Bob Bernick’s Notebook: House GOP Struggling with Medicaid Expansion

Some Utah House Republicans have a tough decision to make: Just how hard are they going to fight against the GOP Senate and Republican Gov. Gary Herbert’s “Healthy Utah” Medicaid expansion plan?

As UtahPolicy reported Thursday, some Senate leaders are saying they believe there are at least 15 votes for Healthy Utah in their 29-member body.

That’s a majority for Healthy Utah.

It’s as yet unclear if there are 15 votes within the 24-member Senate GOP caucus, or whether it will take a few Democratic votes (there are only five) to pass Sen. Brian Shiozawa’s SB164, which is Herbert’s Healthy Utah.

Tuesday, House Republicans held an open caucus (as is their usual practice) to hear presentations on SB164 – or Healthy Utah.

Thursday House Republicans were supposed to caucus on the conservatives’ preferred plan, “medically frail,” so named because it would cover only the most medically ill, poor Utahns.

But House Republicans decided to close their Thursday caucus to the media and the press, something which is perfectly legal, but not very often done.

After that closed meeting, House Speaker Greg Hughes, R-Draper, and two of his leadership colleagues held a press conference.

And they said they talked about doing nothing (not much support there), about Healthy Utah and about the “medically frail” alternative. They didn’t have 38 (a majority) for any option, and will continue talking.

You can see the various options here.

What does all this tell me?

That the anti-Healthy Utah Republicans in the House, and there’s many of them, are beginning to realize just how big this mountain is before them – the mountain being Healthy Utah, the Utah Hospital Association, which says it will in essence give the state $25 million a year if Healthy Utah is adopted, various downtown businessmen/groups that back Healthy Utah, and so on.

Perhaps realizing they were losing the public relations campaign – there are several groups running print and radio ads in favor of Healthy Utah – the “medically frail” backers are now trying to call their plan Utah Care.

Yes, the Utah Care plan does save the state tens of millions of dollars over the next five years.

But it also leaves uncovered maybe 100,000 Utahns or more.

And state government is rolling in money. And I mean rolling in it.

At the start of the 2015 Legislature state economists predicted $638 million more in one-time cash surpluses and increases in ongoing tax collections for the current fiscal year and next.

Then Wednesday updated revenue forecasts give the state $101 million more – or a total of $739 million that can be allocated between this year and next.

This is the biggest pot of new money the Utah Legislature has seen in recent times – probably in state history.

So, how do House conservatives tell the citizenry that they won’t fund Healthy Utah – and try to provide private health care coverage to most ill and poor among us — because it is too expensive, when, in reality, the state has more extra cash than ever before?

There are some pretty good spin misters in the Utah House.

But with the governor and Senate standing against them, I don’t see any kind of spin that’s going to work in this case.

So, do most House Republicans just give up and go along with Healthy Utah – should it get out of the Senate – or do they try to stand their Utah Care ground and refuse to cover around 100,000 poor Utahns – many of them families where one parent is working, although at a very low-paying job.

The really big stick Herbert has is that Healthy Utah will, over the next five years, recapture $3.2 billion – that is billion with a “b” – in federal Obamacare taxes that Utahns WILL HAVE ALREADY PAID in federal taxes.

While Utah Care over the next five years, while costing Utah taxpayers less in state taxes, will only recap around $330 million in federal taxes Utahns have paid to the federal government.

So, why should the state – with record tax surpluses looming – decide to provide health insurance coverage for fewer sick, poor Utahns with Utah Care, only to give up billions of federal dollars when they can pay around $50 million more state taxes to cover 100,000 more needy Utahns under Healthy Utah?

Sure, the House conservatives can argue political philosophy – Utah needs to become more independent of the federal government; Obamacare is socialism and we shouldn’t have anything to do with it; the federal dollars coming back to Utah is not real money, but only borrowed from our children and grandchildren via deficit spending; and so on and so on.

But the fiscal, public relations and political reality is that House Republicans are in a hole with Utah Care.

How do they get out of it without being covered in mud or maybe something a lot worse?

— Decide to do nothing and put this whole mess off for another year – while hundreds of thousands of poorer Utahns suffer medically and more federal matching dollars are lost. (Hughes doesn’t see that happening.)

— Try to find some “compromise” between Healthy Utah and Utah Care – while still giving up hundreds of millions of federal tax dollars with a plan that may not be accepted by the Obama administration, and wouldn’t cover as many poorer Utahns as Healthy Utah.

— Adopt Healthy Utah and eat some very bitter political crow, and then worry about big state-tax matches down the road if the federal government starts cutting back on Medicaid expansion fiscal promises.

Healthy Utah right now is a political slippery pig for House conservatives to handle. Or will it end up handling them?