Will Lawmakers Consider Medicaid Expansion Before 2015?

Gov. Gary Herbert could be headed for a showdown with legislative GOP leaders over whether they will pass his Healthy Utah Medicaid expansion in a fall special session.

Hey, he could be headed for a showdown on whether the Republican-controlled Legislature passes his Healthy Utah at all.

There was multiple activities on the topic Wednesday.

First, in a morning taping of his monthly KUED Channel 7 news conference, Herbert said that Health and Human Services Secretary Sylvia Mathews Burwell and he are “this close” (maybe an inch) to reaching final agreement on Herbert’s Healthy Utah plan – an alternative to Obamacare’s Medicaid expansion.

Herbert’s plan is multifaceted, but the gist is that Utah would use $250 million in expansion money to set up its own, private insurance, health care program for around 55,000 poor adults who make 0-138 percent of the federal poverty income level.

Herbert and Burwell have been dancing around how one defines “work requirement.”

Herbert is now calling it a “work effort,” with the clear impression that able-bodied poor Utahns who apply for the government-aided health insurance would look for a job, and take that job, if one can be found.

But state Rep. Jim Dunnigan, R-Taylorsville, an insurance executive who went with Herbert when he met in person with Burwell in Washington, D.C., last week, gave a different kind of “update” to the House GOP open caucus Wednesday afternoon.

Dunnigan at first said IF lawmakers decided to participate in Medicaid expansion under Obamacare – and take the multi-millions from the federal government – then Herbert’s Healthy Utah plan “is a good proposal.”

That’s the first time I can remember a House leader on health care say that about Healthy Utah.

But then word-play comes up.

Herbert told reporters that folks shouldn’t get hung up on whether it is a work requirement or a work effort.

In fact, he said, in treating the “whole person,” Healthy Utah will be “married” into the state’s Workforce Services job hunting program.

And why would any able-bodied person, who can work, and who asks the government for health care, not want to work? Not make their economic and medical issues better at the same time?

The bottom line, says Dunnigan, is that Burwell – she said she spoke to Obama personally about Utah’s Healthy Utah proposal – says that Medicaid is an economic test program: If you are poor, you qualify.

Not a job-seeking program.

Thus, as Burwell sees it, Obamacare’s Medicaid expansion has no job test component – and thus the federal government can’t give Utah’s Healthy Utah a waiver on that politically critical issue.

The language is still being worked on, says Herbert, who added that within two weeks he should have final “agreements” with HHS officials.

He then can present the full Healthy Utah to lawmakers – and a public debate, and education, over the issues can take place.

But in a UtahPolicy interview before the House GOP caucus started, House Speaker Becky Lockhart, R-Provo, reiterated that she has not seen Healthy Utah, most of her members have not seen it, and in any case committing Utah to a long-term, expensive new government program shouldn’t take place in a one or two day special session this fall.

Dunnigan expanded on those concerns.

If Herbert gets Healthy Utah wrapped up by the end of September, then lawmakers would have to meet in either October or November special session.

(December is reserved for lawmakers and their staff preparing for January’s 45-day general session.)

One couldn’t fairly be briefed, learn about, and vote on Healthy Utah in a one-day special session. Lockhart said it would probably take a week of public hearings and debate.

“And if you haven’t noticed, you have October campaigns to run,” said Dunnigan to his fellow House members.

That leaves November, when you would have in effect a lame duck Legislature making such an important decision, he added.

Lockhart told UtahPolicy that at least once since she came to the House in 1998, a governor has called a special session only to see the Legislature refuse to do what he wanted. And there has been many more such wasted special sessions in Utah’s history, she said.

Under the Utah Constitution, only the governor can call a special session, and only the governor can set the agenda. However, historically governors have not called lawmakers into special session unless there is an understanding they will pass what he wants – or most of what he wants.

Once called into session, lawmakers must adjourn after 30 days, although most modern special sessions last an afternoon or a day.

But in this case, if lawmakers were to amend Healthy Utah, then it would have to go back to HHS to see if federal officials will check off on such changes.

Anyway, said Lockhart, it is wrong to believe there are only a few choices: Healthy Utah, accept Obamacare Medicaid expansion, or do nothing – in effect reject Medicaid expansion.

“There are other proposals out there,” said Lockhart, who is retiring at the end of this year and would have to lead a special session, but will be gone for the 2015 Legislature.

You can see a summary of plans discussed in the 2014 Legislature here.

For example, a special legislative health care task force is still meeting, and could recommend changes to Healthy Utah or some completely other plan to provide health insurance for the lower-income, she said.

UtahPolicy asked Herbert directly if a Healthy Utah’s “job effort” means that if an able-bodied person refused to take a job, he would be kicked off of Healthy Utah and have no medical insurance.

Herbert said there are such provisions under current federal programs now, like TANF – a program to help mothers and children.

But Dunnigan seemed to answer the question later in the House GOP caucus.

He said he told Burwell that Utahns general feeling is that persons who take government aid should help themselves, and take a job if offered.

“Government helps those who help themselves,” he said.

“We believe government should help people,” said Burwell – in effect saying no Healthy Utah plan would be allowed to kick an able-bodied person off of the state’s low-income health insurance if they refused to work at all.

That issue – keeping a non-working adult on Healthy Utah – could be a showdown inside the GOP-controlled Legislature.