Hughes Says Medicaid Solution Could Be Groundbreaking

There will be a special legislative session on Medicaid expansion this fall and most House Republicans will support the final compromise legislation, so predicts House Speaker Greg Hughes.

In an interview with UtahPolicy on Wednesday, Hughes, R-Draper, said work is proceeding well on the plan, a compromise among Republican state executive and legislative leaders – the so-called “Gang of Six.”

GOP House members will make up their own minds, said Hughes. But he believes the new deal will settle major concerns the conservatives have.

Earlier this year House Republicans decided not to go beyond 100 percent of poverty in any Medicaid expansion called for under Obamacare.

Gov. Gary Herbert’s Healthy Utah plan went to 138 percent – thus ensuring a federal match of 90-10 percent.

The House Republican’s Utah Care plan stopped at 100 percent – with Healthy Care supporters wondering how anyone would go with a 70-30 match and give up tens of millions of federal dollars Utahns are already paying in new Affordable Care Act taxes.

But the 138 percent level was a bright line in the sand for House Republicans, with a number of the conservative House members saying Utah just couldn’t afford future budget uncertainty that came with full Medicaid expansion to 138 percent of the federal poverty level.

But Hughes says complicated formulas are now being drafted by the Legislative Fiscal Analyst Office will provide that Utah’s health care industry will pay what would normally be the state’s 10 percent share under Obamacare’s Medicaid expansion.

“It will be complicated,” said Hughes. “But we can do it.”

Furthermore, Utah officials will not ask the administration of Democratic President Barack Obama for permission, or waivers, before acting.

Instead, the Utah Legislature and Herbert will pass the groundbreaking legislation – likely in a special session — and then go to federal officials for any waivers that may be needed.

With Utah’s plan going to 138 percent of poverty, gone will be the biggest waiver ask: Will the feds go above a 70 percent match if a state doesn’t fund above 100 percent.

After all, the assessments put on the health care industry – doctors, hospitals, clinics and such – will cover the state’s 10 percent at the 138 percent level.

The deal, says Hughes, may well become a model for other states – most of them Republican-controlled like Utah – whose leaders don’t want to expand into a new entitlement program with no caps, or end in sight for state tax dollars.

“We will set up a new, separate fund” into which the special health care assessments – call them taxes or fees, it’s all the same as long as the money comes in – said Hughes.

Those assessments will float each year to pay the state’s 10 percent share.

In theory, the state will be held financially harmless.

Except in one area, Hughes said: Children who would normally be covered by Medicaid, but who are not now enrolled – some of the so-called “woodwork” new patients – will be partly covered by the state itself.

Hughes said he doesn’t have a problem with that since poor, sick children should be helped by state government, anyway, under the current CHIP or other programs now running.

Inside the 63-member House GOP caucus “there will be vigorous debate,” predicted Hughes.

“We, as (House Republican leaders) can’t, and wouldn’t, set up a deal, call for the drum beat (of acceptance) and order the caucus to start marching,” said Hughes.

“That won’t happen.”

But he’s confident that after the new deal is explained, and the Legislature’s budget staffers can show representatives draft bills with iron-clad formulas built in to assess the health care industry, then most GOP House members will be satisfied that future Legislatures won’t be strapped with growing, automatic, Medicaid expansion expenses.

Hughes says House Republicans just weren’t going to go along with Herbert’s Healthy Utah plan – which even though a pilot program could well have led to General Fund monies being syphoned off – away from higher education, public education and other Social Service programs.

Hughes spoke to UtahPolicy from summer meetings in Seattle of the National Conference of State Legislatures – where Medicaid expansion was much discussed, and experts provided information.

More than two dozen GOP-controlled states have balked at Obama’s Medicaid expansion – rejecting it outright or stalling implementation.

If Utah is successful in its new plan – and Hughes believes it will be – then other state bosses may follow our lead.

“There is no doubt that our (state) health care industry will see real financial benefits – getting in essence $9 for every $1 they put in through the assessments,” said the speaker.

“I don’t see them, or the health care people in other states, turning that down.”