Republican leaders pitch ‘fallback’ plan for full Medicaid expansion if they can’t get federal waivers


Utah Capitol 03


Republican leaders in the legislature have landed on a “fallback” plan to fully expand Medicaid if their efforts to enact a more limited program falter.

After a closed two-hour meeting, the House Republican caucus decided to make some changes to SB96 and vote it through Friday morning.

Whether the Senate wants to approve the amended bill sometime Friday, and the bill lands on Herbert’s desk Friday night ready for his signature remains to be seen. House Republican leaders plan to pitch the new bill to House Democrats early Friday morning, but they’re not counting on any Democratic votes to pass the bill.

House leaders pitched the full expansion as the failsave position to secure the votes of reluctant House Republicans who were not fully on board with the scaled-back Medicaid expansion Several of those legislators were in districts that voted in favor of Prop. 3, which fully expanded Medicaid without caps or work requirements

House Speaker Brad Wilson, R-Kaysville, told reporters Thursday afternoon that SB96 will have several changes before it gets to that point, although he wouldn’t give specifics on some aspects of the plan.

All Utahns up to 138 percent of the federal poverty line will be covered with health insurance – just as Prop. 3 intended.

The plan will become active by April 1, just as Prop. 3 would have.

If the state gets required waivers from the Trump administration, Utah’s plan will be bifurcated. Those earning up to 100 percent of poverty, approximately 90,000 Utahns, will be included in the expanded Medicaid program. Those between 101 and 138 percent, estimated to be about 58,000 low-income Utahns, will be covered by the existing private insurance “exchange,” which will be inexpensive ($57 a month for a family of four) and give those folks better options for medical care than expanded Medicaid would.

Lawmakers are hinging the entire SB96 plan on securing two waivers from the Trump administration. The first allows the state to expand Medicaid coverage to the population earning up to 100 percent of poverty at a 70/30 percent cost split with the federal government. The second waiver allows the state to impose work requirements and caps at a 9010 cost split. Lawmakers insist they have been given indications by the Trump administration that those waivers are soon forthcoming.

If, for some reason, GOP leaders don’t anticipate, Utah fails to get the needed waivers, the fallback plan will kick in which will fully expand Medicaid to the population earning up to 138-percent of poverty, just as Prop. 3 intended.

But. legislative leaders say, in no case will folks who will get insurance April above 100 percent be kicked off insurance. All 160,000 low-income people eligible for health coverage under Prop. 3 will get insurance and continue to get insurance one way or the other.

GOP leaders, especially in the House, are frustrated that what they say is inaccurate information is getting out to Utahns, especially through TV ads now running paid for by backers of Prop 3.

Following a closed caucus meeting on Thursday afternoon, House leaders are confident they will have a two-thirds majority in the House to pass SB69 – maybe even more than the 50 votes needed. And when the bill goes back to the Senate for final approval, there will be two-thirds majorities there, as well.

That will allow SB96 to become law upon GOP Gov. Gary Herbert’s signature – and the governor told reporters Thursday afternoon he will sign it.

In fact, Herbert believes Utah’s Medicaid expansion law – with the federal waivers – will be model legislation for other states.

“I believe this program as it’s being developed is going to be cutting edge,” said Herbert. “It will give us more flexibility.”

And, Herbert said, instead of busting Utah’s budget in a few years, the SB96 Medicaid expansion can actually show savings over $100 million – all while bringing more than $800 million more into the state’s economy through huge federal Medicaid grants and spending.

“We have to do this in a way so we can give health insurance today and afford it tomorrow. We’re creating legislation that will do it in a fiscally sustainable way,” he said.

As of Thursday night, it is unclear if the Legislature will ask Utah hospitals to pay more in special Medicaid taxes – Wilson said maybe, Herbert seemed to believe that wouldn’t be needed.

But in any case, Utah hospitals and doctors should see more income, simply because more Utahns will be covered by insurance of one kind or another, and so low-income folks’ medical bills now not being paid will be picked up in these new, expanded insurance programs.