There are a number of legislators and anti-Medicaid expansion advocates who continue to bluster over what exactly Utah voters meant when they cast their votes for Medicaid expansion in 2018.
These legislators insist that S.B. 96 is, in fact, keeping with the will of the people because they’re expanding Medicaid to more than what existed prior to Prop 3. They then further state that they’re being faced with a black and white, either-or choice: either they must leave Prop 3 alone and let it be implemented to the letter, or they have full rein to make changes.
When individuals and organizations like Alliance for a Better Utah say, “leave Prop 3 alone,” and “honor the will of the people,” it seems these anti-expansion legislators and advocates are hearing, “literally never touch the proposition.” To those anti-expansion individuals, the notion of literally never touching Prop 3 seems dangerous for the fiscal future of our state. (Never mind the questions about moving numbers and the reality that S.B. 96 could ultimately cost more). Since these lawmakers assume that the request to “leave Prop 3 alone” is impossible, they believe they have no choice but to tamper with it.
Once the decision to tamper with Prop 3 has been made, it seems there are no shades of grey for these anti-expansion legislators. To them, implementing a hospital tax and adjusting the physician pay rate on the backend is the same as adding caps, work requirements, and waiver requests. In for a penny, in for a pound: therein lies the mistake.
This inability to distinguish between “honor the will of the people,” and “literally never touch Prop 3,” is alarming. “Honor the will of the people,” means honor the intent of the law and make the fewest changes necessary to respect the intention of the voters when they voted for it. Now, I can’t speak for all 53% of Utahns who voted for Medicaid expansion, but I can say that all the Utahns I know who supported Prop 3 wanted full Medicaid expansion with no contingencies for coverage, and they wanted their tax dollars to pay for it. S.B. 96 does not honor that intent.
We’ve heard from legislators that constituents were reaching out to them to ask them to “fix” Medicaid expansion–what do legislators think that means? Does it mean fix the financial problems (which, again, are based on a questionable premise), or does it mean “don’t let this pass without making sure poor people are proving their worth before they’re able to access healthcare?”
If they thought it meant “fix the financial problems,” then H.B. 210 would have been a reasonable bill to support because it does just that. If they thought it meant, “we need to make sure that only the most destitute and ‘deserving’ get help,” then S.B. 96 would make sense. And with the passage of the latter bill, it seems clear what these legislators thought it meant.
(Of course, it should be noted that the portion of this process where we debate about what contingencies should be entailed with Medicaid coverage is closed. The rules of democracy–yes, I sad the “D” word–closed that debate on November 6, 2018 when the people voted for full expansion with no strings attached. But it seems having a supermajority comes with many benefits, including being able to change the very rules of the game.)
And so here we are, with a subpar Medicaid expansion bill and a body of legislators unable to see shades of grey. Maybe the problem wasn’t that the people “didn’t read the bill.” Maybe the problem is that the Legislature can’t read its constituents.