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Jay Evensen: On Medicaid expansion, let people have what they voted for

Paul Gibbs gives his experience as Health care advocates meet on Monday, April 1, 2019 at Liberty Park in Salt Lake City for a press conference highlighting areas where people will be left behind through Utah's SB 96 partial Medicaid expansion plan.
Paul Gibbs gives his experience as Health care advocates meet on Monday, April 1, 2019 at Liberty Park in Salt Lake City for a press conference highlighting areas where people will be left behind through Utah's SB 96 partial Medicaid expansion plan.
Scott G Winterton, Deseret News

SALT LAKE CITY — I wish I had counted the times Republican lawmakers assured everyone last winter that people in Washington said Utah likely would get a waiver to make a partial expansion of Medicaid work.

Vote for SB96, they said. We’re pretty sure everything will be OK.

"I will just emphasize that it is highly unlikely that we need to be concerned about this," the Deseret News quoted House Speaker Brad Wilson saying in February.

Pretty sure; highly likely — now we know this was about as useful as those pumps the state set up 30 years ago in the western desert to alleviate flooding, with the exception that the pumps really do exist.

Here’s reality — even a Republican administration that hates Obamacare didn’t grant Utah the waiver it sought, which would have provided 90% federal funding for a plan that covers people up to 100% of the poverty level, not the 138% of poverty called for under the law. The state didn’t even get a chance to formally request it.

Here’s the second reality — the state now faces three possibilities:

• The 5th U.S. Court of Appeals, and ultimately the U.S. Supreme Court, may uphold a Texas judge’s ruling that Obamacare is unconstitutional, which would invalidate the whole Medicaid expansion provision, and a lot of other things. The next step in that case is completely unclear.

Utah’s version of expansion is funded through the end of next June, with only a 70% federal match, but even that could be in jeopardy if the court strikes down Obamacare.

• Lawmakers could finally acknowledge the will of the voters, who passed Proposition 3 last November, calling for full Medicaid expansion for those earning up to 138% of the poverty level. This is, with some complications, the so-called “fallback” provision they approved earlier this year — something that will happen more or less naturally if they do nothing.

• Or they could tinker with the fallback provision, as well, and try to find a new partial solution the Trump administration would accept. That might be tricky to do in the next legislative session, given that 2020 is an election year. But then, it’s unclear whether tinkering with initiatives, or anything else for that matter, has real political consequences for Republicans in Utah.

In politics, nothing is as certain as uncertainty. Laws seem to be written in pencil, subject to change by whichever party takes control next, or whatever courts may decide.

Yet one thing is assured about Medicaid expansion: Utah voters said they wanted it, and not the light version. The final result was 53 percent in favor. Ultimately, that has to account for something.

Some lawmakers made a big deal out of two things during the last legislative session. The first is that Proposition 3 included a 0.15% sales tax increase, which analysts said was not enough to cover the true costs of full Medicaid expansion. The other is that they believed voters didn’t truly understand everything they were voting to approve.

The first should be easy to fix. Just raise taxes to whatever is needed to pay the full cost. Tell voters the exact amount of the tax increase is not as important as the larger concept of fulfilling their desires to provide coverage to more of the state’s downtrodden.

The second may never be fixed. Lawmakers have been skeptical of the initiative process ever since voters made Utah the second state in the nation to adopt it at the turn of the 20th century.

I share some of their dislike. Laws are better when they go through the leveling process of hearings, amendments, compromises and the threat of a veto from the governor. But the initiative process does give vent to popular ideas lawmakers, for whatever reason, continually ignore.

In any event, the Utah Constitution allows for initiatives, and lawmakers have to deal with them. Simply changing them immediately after Election Day is too dismissive of public opinion.

Much of what surely will follow on this subject may be wasted effort. Courts may quickly change the ground rules. The 2020 election may alter life as we know it, with several Democratic candidates arguing for socialized health care.

In the meantime, however, the best course, like it or not, is to let the people have what they asked for, then deal with whatever happens next.