Utah’s own version of Medicaid expansion — offering broad coverage to everyone up to 100% of the poverty line and letting those between 101% and 138% get subsidized coverage through the Affordable Care Act’s competitive exchange — isn’t going to work.
The state wanted a waiver from Washington, letting the federal government fund 90% of this plan just as it funds 90% of coverage in states that expanded Medicaid fully to those at 138% of poverty. The Trump administration said no.
To be rejected by a Democratic administration would have been one thing. Losing out under a Republican administration that once vowed to repeal the Affordable Care Act, however, makes it resoundingly clear that Utah isn’t likely to be able to craft its own version of Medicaid expansion.
But the events of the last few days ought to highlight one other important aspect of this debate. Health care in the United States, and particularly when it concerns the poor and needy, is in a state of flux and uncertainty. That makes it hard for Utah to react or formulate a Plan B.
The 5th Circuit Court of Appeals is considering a lower judge’s ruling that the Affordable Care Act is unconstitutional. Democrats are debating whether to nominate a presidential candidate who will run on a platform of scuttling the Act in favor of a broader form of socialized medicine. Many Republicans remain intent on drastically altering or even repealing the Act and replacing it with some as-yet unknown law.
The best course is for the state to do nothing, and that means eventually triggering part of a recently passed state law that would, with some complications, put full Medicaid expansion into effect.
Not coincidentally, it also would put most of last year’s Proposition 3 into law, with the exception of a work requirement and some cost controls. Some people have been upset that lawmakers immediately changed this proposition, which passed with 53% of the vote. They have a point.
State lawmakers have, for years, resisted Medicaid expansion, but voters said they wanted it. The rules coming out of Washington may change drastically in coming years, but in the meantime, voters should get what they desired.
It’s important to remember that Medicaid expansion would provide much-needed health care to many who otherwise would be unable to function or contribute to society. This includes single men with mental health problems, some of whom have served prison sentences yet can no longer afford important medicines. It includes many of the state’s addicted homeless. It includes many who, absent medical care, will require more expensive public services to deal with the consequences of their actions.
Yes, Utah lawmakers are wise to carefully consider costs and long-term budgetary impacts. But the people have indicated this ought to be a state priority. For the time being, at least, it makes little sense to waste time seeking other solutions in a time of political uncertainty.