Utah has long been a conservative leader and a beacon for innovative reform. We are a state that strives to do the right thing and believes in honoring the commitments we make to our residents while fulfilling the constitutional mandate to balance the state’s budget each year.

The state of Utah has consistently ranked at the top of the list of best managed states, best states for business, entrepreneurship and job creation in recognition of its fiscal prudence and regulatory environment that encourages innovation.

Prior to the passage of the Affordable Care Act, we were finding creative solutions to the problems of cost and accessibility in health care. Just a few short years ago the conversation was about bending the cost curve down and reforming a broken system, but has since shifted to a narrative of, “Trust us.”

Nearly half the extended coverage reach of the ACA was intended to be through the expansion of Medicaid, but 21 states currently remain unconvinced that this is the prudent thing to do.

There has been significant pressure to let the Washington beltway crowd define what is best for Utah even at the expense of other necessary and established programs. Tens of millions of dollars of social service program requests already go unfunded in Utah each year and nobody really knows what Medicaid expansion means down the road for our state, let alone our country. Serious questions remain about the sustainability of such a program.

Conservative Utah has consistently fought back against federal encroachment. Even as some states voluntarily expanded Medicaid prior to the inducements of the ACA, Utah didn’t. When the law passed with the expectation of expansion, some states immediately jumped on board. Utah didn’t. So what’s changed?

Unanswered questions, including the issue of subsidies through the federal exchanges currently being challenged in King v. Burwell, remain. Such uncertainty should give us pause as we contemplate committing to Medicaid expansion and begs the question: Why now?

Within the next year California is projected to have one-third of its population on Medicaid.

Utah itself has seen runaway Medicaid costs begin to threaten the state’s budget stability. Over the past 15 years, Utah’s Medicaid costs have jumped nearly 77 percent and now account for 23 percent of the state’s general fund. By 2020, this growth is projected to hit 30 percent of the general fund without expansion.

That’s not what Utahns want. Utah embraces policies that take care of those unable to take care of themselves, while providing opportunity and a hand up for everyone else.

After years of negotiation with the Obama administration, Utah Governor Gary Herbert has formulated a Medicaid expansion plan called Healthy Utah. A year ago, the Utah legislature was told that Healthy Utah would cost the state $40 million; just one year later that number had risen to $80 million. The overall cost of the program had gone from $400 million to $800 million, a staggering figure for a small state that is proposing to cover a sliver of the population, of which 70-75 percent already have access to some form of health coverage. If we were to expand, most of these individuals would lose the coverage they have and be forced ontoMedicaid – a program not known for it’s great health outcomes.

We have tens of millions of dollars in unmet social service funding requests every year, many for programs that have been implemented but for which we’re not fully paying. Why would we put people on Medicaid who already have insurance and add to the liabilities of our state when we’re not sufficiently taking care of current commitments?

Yet the Obama administration will not allow us to simply target those most in need. In order for states to receive a higher federal match than traditional Medicaid offers, they must expand into the population that is already covered under the federally-funded insurance exchanges, thereby taking on some of the cost and all of the liability.

A number of years ago, President Obama himself proposed a budget that would decrease the federal match in funds to such a degree that were we to expand, we would minimally be facing a doubling of the costs currently projected. How can Utah bank on that?

Representative Jason Chaffetz recently spoke to Utah’s House of Representatives and when posed the question of whether Medicaid expansion makes it harder to change or repeal Obamacare, he responded that it will make it more difficult. He went on to say that with an $18 trillion debt that requires over $200 billion each year in interest payments, we need to change the equation and eventually, “something’s gotta give.”

Our governor, Gary Herbert, sought to receive a federal waiver that would allow Utah to implement a work requirement for Medicaid expansion recipients. He was turned down. He also tried to structure a program with a cap in order to protect the state from serious cost overruns that could put our budget, and the ability to fund other needed programs, in jeopardy. Again, the federal government said no.

Something’s gotta give. Or maybe it’s just that something’s gotta go. And that would be Healthy Utah and Medicaid expansion as currently proposed.

Speaker Greg Hughes has served in the Utah House of Representatives since 2002 and he was elected Speaker of the House in 2014