Speaker Hughes Suggests a Solution for Medicaid Expansion

Utah House Speaker Greg Hughes, R-Draper, has an idea that could break the political logjam over Medicaid expansion at the Capitol:

Let medical care providers pay what would be the state government’s share of Obamacare’s Medicaid expansion.

The providers – hospitals, doctors, medical clinics and others – would get the federal government’s lion’s share of the cost (which starts at 100 percent and drops to 90 percent and then lower).

And then the providers – who would be getting hundreds of millions of dollars in federal Medicaid match – would then come up with ways to cover the remaining (now state) cost – tentatively figured at $78 million the first year of full expansion.

“I’ll take that deal,” Hughes told his 63-member House GOP caucus on Wednesday.

“Let’s just take the Legislature and the state out of the equation,” said Hughes, who has led the sometimes criticized House’s opposition to GOP Gov. Gary Herbert’s Healthy Utah Medicaid expansion plan.

House Republicans couldn’t agree with senators and Herbert on Medicaid expansion during the 2015 general session that ended in early March.

House Republicans came up with their Fair Utah expansion plan while senators passed Herbert’s Healthy Utah plan.

At a stalemate, nothing passed.

And Herbert formed the “Gang of Six” study committee to solve the impasse – made up of Herbert, Lt. Gov. Spencer Cox, Hughes, Senate President Wayne Niederhauser, R-Sandy, House Majority Leader Jim Dunnigan, R-Taylorsville, and Sen. Brian Shiozawa, R-Cottonwood Heights.

Wednesday Dunnigan and Hughes briefed the House GOP caucus; with Dunnigan saying the Gang of Six has met several times (all meetings have been closed to the public) and “we are making progress.”

Hughes has floated his idea of state government getting out of Medicaid expansion before but in brief conversations with the media and legislators.

He expanded it a bit Wednesday.

“This 'Gang of Six' has been a great experience, honestly,” Hughes said.

He compared Obamacare Medicaid expansion to a poker game. Healthy Utah advocates say for every dollar the state bets, the state gets back $9 (90 percent) in federal funding.

“Who wouldn’t take that deal, hand after hand,” Hughes asked.

But the problem is who knows how long the feds will give 90 percent, or their $9 in chips?

“There is no certainty,” in the feds $9 bet. It could drop to $8, $7 or more, the speaker says.

Then there’s the problem of how many poorer Utahns – who are eligible for Medicaid expansion – will actually sign up.

Other states that are in Medicaid expansion are seeing the “take-up” – new Medicaid clients – grow by much more than estimated.

Some states are seeing many more people signing up as originally believed. And each state has to pick up that 10 percent.

Utah’s share is now estimated to be $78 million after five years. But what if that share doubles?

Hughes answer is to take the state out of the poker game.

“Let the health care providers bet the $1, win and take the whole pot” with the $9 of federal money.

“We are out of the game completely,” said Hughes.

Now, before the 2015 Legislature, some in the Utah health care community – mainly the hospital association – were talking about helping out financially in some manner.

After all, Medicaid expansion would mean hundreds of thousands of new patients who don’t have healthcare insurance now, and so are not getting health care or are going to hospital emergency rooms, getting expensive treatment, and then not paying their bills – they don’t have the money.

There is precedence for this: Years ago Utah had a Medicaid wait list – the state didn’t have the money to take care of all the poor people qualified to get on the rolls.

So, Medicaid-accepting hospitals and nursing homes asked the Legislature to actually put a special per-bed tax on them so more poor/sick/disabled people could be brought into the health care system – the health providers would get new clients (with federal matching dollars), more poor people get health care, the state gets the bed tax, and it was a win, win, win situation.

What Hughes is suggesting would put health care providers at greater financial risk, involve many, many more patients, and require federal waivers and a lot of political movement.

“It is easier to describe this than to do it,” admitted Hughes. “But it is something worth exploring.”