Revamped Medicaid bill will implement Prop. 3 in July 2020 if the state can’t get needed waivers

The revamped Medicaid expansion bill passed by the House on Friday will implement Prop. 3, as passed by voters, if the state does NOT get expected waivers from the Trump administration.

GOP legislative leaders and Republican Gov. Gary Herbert believe, when all is said and done, Utah voters will be pleased with how they changed Prop. 3 this session.

And the 160,000 low-income Utahns who would have gotten Medicaid coverage under Prop. 3 will be pleased, even delighted

But that remains to be seen.

Here are some of the highlights of what will happen – the so-called “fallback” provision that will be incorporated in SB96 Friday, approved by the Senate early next week and signed into law by Herbert – should Utah NOT get federal waivers:

  • Utah hospitals will be assessed $15 million if the small sales tax that comes with Prop. 3 fails to cover all the anticipated Medicaid expansion costs – which is generally assumed to be the case.
  • The coverage on some Medicaid recipients will be reduced just a bit – “it will not be as rich,” one leader said. Overall, that impact won’t be seen of felt by most of the households.
  • Other state Health and Human Services budgets will be trimmed up to 10 percent to help pay expanded Medicaid costs.

But the above WILL NOT happen unless Trump officials refuse to give Utah at least two waivers. The first allows Medicaid expansion up to 100 percent at 70-30 percent federal to state financial match. The second changes the federal match to be 90-10 percent – which will result in more than $800 million in federal dollars flowing into Utah’s health care industries.

The “fallback” position is similar to Rep. Ray Ward’s HB210, leaders said.

So, to sum up, starting April 1 low-income folks who are up to 100 percent of the federal poverty will get Medicaid coverage.

Those from 101 percent to 138 percent will get “premium” exchange coverage for a subsidized rate, private health insurance from HealthSelect, as low as $57 a month for a family of four.


During Friday’s debate, House Minority Leader Brian King, D-Salt Lake City, said he would not introduce his substitute bill, which would have raised taxes on those who take capital gains – “the better off among use.”

He said later he would ask leave of the House to open a bill file and asked that raising the capital gains tax on some of the wealthy to be debated this session.

Of course, Republicans in the House don’t have to let him introduce a bill (the time where lawmakers can do that on their own has passed). And even if they let him introduce a capital gains tax hike bill, they don’t have to let it out of the Rules Committee, they don’t have to let it be debated in a committee or on the floor, and they certainly don’t have to pass it.

Democrats said time and again that the will of the voters on Prop. 3 should be respected – that the measure had a majority in 44 of the 75 House districts (38 is a majority of districts).

And a few Republicans said Prop. 3 did, indeed, pass in their districts. But as representatives of the people, they needed to be responsible for the budget, not just the 150,000 people who would have gone on to Medicaid in Prop. 3. They contend since all of those 150,000 people will be covered one way or another – and all of them will be under Medicaid by July 2020 should the Trump administration refuse to give Utah the expected waivers – then Utah is getting a better deal under SB96, as amended.

“The elephant in the room is that Prop 3 passed; it is what citizens wanted,” said Rep. Marie Poulson, D-Cottonwood Heights. And SB96 “is not in the spirit of Prop 3.”

Voters are engaged, and informed, she said. They knew what they were doing in passing Prop. 3.

There is a $1.3 billion tax surplus this year, and Republicans are talking about giving a $225 million tax cut this year. “We can afford this (full Medicaid expansion),” she said.

“This issue affects lives. We can save lives” with full Medicaid expansion, and “alleviate suffering.”


House leaders emphasized that while technically they must amend SB96, in effect senators, representatives and Gov. Gary Herbert have been working behind the scenes daily to reach this compromise.

From a political standpoint, there still may be some work to do with the public – as pro-Prop. 3 forces have been effective with a critical TV ad now running and criticism of the Republicans who run state government over Medicaid expansion. Prop. 3 was approved by 53 percent of voters laws November.

“But as time passes,” said House Speaker Brad Wilson, R-Kaysville, “we think Utahns and those on Medicaid” will be pleased with how the Republicans modified Prop. 3 to both save taxpayers dollars and cover all of the 160,000 low-income Utahns.

Time will tell with that, however.

The Utah Senate will vote on the changes made in the House on Monday morning.

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