This is an archived article that was published on sltrib.com in 2016, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
If the Utah Legislature would change its mind and fully expand Medicaid as allowed by the Affordable Care Act, it would help 42,000 uninsured Utahns who suffer from mental illness or substance abuse.
The U.S. Department of Health and Human Services said that Monday in a report looking at how behavioral health care might improve with full Medicaid expansion available under "Obamacare" in the 20 states that have rejected it, including Utah.
The report was a not-so-subtle prod from the Obama administration for Utah and the other states to reconsider.
"Today's report shows that Medicaid expansion is an important step Utah can take to address behavioral health needs, including serious mental illness and opioid and other substance use disorders," HHS Secretary Sylvia Burwell said in a written statement.
The new report said that about 40 percent of the low-income, uninsured people in Utah have behavioral health needs. It figured only about 16.1 percent of them are currently receiving some care for their conditions.
After years of fighting, the Utah Legislature passed — and Gov. Gary Herbert signed last week — a scaled-down expansion of Medicaid. It aims to help about 16,000 people who are homeless, recently released from prison or earn less than 55 percent of the poverty level.
It will cost an estimated $100 million, with a 70-30 split between the federal and state governments. It still requires some yet-to-be-received waivers from the federal government.
A full expansion under Obamacare would have covered people earning up to 128 percent of poverty. It would be paid 100 percent by the federal government in 2016, 95 percent in 2017 and scaling down to 90 percent in 2020 and years beyond that.
Utah's Republican-controlled Legislature preferred their scaled-down expansion — even with a higher local match percentage — saying it produces more predictable and affordable overall costs because full expansion had no caps on how many people might be served — which could lead to runaway costs. Most also strongly oppose "Obamacare," and did not want to participate in it.
President Barack Obama recently proposed an extra incentive for the 20 states that have not fully expanded Medicaid, offering to provide Medicaid expansion the same three years of full federal support and gradual phase-down as the states that expanded it in 2014 received.
Herbert had proposed his own middle-ground plan that was more generous than what was finally passed, but he accepted the scaled-down version as the best that was possible politically — and said doing something is better than nothing.
During a debate last week, two Democrats challenging Herbert called for full Medicaid expansion.
Mike Weinholtz said the scaled-down expansion that passed covers "the least amount of Utahns at the most expensive price. So not only was this morally bankrupt, but it was fiscally irresponsible."
Vaughn Cook said, "I think we should stop bickering about Obamacare, and being embarrassed to think we're going to take advantage of it. I think we should take advantage of it," and accept all it offers to help the uninsured.
Meanwhile, Jonathan Johnson, a Republican running against Herbert, criticized him for doing too much to follow Obama's wishes in his middle-ground proposal.
Johnson said Herbert's plan relied "on federal dollars and expanding it the way the federal government wanted us to expand it. We should be expanding it on our own terms.… We should be figuring out how we get our dollars back without taking uncapped, unbound liabilities on our own taxpayers."