Governor Gary Herbert and legislative leaders say they are not starting from square one on Medicaid expansion, and they say they will absolutely meet the self-imposed deadline of July 31st to come up with a deal.
Herbert, House Speaker Greg Hughes, (R-Draper), and Senate President Wayne Niederhauser, (R-Sandy), met with Health and Human Services Secretary Sally Burwell in Washington, D.C. on Wednesday. Senator Brian Shiozawa, (R-Cottonwood Heights) and House Majority Leader Jim Dunnigan, (R-Taylorsville) also joined the negotiations as they try to find a solution to cover Utahns in the Medicaid gap.
"This is a generational decision," said Hughes. "This was an important meeting for both sides. We could share what Utah's real concerns are and for us to start the discussion to see how we can overcome them."
Herbert said the two sides are looking to find common ground so that Utah can come up with a plan that lawmakers will pass. The biggest sticking point is still how far the state will go on covering those who need health insurance. House lawmakers would not go beyond 100% of the poverty level while the Obama administration is adamant that coverage must extend up to 138%. That's the only way the state would get an enhanced match on federal tax dollars, which comes in at a 90/10% split with the federal government. Without expanding coverage to the higher poverty level, the state is stuck at the more traditional match of 70/30.
"We're not back at square one, but I don't know where we are," said Herbert. "We have gone over a lot of ground to get to this point."
Technically, that's true. The Senate passed a version of Herbert's "Healthy Utah" plan that covers the Medicaid gap up to 138%. That bill died in a House committee during the 2015 session. Meanwhile, House lawmakers gave their approval to a much more modest plan that only went up to 100% of the poverty level. Those two competing plans led to the impasse on the issue when lawmakers adjourned in March.
But, to characterize the path forward as an easy one would be disingenuous. Numerous legislators say privately that the House is unwilling to move past the 100% poverty threshold.
"We are trying to cover as many people as we can afford," said Herbert. "The idea of what we can do to ensure predictability for our budget is one they're willing to explore with us."
Hughes was more blunt with his assessment.
"We need specificity," he said. "How do you reduce the financial risk? There are big consequences when you get it wrong."
At the end of the 2015 session, Herbert gave his "Super Six" committee until July 31 to come up with a deal that will pass both houses and he can sign into law. He's still confident they'll get there, but there's one big factor that will limit how much work they can do. The Supreme Court is expected to rule on the King v. Burwell case, which challenges the constitutionality of federal subsidies. That decision will come in May or June.
"There is an incredible amount of attention the consequences of that decision to the Affordable Care Act," said Hughes. "It's going to be hard to get too far along without knowing that decision. That decision is going to be pivotal."
The members of the committee say they will continue to meet behind closed doors while they try to come up with a plan that will win approval from both the Utah Legislature and the Obama Administration.