House GOP Discusses Medicaid Expansion Options

So, Reps. Dean Sanpei and Jim Dunnigan spend around an hour Tuesday afternoon in an open GOP caucus discussing the House’s solution to Medicaid expansion.


And then a GOP leader asks if there are any questions by the 61-member Republican caucus.

Silence, then laughter.

Where in the heck does one even begin to understand Medicaid expansion under Obamacare, much less the solution put forward by Dunnigan, R-Taylorsville, and Sanpei, R-Provo?

These are two, smart, articulate guys.

Yet one could see the glazed look in many of the House Republicans’ eyes.

Oh, brother, were they thinking; we have to vote on this?

The Sanpei/Dunnigan bill has yet to be introduced, so we can’t make a hyper-link to it.

A nice color chart, passed out in the caucus accompanies this story. Take a look. Then you know what the House members are up against.

Still, here are a few simple summaries stated by Dunnigan, Sanpei and other House Republicans on Tuesday:

— The House GOP plan does NOT expand Medicaid as Obamacare offers.

Politically speaking, this is a good thing for House Speaker Becky Lockhart, R-Provo.

In her opening remarks the first day of the 2014 Legislature, Lockhart took a slap at GOP Gov. Gary Herbert, who had said he believes Utah should take some Medicaid expansion money, but probably not all of it.

Lockhart said Utah should take NO Medicaid expansion federal cash – to be used to cover more lower-income Utahns who now find themselves without health care.

It is beyond reason that anyone (like Herbert) would even suggest such a thing, said Lockhart, who may be running for governor in 2016.

So the House GOP plan follow Lockhart’s basic desire – tell Obamacare to go jump in the lake.

— Utah should “experiment” with “uniquely Utah solutions” to Medicaid expansion over the next two years, said Sanpei and Dunnigan.

By 2017 Utah health care bosses will know what works and what doesn’t, will know how many “medically frail” Utahns fall into the roughly 54,000-60,000-person  “bucket,” or “donut hole,” which is created by Obamacare – those who are 0 percent to 100 percent above the federal poverty line.

We will also know how many sick parents with children living at home are also in the “donut hole.”

And the Sanpei/ Dunnigan plan (let’s call it the SD plan to save typing) will somehow raise those few – maybe 10,000, maybe 15,000, no one knows for sure – unhealthy people to the top, and probably make sure they get their medical bills paid for.

— The SD plan will require any number of federal health care waivers.

The good thing, says Sanpei, is that by NOT accepting Medicaid expansion, Utah is eligible for the waivers it may need.

If Utah accepted Medicaid expansion now – and the $500 million to $600 million it would bring to Utah state health care budgets per year – then the state likely couldn’t set up the really neat, experimental alternatives to Medicaid expansion (assuming we get the waivers.)

The bad news, says Dunnigan, is that even with Utah’s unique solutions, the state will still lose at least $150 million a year in 2015 and 2016 in taxpayer money before we get to 2017, when the rubber really hits the road and Utah will have to say “we’re in” Medicaid expansion, or “we’re out” – and we have these “uniquely Utah” solutions.

— Herbert said in his State of the State address that Obamacare Medicaid expansion money (the federal government will cover 100 percent of the cost over the next three years, then 90 percent after that) is taxpayer dollars, just like Utah taxes paid by citizens are taxpayer dollars.

So, if we consider both federal and state taxpayer dollars as coming from Utah taxpayers, then what’s the big gripe about accepting some Medicaid expansion dollars? the governor asked.

It only makes sense.

Sanpei says the same thing: Medicaid expansion dollars – which the federal government doesn’t have, but are borrowing – are just taxpayer dollars, federal and state.

So we shouldn’t be spending any more on Medicaid expansion, if we can actually save taxpayer dollars by adopting the SD plan – which will save hundreds of millions of dollars over time.

It only makes sense.

Here’s the big fiscal pill – if you will excuse the pun.

Accepting Medicaid expansion, technically, won’t cost the Utah budget any money next year and the year after – the feds pay for all of it for the first three years, then Utahns have to pick up 10 percent.

But the SD plan, “maybe,” will cost $30 million to $35 million in the 2015 budget, which lawmakers have to adopt before adjournment March 13.

That’s bad news.

The good news, is that because by 2017 the SD plan will be self-sufficient (with federal waiver money), “maybe,” conservative legislators can use “one-time” monies to pay for SD in 2015 and 2016.

One-time revenue surpluses are much easier to find than ongoing funds – which are gobbled up in public education, higher education, employee salary increases, retirement demands and so on.

(The bad news for Lockhart is that she’s looking for $50 million in one-time money for hard-wiring Utah schools for broad-band WiFi for her high-tech initiative. But that’s a whole other story. Let’s stick with Medicaid expansion for now.)

Back to the 54,000 to 60,000 low-income Utahns who don’t have health care now, but would have it under Medicaid expansion.

Sanpei says that the SD plan will place high priority on really sick folks – however many that may be, no one knows.

Most in the “donut hole” of 54,000 to 60,000 are really people like college students or younger folks who aren’t paying for health care now because they are healthy.

In theory, a young person would get low-cost care under S/D, like primary care, or emergency room care or maybe some middle-help classified like “urgent care.”

If a healthy person in the “donut hole” got cancer, then it’s likely they could be reclassified into some current program, or into expanded programs under SD and get the help they need.

Maybe the healthy would get tax credits to help pay for commercial health care. Maybe the state would give them a direct subsidy to get them into their employer’s health care insurance. Maybe grants could be given to current programs to expand to handle primary care for healthy low-income people.

But some way, some how, SD would take care of these folks – if SD can get the federal waivers available to states who don’t join up for full Medicaid expansion.

So, the question was asked: What if the feds, just to be jerks to folks who won’t join Obamacare’s Medicaid expansion, won’t give Utah the waivers needed?

Sanpei said the feds have already given Utah and other states a few waivers – even though the feds threatened not to before they gave them. So probably the feds will give them now.

And Utah will be able to craft a “uniquely Utah solution” to the crazy spending that would come with accepting full Medicaid expansion.

At the Capitol Tuesday was a group of pastors and lay folks with a coalition of religious groups asking for full Medicaid expansion – so Utah’s low-income and needy can be taken care of.

Mostly their pleas fell on deaf lawmaker ears, several told UtahPolicy. “They can take federal road money, but not federal health care money,” said one pastor.

But the SD plan “closes no doors,” said Dunnigan.

In two years, the state could still decide to take Medicaid expansion (although the state will be out the hundreds of millions of dollars it would have gotten in 2015 and 2016.)

But, said Sanpei, if Utah steps through the Medicaid expansion door now, then it will never be able “to go back” – never be able to try the innovative Obamacare alternatives.

Meanwhile, Senate GOP leaders said Tuesday that Republican senators have not decided on a Medicaid expansion solution.

“We are still looking at options,” said Senate Majority Leader Ralph Okerlund, R-Monroe.

Senate and House Republicans have also been talking to Herbert’s office, which has not released a detailed option that the governor prefers.

It was said in the House caucus that, technically, Herbert doesn’t have to go along with any legislative plan – while lawmakers have to fund any Medicaid expansion down the road (the 10 percent state match in fiscal 2017), federal law says it is up to state governors to join up on Obamacare Medicaid expansion or not.

A Herbert spokesperson said the governor would be briefed by Sanpei and Dunnigan Tuesdayevening and would have a comment on their plan at the Wednesday 10 a.m. taping of his monthly KUED Channel 7 press conference.

Medicaid expansion is not over with; stay tuned.