A House panel killed the Healthy Utah Medicaid expansion plan on Wednesday night while advancing an alternative plan of their own.
The public hearing was the culmination of weeks of negotiations between the House and Senate as the upper chamber tried to shake loose the Healthy Utah plan that had been blocked by House leadership. Earlier Wednesday, UtahPolicy asked House Speaker Greg Hughes, R-Draper, who had previously refused to let Healthy Utah be debated in committee whether he could guarantee a full House vote on the bill — something that GOP Gov. Gary Herbert asked for.
“No,” said Hughes. “We’re going to let the process work. If it comes out of committee or doesn’t, that’s up to the (committee) membership.”
After more than 90 minutes of debate, Representatives voted 9-4 against SB164, sponsored by Sen. Brian Shiozawa, R-Cottonwood Heights.
Shiozawa's bill, as has been reported ad nauseam, would extend coverage to an estimated 96,000 Utahns, who fall in the Medicaid coverage gap. It has been whittled down to a 2-year pilot program, funded with $25 million in one-time money, giving the plan a definite end date.
Even with all of those restrictions, House members were clearly squeamish about the long-term implications of Healthy Utah. They spoke multiple times about the difficulty of tearing benefits away from recipients after two years.
Even Shiozawa agreed the long-term sustainability of Healthy Utah is a problem, but it's the best option on the table.
"This is unsustainable," he said. "I didn't vote for Obamacare. That's not what we are talking about tonight. We have been dealt this hand, and this is our response to it. If someone told me I could give you health insurance for two years, or I can give you nothing, I would gladly take the insurance for two years."
Rep. Jon Stanard, R-St. George, said the choice presented to lawmakers is a terrible one.
"In my opinion passing Healthy Utah for two years with the intention of taking it away is immoral. Passing it with the intent to keep it is irresponsible."
In the end, worries about the sustainability of the program carried the day, and Healthy Utah fell on a 9-4 vote.
Immediately after, the same committee advanced HB446, a more modest expansion dubbed "Utah Cares."
The bill, sponsored by Rep. Jim Dunnigan, R-Taylorsville, would offer Medicaid coverage to 20,000 medically frail residents while expanding the primary care network for about 40,000 Utahns. Instead of the 90/10 federal match of funds, it operates under the existing 70/30 match in Medicaid, meaning it's more expensive to the state and brings back fewer federal dollars, at least for the first two years.
"We think this is sustainable," said Dunnigan. "It will cost the state $31 million in its first year. We think that's doable. We won't go into this for two years. This concept plans on providing this forever."
Dunnigan told committee members he remembered the pain for many Utahns when the legislature provided low-income residents a Medicaid vision and dental benefit then took it away.
"In this case it makes sense to go slow and be conservative. There is no deadline to expand Medicaid."
Dunnigan said House leadership had a conference call with Rep. Paul Ryan, R-Wisconsin, who said there's legislation in Congress to repeal the 90/10 federal match of dollars under Medicaid expansion, which is the basis of Healthy Utah.
"He told us as soon as Obama is out of office; that match is gone."
Opponents of Dunnigan's plan said the primary care network is insufficient to cover the needs of many Utahns, so expanding it under his plan is not ideal.
"PCN covers only four prescriptions per month," said Rylee Curtis with the Utah Health Policy Project. "It does not cover specialized care. if someone is diagnosed with cancer, they will not be covered."
Jennifer Davis, who represents many of the doctors who make up the primary care network, was unimpressed with Dunnigan's plan.
"I know you want to do something, but this sets the bar breathtakingly low."
Dunnigan acknowledged his plan was not as expansive as Healthy Utah, but it's the only option many lawmakers are comfortable with.
"Utah Cares does not do everything, but it's a good start. maybe it's a Yugo instead of a Cadillac, but it still drives."
The committee passed the bill on a 9-4 vote.
This now sets up an interesting endgame in the last days of the 2015 session. Will the Senate, who clearly favored Healthy Utah, give the green light to Utah Cares in an effort to not leave the Hill empty handed? Sen. Shiozawa repeatedly said he was hoping to find a way to marry Healthy Utah and Utah Cares in a compromise bill.
Then there's Governor Herbert, who spent nearly two years negotiating with the feds on Healthy Utah. Will he be willing to walk away from that if Utah Cares makes it to his desk?
In an email statement following the committee vote, spokesperson Marty Carpenter said, "Healthy Utah is the best plan for taxpayers and the most practical alternative to Medicaid expansion. There is sharp contrast in terms of cost and coverage between the plans supported by the House committee and the Senate. The governor looks forward to working with the Legislature on a solution that best protects the interests of the Utah taxpayer and provides necessary coverage for Utahns in need.”
That doesn't exactly sound like a man who is ready to give up the fight.