Lawmakers Wary of Medicaid Expansion

Dan Liljenquist may have been out of the Utah Senate for two years, but lawmakers still want his advice – or perhaps warning is a better word – about Medicaid expansion.


Liljenquist, a Republican from Davis County, resigned his seat in 2011 in preparation for a 2012 challenge to U.S. Sen. Orrin Hatch, R-Utah.

Liljenquist – who had made a name for himself in the short time he was in the state Senate for tackling complicated problems – forced Hatch into a GOP primary. But then lost badly to the veteran Hatch.

Liljenquist has been writing a column for the Deseret News for several years. And at times he’s detailed his Medicaid expansion concerns there.

You can go the DN web site and search for “Liljenquist” and “Medicaid” for some of those columns.

Wednesday, Liljenquist spent around 15 minutes in the open House GOP caucus discussing his concerns; then left for an hour-long presentation in the closed Senate GOP caucus.

Some of the open House highlights:

— State legislators shouldn’t rush into anything, Liljenquist said. (This is a bit of an overstatement since Utah is one of only a handful of states that has made NO decision on Medicaid expansion, and legislators have set up a special task force to look into the Obamacare mandate.0

— Utah’s state government Medicaid costs could well be four times more expensive than some now believe.

GOP Gov. Gary Herbert seeks federal waivers in his Medicaid expansion plan, called “Healthy Utah.”

Later this summer, Herbert had planned to call a special legislative session to get approval of Healthy Utah.

But led by House Speaker Becky Lockhart, R-Provo, House Republicans want to put off any Medicaid expansion decision until the January 2015 general session – much to the displeasure of Herbert.

GOP senators are also hesitant to go into a summer/fall special session on Healthy Utah.

Through side comments in the House GOP caucus, it is clearly they believe Liljenquist’s concerns could well push Senate GOP colleagues to join the “no SS for Medicaid Now” movement.

— Medicaid expansion is complicated. And Liljenquist’s concerns, in turn, are complicate.

But put simply, Liljenquist worries that the number of new Medicaid subscribers – now estimated at around 57,000 for those between 100 percent and 138 percent above the federal poverty line – could balloon to over 400,000.

And thus drive the costs to the state – at the 10 percent Medicaid match requirement in three years time – much higher than now anticipated.

It’s those “down the road” Medicaid expansion costs to the state that have Lockhart and others balking at Herbert’s Healthy Utah.

The governor counters that Healthy Utah – if given the required federal waivers – is just a three-year trial program.

And Utah could dump it in favor of some other solution when the time comes, says the governor.

As part of his plan, the feds would give Utah $258 million in a block grant. And the state would set up its own (Healthy Utah?) Medicaid expansion program.

Like all of Obamacare, the feds would pay 100 percent of Medicaid expansion for the first three years, and pay 90 percent thereafter, with each state kicking in a 10 percent match.

Liljenquist said he’s seen no detailed study about his main concern – that employers who provide health care now for their employees who are making between 100 percent and 138 percent above the federal poverty level will decide to just end their employee health care.

And all of those folks will be “crowded out” of their current private health care and be placed on a subsidized Medicaid plan.

Even if Utah is only paying 10 percent of the health care insurance costs for those estimated 400,000 Utahns – who were on private insurance, but who went on to the Medicaid rolls – it could have a great financial impact, said Liljenquist.

Liljenquist, who while in the Utah Senate worked to “cap” Medicaid expansion costs, said that Utah’s share of Medicaid expansion could reach hundreds of millions of dollars just a few years into the state’s paying its 10 percent Medicaid expansion match.

House Majority Leader Brad Dee, R-Washington Terrace, said that Republican legislative leaders have not been sitting and doing nothing as Herbert develops his Healthy Utah plan and seeks federal waivers.

“We are working on ideas to mitigate or eliminate growth in these (state matching Medicaid) funds.”

As Liljenquist works with the Senate, said Dee, the Legislature is moving forward with its Medicaid task force – which is meeting this summer.

Rep. Jim Dunnigan, R-Taylorsville, an insurance agent, has been assigned by Lockhart to delve into the Medicaid expansion issue.

In the 2014 Legislature, Dunnigan and Rep. Dean Sanpei, R-Provo, came up with an alternative that was mocked by GOP senators and Herbert.

It would reject the feds’ $258 million annually for expansion and instead spend $38 million of state tax dollars on a watered-down plan that would help only the most needy and poor with health care.

Dunnigan agrees with Liljenquist that local business owners with more than 50 employees (fewer employees and owners are exempt under Medicaid expansion) will dump their private insurance plans and force lower-income workers on to Medicaid expansion.

Doing that doesn’t come without penalties, said Dunnigan. Businesses would be assessed fines under Obamacare. But it may still be cheaper for firms to dump their employee health insurance, he added.