Bob Bernick’s Notebook: Another Chapter in Medicaid Expansion

Utah House Speaker Greg Hughes seemed adamant: Those Utah health care industry segments benefiting from new patients – and thus new patients fees – from Medicaid expansion should pay the state’s share of expanding the low-income health coverage program.

What’s the adage: Be careful what you ask for, you just might get it?

The “Gang of Six” came out with its Medicaid expansion plan this week.

And Hughes got what he wants.

On average, each different health care provider group in Utah – doctors, hospitals, pharmacists, opticians, nurses, chiropractors – I mean everyone – will pay a new 7 percent tax/fee to the state.

In return, those professionals will have the opportunity to serve more than 150,000 new patients – new because they will be able to afford health care via ObamaCare and Medicaid expansion.

But the plan is confusing. Really confusing.

And already association groups for doctors and hospitals are questioning Utah Access Plus, or outright opposing it.

Doctors, hospitals, and pharmaceutical companies historically have a lot of pull in the Legislature.

As former Lt. Gov. Greg Bell – also a former state senator – who represents the Utah Hospital Association puts it: Every time you raise someone’s taxes, you make an enemy.

Some arch conservative House Republicans are already against Medicaid expansion because it is part of ObamaCare.

And they hate ObamaCare; as they hate Democratic President Barack Obama.

If ObamaCare found a cure for cancer and asked the Utah Legislature to pay 10 percent of the cure, and the feds would pay 90 percent of providing the cure – these guys may still be against it.

Doesn’t seem to matter that the goal of this whole program is to get more low-income Utahns – men, women and children – health care.

The political discussion on Capitol Hill has all been amount money – where the money comes from and who pays it.

Now that the Gang has come up with a proposal, perhaps further compromises can be made.

Maybe instead of the health industry paying 7 percent, they pay 3.5 percent, with the state picking up a few millions more.

But Hughes et al. are already agreeing to picking up ALL of the cost of “woodwork” children – an excellent description of minors who could qualify for Medicaid now, but whose parents haven’t gotten them enrolled.

The feeling is – and there is evidence of this in other states that have adopted ObamaCare’s Medicaid expansion – that with all the publicity around expansion, many of those not-signed-up-kids are coming out of the woodwork and getting coverage – thus increasing the state’s share of Medicaid expansion.

Hughes is not helping his chances of success by playing hardball with House Democrats.

As reported previously by UtahPolicy, Hughes wants Utah Medicaid expansion to be the sole responsibility of the Republican majority.

There are 75 House members. A majority is 38. There are 63 GOP House members, only 12 Democrats.

So Utah Access Plus could pass the House with 26 GOP and 12 Democratic votes.

Not going to happen, says Hughes.

He wants the GOP majority “to own” Medicaid expansion – so he wants 38 “yea” votes out of the 63-member House GOP caucus.

No Democratic House votes will be needed, Hughes says.

This really upsets the House minority – which has been in favor of the full ObamaCare Medicaid expansion, in favor of Herbert’s Healthy Utah, in favor of about anything that will expand Medicaid to 138 percent of poverty and bring in that 90-10 fed/state split in monies.

Few remember that Herbert’s Healthy Utah (SB164) passed the Senate last session 17-1, but with only 13 Republican votes. It took Democrats to pass that bill in the Senate.

And Hughes says that’s not going to be necessary for the House – no matter what.

If there are not 38 GOP House votes, then the House GOP caucus will not support bringing Utah Access Plus into the special session.

On Oct. 13 the House GOP caucus will meet again behind closed doors, votes will be counted.

Perhaps some compromises can be made to UAP (Utah Access Plus), making it acceptable to more House Republicans.

If the October deadlines can’t be met, maybe Medicaid expansion will just have to wait until the 2016 Legislature, which convenes in January.

But 2016 is an election year for all House members and half of the Senate. It would be best to decide this political hot potato outside of election-year campaigns.

Will we see UAP 2.0?

We’ll see, as what seems like the never-ending story of Utah Medicaid expansion goes forward.