How Far Away Are We From a Deal on Medicaid Expansion?

While no doubt all six members of the “super Medicaid committee” organized by GOP Gov. Gary Herbert hope a compromise can be worked out over Healthy Utah and Utah Cares – the two competing government-sponsored health insurance plans for Utah’s poorest, sickest people — the hard political truth is the 63-member Utah GOP House caucus is still far away from doing what Herbert and state Republican senators want.

And it remains unclear how far Herbert and the senators will retreat from the full 100 percent-to-138 percent coverage those Healthy Utah advocates demand.

UtahPolicy has spoken to a number of House Republicans, inside and outside of leadership, to get a better understanding of Medicaid expansion’s rocky road during the 45-day 2015 general legislative session, which ended March 12 with no resolution on expansion.

They agreed to speak not for attribution – as much work still remains on expansion and the six-member committee will be meeting in private and traveling to Washington, D.C., to confer with Obama administration officials.

What is hoped, one GOP leader told UtahPolicy, is that federal officials will be eager to provide additional expansion waivers to Utah, to better shore up federal financing and/or health care provisions so Utah GOP House members, Herbert, and senators can each move off of their now-solid positions.

Twenty-two Republican-controlled states have so far refused to accept the Medicaid expansion as provided by Obamacare – and further defined by U.S. Supreme Court decisions.

Herbert has gotten, for Utah, more compromises out of federal Health and Human Services Department officials than any other state.

And, this GOP leader said, if the Obama administration wants to get a very red state – Utah – to adopt a version of Medicaid expansion, then what better opportunity than now to make further compromises?

Short of those federal waivers, this Republican sees a very hard row to move the House GOP caucus off of its strong Utah Cares support seen in the just-completed session.

“There is the belief,” this person said, “that we (House GOP leaders) will go back to D.C., learn for ourselves that the feds won’t move (more on waivers or assurances) and then we come back” and convince the House GOP caucus that they must accept Herbert’s Healthy Utah expansion plan.

But the great frustration for House Republicans is that Herbert and GOP senators won’t see the House has compromised – and moved – more off of their original Medicaid expansion stands.

And that any real compromises now must come from the feds and/or Herbert and Senate Republicans.

Some political facts that Herbert and senators apparently don’t want to see, this person said:

— The House Republicans, out of 63 members, had 12 votes in December for Herbert’s Healthy Utah.

After closed caucuses and much discussion during the session – and pressure from Herbert and the Senate – the House caucus still only had 12 votes for Healthy Utah.

“We hadn’t moved an inch” toward Healthy Utah, one Republican insider said.

But the caucus had moved on the Medicaid expansion issue.

In the December closed caucus, there were just short of 38 votes (a House majority) in the caucus for doing nothing on Medicaid expansion this general session.

Other GOP-controlled states had decided the same thing – do nothing on Medicaid expansion and see how the federal government plays it out.

You’ve heard the GOP House members’ arguments before: The feds won’t keep their commitment to the 90-10 percent funding match for several years. The feds, under great pressure to move toward a balanced federal budget, won’t even keep the 70-30 percent match promise several years out of Utah adopting Medicaid expansion.

House Republicans don’t want to start a health care program that the state can’t continue to support – either robbing other state programs for funds and/or cutting back on coverage promised Utah’s poorest, sickest citizens.

In hindsight, GOP House members realize they lost the public relations battle over Herbert’s Healthy Utah.

It was a mistake for new House Speaker Greg Hughes, R-Draper, to refuse to let the Healthy Utah bill, SB164, go to a House committee hearing, several House Republicans said.

Hughes was pounded on in the local media and on radio talk shows. A former boxer, Hughes said late in the session he gladly would be the “point of the spear” in the SB164 debate.

Those close to the speaker told UtahPolicy that Hughes believed, since SB164 had only 12 votes in the 63-member House GOP caucus, that it would be clear to Herbert and Senate Republicans it was dead on arrival.

Thus, it would be a waste of time and energy to go to a hearing and take votes on the bill.

Also, when House Majority Leader Jim Dunnigan, R-Taylorsville, the House point man on Medicaid expansion, started seeing anonymous flyers showing up in his district bashing him on Healthy Utah, Hughes got mad, sources said, and decided just to fight back – as is sometimes his way.

During the session, Hughes told UtahPolicy that out of his campaign funds he paid for a response flyer to go out to Dunnigan’s district.

And not wanting to see other of his House colleagues facing the “political pounding,” as one GOP legislator put it, Hughes just decided not to bring to a committee or floor vote a bill that was clearly already dead.

But that was a political misstep, several House Republicans now admit.

SB164 – Healthy Utah – did get a hearing in the House Business and Labor Standing Committee. It failed badly there.

Then, two days later, in floor debate over the House Republican’s alternative – Utah Cares, or HB446 – Democrats tried to substitute Healthy Utah into the Republican’s bill. That attempt also failed, after some debate. (You can see both those Healthy Utah votes in the above links.)

In essence, then, Healthy Utah had a committee hearing and a vote – where it died. Then it had a floor debate, and a vote, where it died.

House Republicans are frustrated that most Utahns STILL don’t realize that Healthy Utah, Herbert’s plan, had two debates in the House (after Hughes’ had said it wouldn’t be heard) – and was voted down twice.

Lessons were learned, several House Republicans told UtahPolicy.

The question now is, if a compromise can’t be reached by the Committee of Six, how will that stalemate be played out in the public?

Will Herbert call a summer special legislative session even if there is no compromised reached by the Six?

Will 12 votes for Healthy Utah in the GOP House caucus somehow be turned into 38 votes in favor of it?

(Currently, GOP House members UtahPolicy talked to don’t see that happening.)

In his session-ending interview with UtahPolicy, Herbert flatly promised that the Committee of Six would find a compromise by July 31.

But House Republicans UtahPolicy spoke to aren’t so sure.

“We’ve come a long way,” one House GOP leader told UtahPolicy recently, on Medicaid expansion.

It’s time, some GOP representatives believe, for the feds, Herbert and Senate Republicans to give some, also.