched the federal marketplace for subsidized plans offered to families of six at just above the federal poverty level, and he found other plans at lower costs.
But Courtney Bullard with the Utah Health Policy Project, said Bagalwa's situation is complex — and his income has fluctuated because his wife worked before she recently had another baby. As a health care navigator, Bagalwa is "very fluent" in the health care system and chose the best option for his family, she said.
Regardless, Bullard said the point is the cost of health care is too much for families not covered by Utah's limited expansion.
Christensen, R-Ogden, did not immediately return a request for comment Monday.
Open for enrollment
Kolbi Young, spokeswoman for the Utah Division of Medicaid and Health Care Financing at the Department of Health, said as of Monday about 19,000 Utahns were enrolled in Utah's expanded program.
Most of those were automatically converted from the state's Primary Care Network, Young said. About 1,400 of them were early applicants that have already been approved by the Utah Department of Workforce Services.
"We're closely watching that number, and it's continually growing," she said.
Utahns can apply for coverage at medicaid.utah.gov or call 866-435-7414 for more information.