Exclusive: Republican lawmakers consider expanding Medicaid under Obamacare, but only under certain conditions

There is a chance, Utah House Speaker Greg Hughes said Thursday evening, that the 2018 Legislature could accept Obamacare’s Medicaid expansion under certain circumstances.

If the GOP-dominated Legislature did so, it would be a political bombshell that could derail the current citizen initiative on the same subject, now aimed for November’s ballot.

In response to a question from UtahPolicy Managing Editor Bryan Schott, Hughes said in an interview that Medicaid expansion under certain circumstances is now in a draft bill; one that has not yet seen the light of day.

The 2018 Legislature starts Jan. 22. And after the October announcement by the Donald Trump administration that Utah would get waivers for the much-scaled down expansion passed by the Utah Legislature two years ago, most Capitol Hill watchers would have said Medicaid expansion was dead in the Legislature.

Thus the citizen initiative petition this year aimed at bypassing reluctant Republicans who didn’t want to adopt Obamacare’s expansion for health coverage for tens of thousands of low-income folks.

Hughes says the opportunity arises because of the Trump administration’s decision to give states the authority to tie some kind of work requirement to Medicaid benefits – something not allowed by the previous Democratic federal administration.

Here are the conditions Hughes puts on the deal:

— Expansion under Obamacare (Hughes uses the official title, the Affordable Care Act) of Medicaid in Utah would have some work/training requirement for recipients.

— Expansion would be up to 100 percent of poverty, not the 138 percent that was in GOP Gov. Gary Herbert’s Healthy Utah expansion, which was passed in the Senate several Legislatures ago, but killed in the state House by Republicans.

— Expansion would be under the 90-10 split – the feds picking up early years funding at 90 percent, the state at 10 percent (with the state’s role in funding expanding over time).

— But there would be a cap on how much the state would ever spend on expanded Medicaid.

The state’s share would not be open-ended, one of the significant hurdles House Republicans would not go along with in the original Healthy Utah or full Obamacare expansion.

Hughes said he personally has not talked to Trump Health and Human Services bosses about the new deal in Utah, but that “someone else” in the Legislature has.

He declined to name the sponsor of the draft bill, nor who the Trump administration contact is.

All that will come later said Hughes, as the proposal – likely in bill form – is discussed in the 2018 session.

“We have to have those discussions,” and assurances from the HHS in the form of waivers so that Utah’s funding share of ACA Medicaid expansion would be capped – future Legislatures would know exactly how much the state may be called on to fund down the road.

“We have to look before we leap,” said the speaker.

But just the chance that Utah could actually expand Medicaid close to where Obamacare would go is, well, a staggering idea, considering how strongly state House conservatives stood against Herbert’s Healthy Utah and the former president’s full Medicaid expansion under the ACA.

Even Herbert’s revised form of Healthy Utah had some work requirements in it, said Hughes. So that idea, coming out of Washington, D.C., this week, is not new, added Hughes.

“I’ve heard rumblings about this bill” now being drafted. “There are a lot of protected bills,” or secret bills, “underway.” This is one, said Hughes.

A new expanded Medicaid effort is not being made to specifically undermine the initiative, said Hughes. “That’s not the driving force” behind a renewed legislative action.

“But it could blunt it; it could have that effect,” said Hughes.

A recent UtahPolicy.com poll by Dan Jones & Associates finds Utahns support the initiative, 59-36 percent.

So if backers can get the required 113,000 voter signatures to get the measure on the ballot, it could pass if lawmakers in this session don’t do something about Medicaid expansion.

You can read about the citizen initiative and what it would do here.

The backers, worried about the political/financial impact of expansion – what the Utah House Republicans tied their opposition to — have in their initiative a small sales tax hike to pay for increased state Medicaid costs.

With hundreds of millions of dollars in surplus coming before lawmakers in 10 days, it is unclear if in an election year GOP legislators would want to raise any tax to pay for expanded health care for the poor.

So if the new expansion were to pass, it’s likely it would not come with a tax hike, but funding from current and expected tax revenue.