Lawmakers Heading Toward Showdown Over Healthy Utah

The Utah Senate advanced a stripped down version of Gov. Gary Herbert’s Healthy Utah Plan while House leadership made it clear the issue is DOA if it gets to them.

The Utah Senate moved ahead with an altered version of SB 164 that implements Healthy Utah for just two years instead of the original three. The revised plan is funded with one-time money rather than ongoing funds, a fiscal salve for frayed legislative nerves.

Sen. Brian Shiozawa, R-Cottonwood Heights, sponsor of the bill, says while his colleagues may find the Medicaid expansion situation untenable, lawmakers have to do something.

“Most Utah citizens want something done and they favor Healthy Utah,” he said. “We serve the entire state of Utah. SB 164 is not perfect, but it’s the best solution to problem we have to address.”

During floor debate, there was an attempt by Senate Democrats to replace Healthy Utah with full Medicaid expansion. Republican Senators easily beat back that gambit.

Senators will have to consider Healthy Utah one more time before potentially sending it to the House, but that may be a vain effort as House leadership made it clear Tuesday afternoon that they will not vote for Healthy Utah this session. That opens up the very real possibility that there may be no action on this issue in the 2015 session.

House Speaker Greg Hughes, R-Draper, told media members that “the votes are not there” for Healthy Utah. What he really means is there are not 38 Republican votes (a majority in the House) in the 63-member GOP caucus. There are 12 Democrats in the House who would likely support Healthy Utah, meaning Republicans would only have to come up with 26 votes in their caucus instead of 38. But, House leadership will not let something as important as Medicaid expansion take place without having a majority of House Republicans on board.

This after Herbert told a press briefing that most Utahns want Healthy Utah. This now sets up a standoff between the Republican governor and GOP-controlled Senate on one side and the Republican-controlled House on the other.

House leaders also say they don’t have enough support in their caucus for the so-called “frail Utah” alternative, which was favored by a legislative task force in December.

This is the first time that GOP House leaders said they would be willing to just adjourn on March 12 without taking any action on Medicaid expansion.

Opponents of Healthy Utah in both the House and Senate worry about the cost of Medicaid expansion to the state, and how that will add to the ballooning national debt.

Hughes and House Majority Leader James Dunnigan, R-Taylorsville, the House’s expert on Medicaid expansion, said there always seems to be some fudging by federal officials on Obamacare.

For example, Herbert told reporters Tuesday that there seems to be some movement in Washington, D.C. in favor of the feds placing some caps on Medicaid expansion – so state lawmakers and governors can have more certainty on how much Medicaid expansion will cost them in years to come.

Upon hearing this, Hughes and Dunnigan said it’s just another example of how Utah GOP legislators can’t count on Washington to be straight with them on what Healthy Utah will ultimately cost Utah taxpayers.

Herbert’s original Healthy Utah was a three-year pilot program. To try to accommodate some GOP lawmakers’ concerns, he has agreed to shorten that to just a two-year program.

Sen. Wayne Harper, R-Taylorsville, said he’s hesitant about Healthy Utah because there’s really no such thing as a “pilot program.”

“Pilot programs rarely, if ever, disappear,” he said. “If we agree to this, we are acquiescing to more federal control.”

Hughes is also not sold on the move to scale back Healthy Utah. He sees the change as just another example of how the plan is too wishy-washy, with no defined costs or accountability.

“Lawmakers can’t promise healthcare benefits to some of the lower income Utahns only to find the state can’t afford it down the road,” he said.

When vision and dental care for former Medicaid recipients had to be cut back during the Great Recession, poor Utahns facing loss of those benefits turned Legislative budget hearings into “human carnage,” said Hughes.

Meanwhile, several Senate sources said there is some belief that not acting on Healthy Utah during the 2015 session could result in federal officials giving in on even more important issues. For instance, some conservative states are refusing to go along with Medicaid expansion as more and more “flexibility” waivers are granted by the feds.

Hughes said there are “people out there” – he didn’t name them – who know the Healthy Utah financial numbers don’t add up, but they still want Healthy Utah to be adopted, perhaps hoping that future Legislatures will fund it rather than risk the political backlash of taking away from Utah’s poorer, sicker citizens their subsidized health care insurance.

On the Senate side, lawmakers feel squarely between the rock and the proverbial hard place. Sen. Todd Weiler, R-Woods Cross, put words to the unease many in that body are feeling.

“I wish Congress hadn’t passed the Affordable Care Act,” said Weiler. “I wish the Supreme Court had invalidated the law. I wish Mitt Romney had been elected president. None of that happened. And, while I wish the ACA was not the law, given the circumstances, Healthy Utah is the best option we have today.”

Here is a link to the costs and coverage of several proposals now being discussed, including Healthy Utah and the so-called “medically frail” option that some GOP lawmakers are supporting.