Utah House Speaker Greg Hughes is getting bashed around these days over Utah’s Medicaid expansion.

Never one to walk away from a fight – physically in his boxing days, nor politically today – Hughes says fine, he’ll take the heat.

But the speaker is clear that he is NOT changing the internal political GOP House caucus rules, operated by the Republican since the days he walked in as a green freshman back in 2003.

To wit: House Republicans come up with 38 votes – a majority in the 75-member Utah House – on critical issues, like budgets, or tax hikes, or tax cuts, or major policy-making actions – such as building a new prison and where it goes.

“That’s how it has always been,” Hughes told UtahPolicy on Monday. “And I’m not going to change it now,” nor ask his caucus to change it.

First the raw numbers: It takes 38 votes to pass a budget or bill in the Utah House.

After a very successful 2014 election, there are 63 House Republicans, only 12 Democrats – their lowest numbers in a generation or more.

Half of the GOP caucus is 32 votes.

So UtahPolicy asks: On something as controversial as ObamaCare’s Medicaid expansion – something that a lot of Utahns want in one form or another – why not just settle for 32 votes (a majority) of House Republicans and pick up the other six (or more) votes from House Democrats?

For that matter, why not just put Utah Access+ out there and take the 38 votes for passage where ever you get them, even if is just 26 GOP votes and 12 Democratic votes?

Because, says an emotional Hughes, that is NOT the way policy is made in the Utah GOP-controlled House.

Hasn’t been before. No reason to change now.

But while Hughes is prepared to take the political heat for this, he also glances over his shoulder at Senate Republicans and Republican Gov. Gary Herbert.

By state constitutional law the governor calls the Legislature into special session, and the governor sets the agenda.

It is Herbert’s call, says Hughes, to assemble lawmakers and put Utah Access+ before them.

What happens then is up to the House and Senate GOP caucuses.

  And Hughes doesn’t see the House GOP caucus changing its long-held internal rule of 38 votes (or more) on major bills, taxes, and political issues.

Little discussed today is that in the 2015 Legislature Herbert’s own Healthy Utah Medicaid expansion bill (SB164) passed the Senate 17-11-1 with only 13 GOP votes. Fifteen votes is a majority in the 29-member Senate.

Thus, while SB164 had a majority of Senate GOP caucus votes for it (13 out of 24 Republicans), it still took at least two Democratic votes to pass the whole Senate.

Healthy Utah failed in the House vote, with only two dozen House Republicans voting for it.

Utah Access+, says Hughes, is not his favorite alternative.

It is compromise reached by Herbert’s Gang of Six committee put together after Healthy Utah failed in the 2015 Legislature – made up of Herbert, Lt. Gov. Spencer Cox; Hughes, R-Draper; Senate President Wayne Niederhauser, R-Sandy; House Majority Leader Jim Dunnigan, R-Taylorsville; and Sen. Brian Shiozawa, R-Cottonwood Heights, (SB164’s sponsor).

Utah Access+ “is not 100 percent of what I wanted,” said Hughes. “We worked together to get at it.”

“I have not raised the bar to 38 votes” – the House majority coming from the GOP caucus, said Hughes.

“That has always been the bar – even before I came to the House.”

If Utah Access+ “has now become the Greg Hughes show,” says the speaker. “Then some basic questions need to be answered” by those opposing the Gang’s proposal and how to get it passed.

“The state is stepping up with $25 million” to fully fund the state share of the so-called “woodwork” children – those who have always qualified for Medicaid, but were never signed up by their low-income parents.

Those extra kids, because of all the Medicaid expansion publicity, will likely come into the new program once passed.

That $25 million “is at least twice” the cost of any of the 14 health care professional groups’ new assessments under Utah Access+.

“We are doing our share,” said Hughes.

More importantly, all these medical groups demanding Medicaid expansion – and the $450 million in federal dollars coming to Utah (and into their pockets) – are only going to have to contribute 7 cents for each new dollar coming through expansion – and the more patients and clients they serve.

“I swear if these (health care groups) demanding we leverage the $450 million” in federal money “across these 14 medical groups say we should not do this” – have the 7 cents-per-$1 assessments -- “then we need a strong public dialogue on why they don’t want to do that.”

For if the state is stuck with the whole 10 percent match, then “as I stand here I promise it will impact growth in funding new students, it will impact higher education funding” down the road.


Because Medicaid expansion up to 138 percent of poverty will grow year after year, and it will be funded first – “off the top” – of other state spending.

“It is a risk I will not take; I will never take,” says Hughes.

There is today a concerted effort in the media – even by some members of the media – to make the issue today that “Hughes hates the poor and sick,” and will only talk process and never the lives affected, says the speaker.

Not so, he adds.

“We are asking doctors, on average, to pay an extra $67 a month” in the new Utah Access+ licensing fees. Other health care providers will be asked to contribute more, too, to make up the state’s 10 percent share to get the feds 90 percent share -- to get that new $450 million flowing into Medicaid expansion in Utah, says Hughes.

That is not unreasonable, he adds.

Just as it is not unreasonable for the House GOP caucus to make the major budget and public policy decisions based on finding 38 votes within the majority.

If Herbert wants to move ahead without 38 firm votes in the House GOP caucus, okay says Hughes.

Let the GOP governor – who agrees with the Gang of Six’s Utah Access+ Medicaid expansion – take his constitutional authority to do so: Call a special session.

The Utah GOP caucus will hold a closed meeting Oct. 13 to hash out the plan and take a head count.

Maybe there will be more than 38 “yea” votes there.

But whatever the number is, Hughes and other House GOP leaders, and caucus members themselves, will expect those “yea” votes to hold up on any floor vote for Utah Access+ taken publically later.

No saying in the caucus you vote yes, then going to a House Democrat and trading your switched “no” vote for his or her “yea” vote so the bill will pass on the floor.

“That’s what I mean when I say we all have to own our Medicaid expansion votes, one way or the other,” said Hughes.

He adds that Utah Plus+ is a fair, reasonable approach to Medicaid expansion.

But no GOP House member will be pressured by leadership to accept it; the votes will come based on the plan itself. Or they won’t.