‘Utah Cares’ Leaves $2.7 Billion in Federal Funds on the Table

For the second time in 24 hours Utah House Democrats, with the votes of a dozen Republicans, failed to get the House to consider GOP Gov. Gary Herbert’s Healthy Utah Medicaid expansion program.

Instead, as expected, by a large majority of Republican House members advanced to the Senate HB446, a scaled down health insurance program for poorer Utahns.

Senate GOP leaders – after the Senate had previously passed Healthy Utah – told reporters Friday that they expect the two plans to be merged – the next two years being Healthy Utah, to be followed by implementation of HB446, or what House Republicans call Utah Cares.

Meanwhile, UtahPolicy asked Herbert’s office to determine how much federal money – which would have come to Utah under Healthy Utah – would be lost when Utah Cares kicks in after two years.

Herbert aides report a total of $2.7 billion will be lost over six years, or from fiscal 2016 to fiscal 2021 – a time frame often used in comparisons in the Medicaid expansion debate.

FY16 FY17 FY18 FY19 FY20 FY21 6 Year Total
$300,771,200 $424,486,300 $448,886,300 $483,186,300 $514,586,300 $552,886,300 $2,724,802,700

Herbert has repeatedly noted that these are Obamacare taxes paid by Utahns, and that by not adopting Healthy Utah in full Utahns will lose these monies, which in theory could go to other states, or could just not be spent at all by the federal government – but could have come to Utah with Healthy Utah.

There are still disagreements over how much Healthy Utah and Utah Cares will cost, how many people each plan will cover, and perhaps critical to Utah Cares, whether the Obama administration will have to give waivers to the scaled-down plan.

Herbert communication director Marty Carpenter told UtahPolicy that both Healthy Utah and Utah Cares will need waivers – but that HHS bosses personally told Herbert they will agree to Healthy Utah’s.

Federal officials have not seen Utah Cares – it was just introduced a few days ago.

And Carpenter said it is unclear if the feds will even let Utah adopt Utah Cares.

House Majority Leader Jim Dunnigan, R-Taylorsville, the sponsor of Utah Cares, acknowledges Utah Cares needs federal waivers – even though it is an extension of current Medicaid rules/payments and an expansion of the current federal medical subsidy program Primary Care Network.

So, for now, the debate moves over to the Senate, where Senate President Wayne Niederhauser, R-Sandy, said it makes no sense to him to adopt either Utah Cares, or combine Utah Cares with Healthy Utah were Utah Cares starts immediately and Healthy Utah kicks in later.

That would cost the state tens of millions of dollars and not provide the higher care and coverage of Healthy Utah for two years, said Niederhauser.

So the compromise seems to be this: Adopt Healthy Utah for two years, and work to get federal waivers for two years and then go with Utah Cares, with extended PCN coverage for poor Utahns who earn between 100 percent and 138 percent of the federal poverty level.

Still, says Herbert, that will leave, over six years, $2.7 billion in federal money that would have come to Utah by just adopting Healthy Utah for all six years on the table – lost to the Beehive State.

Here are the votes in the House on Friday in favor of substituting Healthy Utah into HB446 – or an indication of the governor’s plan’s support in the 75-member House.

You can see that 10 Republicans joined with the 12 Democrats in the failed attempt to adopt Healthy Utah in the House – 22-52.

And here is the final vote on HB446 – Utah Cares – as it passed the House and goes to the Senate for consideration – 56-18.

A few Republicans who voted in favor of Healthy Utah, rather than get nothing, switched and voted in favor of HB446, and a few conservative Republicans who don’t want any Medicaid expansion voted against HB446 and against the Healthy Utah substitute.