Herbert's 'Healthy Utah' Plan Could be a Political Hot Potato

Written by Bob Bernick on . Posted in Today At Utah Policy

Will most of the 61 Utah House Republicans accept the taking of $258 million in federal dollars annually for GOP Gov. Gary Herbert’s “Healthy Utah” Medicaid expansion?

 

That’s a political question yet unanswered as Herbert and his top health aides grapple with federal officials over the governor’s stylized “Utah solution” to the Obamacare’s increased Medicaid expansion requirement.

Some GOP-dominated states – and Utah leads the pack in that category – have refused the Medicaid expansion, even though the feds would pay 100 percent of its cost for the first three years.

Utah stalled making that decision – in part because in the 2013 Legislature Utah House Republicans stood behind Speaker Becky Lockhart’s opening-day speech in which she called the expansion a shell game and a fraud.

Herbert has just returned from a visit to Washington, D.C., and talks with out-going Health and Human Services Sec. Kathleen Sebelius.

He told reporters Wednesday that he’s optimistic that Sebelius and White House Obamacare officials will OK a bloc grant for Utah’s Medicaid plan.

If he gets an agreement – and he said he hoped to have assurances “in several weeks” – then by the end of summer, said the governor, he’ll call a special legislative session to ratify his program.

But then it becomes a political question as much as an operational one.

Lockhart, R-Provo, may run for governor in 2016. And if Herbert decides to run again, she would be challenging him for the Republican Party nomination.

Thus, Lockhart in the past two years (she’s retiring at the end of this year) has tried to mark differences between herself and Herbert.

The speaker fell short in getting Senate Republicans and Herbert to fund her aggressive public education technology initiative in the 2013 general session.

At the least she needed between $45 million and $50 million to pay for linking all Utah K-12 schools up to high-speed Internet.

While Senate Republicans dithered, Herbert announced that if anything more than $30 million was budgeted for Lockhart’s plan, he would line-item veto that expenditure.

In the end Senate and House budget negotiations faltered – the Senate offered a small amount and Lockhart said forget it.

House and Senate Republicans also didn’t come close to agreeing on Medicaid expansion – with House Republicans coming up with a rather screwy option that took no fed money but spent $35 million in Utah taxes on a downsized plan aimed at helping out some Utahns in the so-called “donut hole” of Medicaid expansion.

Now Herbert is nearing an agreement with the feds on a plan where Utah takes $258 million in federal dollars.

In return, Utah can craft its own “unique” Medicaid expansion program for the 111,000 folks who fall into the expansion proposal – those who make 100 percent to 136 percent of the federal poverty line.

Those folks will have to “have some skin in the game,” said Herbert – and will pay around 2 percent of their income for health insurance premiums.

That could amount to perhaps $200 to $400 per year.

They must also either be looking for work, or get a job of some kind – if, in fact, they can work.

Many will have disabilities or other problems that won’t let them hold down a job.

“We were received very well” in D.C., reported Herbert.

And “conceptually” there is nothing in Herbert’s “Healthy Utah” plan that would be a “deal breaker,” said the governor.

More negotiations must be done, he added.

Utah, like other states, needs to create its own solution to Medicaid expansion, one that meets our demography, culture and politics, said Herbert.

The politics is clearly anti-federal government.

Herbert said he understands Utahns (read that GOP legislators’) dislike of taking any more federal money.

About a third of Utah’s $13.5 billion annual budget is fed money now.

But, Herbert said, those who balk have to come to understand that Utahns are already “specifically being taxed” for the Medicaid expansion.

The $258 million is really Utahns taxes that are going back to D.C., rolled around, and then sent back to the Beehive State to pay for poor folks’ health insurance coverage.

To those – the opposite of state House Republicans – who say take all of the federal expansion money, more than $400 million a year, and have no client co-pays (the 2 percent), Herbert said Utah’s solution will better reflect both the reality of Medicaid health care and our sense of what’s fair.

He repeated the story of his sister – who lost her husband last year. The couple have a special needs daughter, who has been covered by Medicaid since birth.

But, said Herbert, his sister would much rather have the little extra cost to her and the ability to decide for herself about her daughter’s care.

Many doctors don’t take Medicaid patients, and those that do – well – his sister didn’t like the care the girl was getting under Medicaid previously.

There will be internal savings, if Utah can run its own program, added Herbert.

Several other states have figured out to add dental and vision insurance and still save money – maybe Utah could offer dental and vision insurance in his “Healthy Utah” plan, Herbert said.

“You would be able to tailor your (health care insurance) plan to your needs,” said Herbert.

But Herbert will still have to get 38 votes in the 75-member House. And in that process, he’ll have to convince some conservative House members to accept $258 million in federal money for expanded Medicaid coverage.

“Some believe that just taking federal money is evil,” said Herbert.

But they misunderstand that the federal Medicaid expansion money is taxes already paid by Utahns.

“We are not borrowing this from China,” he said.

Utah already accepts billions of dollars each year from the federal government – usually coming as grants or “shared responsibility” programs in health, transportation, public safety and education.

“I understand (Utahns and lawmakers) the concern with federal irresponsibility in fiscal matters.”

“But if we don’t take (Medicaid expansion dollars) it will be left on the table and spent somewhere else” in the United States.

“We are charged for this (expansion) whether we use it or not.”

Utah will spend its Medicaid expansion money “in more responsive ways.

“We’ll get past the ideology and spend taxes better here.”

By the end of summer, when the special session will be called, the House and Senate members seeking re-election this year will have already been through their party conventions and primaries (if they even have any).

That will make it easier for incumbent Republicans to vote for Herbert’s Medicaid expansion and the acceptance of the feds’ $258 million.

Lockhart is leaving office next December, her influence over GOP House decisions dwindling. The later this year the special session, the weaker the speaker will be.

Herbert’s path? First strike the fed deal, then move legislative Republicans to accept it.