House Republicans aiming to pass the limited Medicaid expansion bill by Friday, but changes may delay that timeline

Utah Capitol 17


House Republicans are rolling toward finishing up Medicaid expansion for this session.

The plan, if it works, is to hold a closed noon Thursday caucus where leaders will listen to members’ concerns and count heads.

The goal, is told, is to find compromises, if needed, to get to two-thirds – 50 – votes within the 59-member caucus.

The Republicans likely won’t get, and don’t want to count on, Democratic votes in the 75-member House.

SB96 has already passed the Senate with two-thirds vote.

Republicans in the House tell that leadership is pushing hard to get to that 2/3 total, particularly focusing their lobbying efforts on newly-elected members of the caucus. House leaders insist they’re not telling members how to vote.

If any demanded changes from the House GOP caucus are not too technical and far-reaching, then amendments can be made over night allowing for a floor vote Friday.

Otherwise, the effort may flow into next week – something leaders don’t want, but will accept if that is the will of their caucus.

Should House Republicans fall below 50 votes – then that will allow supporters of Prop. 3, full Medicaid expansion, to run a referendum aimed at overthrowing what lawmakers do. Pro-Prop. 3 groups are champing at the bit to file that action and get it on the ballot if the House cannot meet that threshold. Placing a referendum on the ballot is similar to the process for voter-backed initiatives. Backers must get signatures equal to 10% of the vote in the last presidential election. They must also meet the 10% threshold in 15 of the state’s 29 counties.  

“I’d welcome that,” said one House majority leader, who actually started bouncing on his feet he got so excited at the idea of such a public fight.

Many legislative Republicans are angry over the pro-Prop 3 TV ads now running – claiming they are making the legislative Republican look mean and uncaring to Utah’s poor.

This leader said already some big financial donors are being lined up to run an anti-Prop 3 public campaign if a referendum comes.

In addition, House and Senate GOP lawmakers have lists of loyal Republican voters in their districts – numbering between 15,000 and 17,000, this person said, a good base to start an anti-referendum effort.

“We can win that fight” – at the grassroots – this leader believes.

In what normally would be considered a quite strange occurrence, Wednesday night Rep. James Dunnigan, R-Taylorsville, the House sponsor of SB96, voted against his own bill.

That, he told on Thursday morning, is because some changes need to be made to it. If those changes don’t come, said Dunnigan, he will vote against his own sponsored bill, SB96, when it comes up for final passage.

Thursday, a clearly frustrated Dunnigan – who has worked on Medicaid expansion since 2014 – said the continuing claim by pro-Prop 3 advocates that SB96 would leave 50,000 or 60,000 low-income Utahns without health coverage “is just a lie!”

Those folks today can get private health insurance under “exchanges” provided under the Affordable Care Act, or Obamacare.

Even under SB96, says Dunnigan, individuals and families who make 101 percent to 138 percent of the federal poverty level, or $25,100 to $34,600 a year for a family of four, can get “platinum” health insurance (outside of the GOP Legislature’s Medicaid expansion) for $57 a month, with $0 deductible and $10 co-pay to visit a doctor of their choice under SelectHealth, a very good private health insurer.

That is not throwing poor people off of Medicaid expansion, says Dunnigan, but just the opposite – taking very good care of them.

To see TV commercials that say 60,000 poor Utahns would be thrown off of health insurance if SB96 is passed is maddening, he said.

All this would come out in a public, well funding debate should a referendum against SB96 take place later this year, GOP leaders say.

But, of course, that is a last resort.

Much better to find 50 or more votes in the caucus, and get there by changing SB96 to bring those members along, instead of twisting arms and forcing votes on a version of SB96 that otherwise would fall short of two-thirds.

Further complicating matters, the Utah Supreme Court recently agreed to hear a legal challenge to the 2/3 threshold to block a citizen referendum to repeal an action of the legislature. The suit was brought by opponents of the legislative compromise over Prop. 2, which replaced the voter-approved medical marijuana bill. Groups seeking to file a referendum to undo that action were rebuffed by the state because H.B. 3001 passed a special session with the required 2/3 majority in both houses. If the high court rules the referendum law is unconstitutional, all bets are off.

On Wednesday evening, a House committee stripped out a provision in the bill that rolled back any Medicaid expansion if the state is unsuccessful in their effort to get a waiver from the Trump administration allowing Utah to expand Medicaid to fewer people than mandated by the Affordable Care Act but still giving the state a much more favorable financial split with the federal government.

If those expected waivers don’t materialize (no state has ever been granted such a waiver before), SB96 essentially creates a new, ongoing program that is currently funded with one-time money. Lawmakers have allocated approximately $71 million in one-time money to act as a “bridge” to fund the expansion until the waivers show up. No waivers mean the state will be on the hook for the approximately 90,000 low-income Utahns who will be covered by the expansion and lawmakers will have to find the funds going forward.

“It’s not an ideal situation,” said Sen. Jerry Stevenson, R-Layton, who is the Senate chair of the Executive Appropriations Committee. “If it comes to that, we’ll have to move some money around, but I’m convinced we’ll get those waivers.”

But, if the worst-case scenario does come to fruition, he says it’s going to be painful budget wise. “We’ll have to find which bull gets gored,” he said.

In any case, one way or another, GOP lawmakers want a Medicaid expansion bill they like on the governor’s desk by Friday or early next week.

Then it will be on to other fights this 45-day legislative session.