Legislators Still at an Impasse Over Medicaid Expansion

The fate of Medicaid expansion during the 2015 session could end up where it started.

Legislative sources tell UtahPolicy.com that the House has moved as far as they are going to on the issue this year with HB466, also known as Utah Cares. Senate leaders are hoping to find a way to marry Herbert's Healthy Utah plan with Utah Cares, but the feeling is the House is too entrenched on the issue to give much ground.
House Speaker Greg Hughes, R-Draper, said Tuesday that he is still optimistic a compromise on Healthy Utah/Utah Cares can be reached. But there are only two long working days left in the 2015 Legislature.
Hughes said while he is not issuing an ultimatum to Gov. Gary Herbert and the GOP-controlled Utah Senate (which has already passed Herbert’s Healthy Utah bill), “it takes three to tango, and the House has been, and continues to dance. Some others have to dance as well” — meaning Herbert and GOP senators need to compromise on Healthy Utah.
Hughes basically admitted that the House — which has passed Utah Cares, HB446 — continues to hold House Majority Leader Jim Dunnigan’s bill for politically tactical reasons, just as the Senate held Healthy Utah, SB164, for several days after it passed the measure.
Can a compromise be worked out? Or will the 2015 Legislature adjourn doing nothing on Medicaid expansion, the issue left to a special session later this year or the 2016 Legislature?
Seventy working hours can be an eternity in the Utah Legislature. So, of course, some compromise can be reached.
But Hughes seemed to say Tuesday afternoon that House Republicans have moved a “long way” from where the 63-member GOP caucus started out on Medicaid expansion in December — when the caucus met in closed session to discuss major issues for the upcoming 45-day general session.
Back then, said Hughes, a goodly number of House Republicans were good with doing nothing on Medicaid expansion this session.
“But we moved,” said Hughes, and over the last several weeks agreed to “fund the gap” — the hole in Obamacare, with a U.S. Supreme Court decision — several thousand poorer folks between 0-100 percent of the federal poverty line that were not covered under Obamacare.
“So we’ve moved again” to get to Utah Cares, said Hughes.
And all the time, Herbert, and the Senate has been stuck on Healthy Utah — with a few small changes, like making it a two-year pilot program instead of a three-year pilot program.
Will the House move to the next possible compromise — have Healthy Utah for two years, so the state can get the 90 percent federal match — and then adopt Utah Cares after that time?
Hughes didn’t directly answer the question, but hinted that such a move would be more than most of the House Republicans want — since they believe they have been the ones compromising since December, while the governor and Senate have just held one position: Healthy Utah.
Hughes basically admitted that the Republican House has, and is, losing the public relations campaign — as Hughes and GOP House members have been slammed in the traditional media, in social media and on radio talk shows.
But, said Hughes, if nothing is done on Medicaid expansion this session, he and his caucus members will just have to go back to their constituents in town meetings and other venues and make their case that Healthy Utah can’t be financially sustained, is way too costly for taxpayers, and isn’t the right solution.
On Tuesday afternoon, Senate President Wayne Niederhauser, R-Sandy, said there are no negotiations right now on Medicaid expansion. Niederhauser said he met with Hughes for several hours on Monday night, but the issue was only brought up tangentially. 
"We are not negotiating on this," said Niederhauser. "We have other issues we need to address and we are spending most of our time on those other issues."
The specter is looming ever larger that lawmakers will end up with nothing to show on Medicaid expansion at the end of the 45-day session. 
Gov. Gary Herbert is still holding out hope that lawmakers will be able to get something done. After all, two days is a lifetime during a Utah legislative session.
"I hope we're not at the point where people are saying 'my mind is made up, don't confuse me with the facts,'" he said. "This has got to be frustrating for the public, for the people who expect us to come up here and solve problems. It's also frustrating for the Senate and the House who both did a lot of work on this issue."
Some healthcare advocates are saying privately they're hoping Gov. Herbert steps in and ends this tete-a-tete between the House and Senate, even vetoing HB466 if it makes it to his desk. The rationale being Utah Cares would be so ineffective that they would prefer to start over.
But what happens if lawmakers don't make a decision? A special session is a possibility. Or, legislators could work on the issue over the interim.
Sen. Brian Shiozawa, R-Cottonwood Heights, who shepherded Healthy Utah through the Senate, said both sides have spent a lot of time on their plans, and it would be a shame to give that up. But there's a bigger shame.
"What bothers me is extending the timeline," he said. "People will go more months without us taking action on this. I hate to have them suffer in the interim."