This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

They stabbed it with their steely knives but they just couldn't kill the beast.

After seven years of promises, proposals, votes, vetoes, complaints and compromises, Republicans in Congress last week basically established that they are not able to repeal the Affordable Care Act.

Not now. Maybe not ever.

With no real plan for what to put in its place, no willingness by the majority Republicans (and no need for the minority Democrats) to work across the aisle for any kind of grand compromise, it became much sound and fury, signifying nothing.

Republican leaders in Congress indicated Friday that they were whipped and eager to go on to other things, most prominently tax reform. President Trump, who demanded repeal but never put forward a replacement plan of his own, basically shrugged it off and went back on the campaign trail to revel in the adulation of his base.

So, for now, the law known first to its enemies, later to its friends, as Obamacare remains on the books.

That could mean a great many things to a great many people. What it means for the people in Utah, particularly the governor and members of the Legislature, is that their primary excuse for not accepting the expansion of Medicaid coverage for low-income households has been swept aside and any further delay in reaching out to take the money is unreasonable.

Because the Supreme Court ruled that the part of the ACA that greatly expanded eligibility for the Medicaid program was optional for each state rather than a mandate, that key part of the law did not reach everywhere. Utah was one of those that ducked.

Many of us grumbled that that decision was a partisan temper tantrum, one aimed at Barack Obama but that hit poor people in Utah. The stated reason from Utah lawmakers, though, was that the ACA was under attack, was likely to be repealed in 2013 (or 2017) and that when the hundreds of millions in federal aid stopped flowing, Utah would be faced with the unenviable choice of picking up the costs itself or cutting off thousands of people who had come to depend on a program the state could no longer afford.

As it happened, there were enough states — including several governed by Republicans — that found themselves in exactly that situation. But, rather than give up, those governors put significant pressure on their senators to kill any Obamacare replacement that failed to maintain the Medicaid expansion. Or any that did not, at the very least, include the billions of dollars they need to fight the deadly opioid epidemic.

Obamacare opponents talk vaguely about just letting the whole system implode. But even if they take that heartless action — the outcome of which is not assured and could be very different from state to state — the issue of whether the subsidized exchanges for individual health care plans survive is separate from the matter of federally funded Medicaid for the poor.

Just as all the huff and puff about Obamacare was going down in Washington, elected officials in Utah were rallying together to promise some real, final, definitive action to fix the growing squalor and violence among the many homeless people who congregate in Salt Lake City's Rio Grande neighborhood.

If those officials are serious, really and finally serious, about that, the single best thing they could do now is the single best thing they could have done three years, and more than $1 billion, ago. They should accept the full expansion of Medicaid. And then join elected officials, including many fellow Republicans, in other Medicaid states to demand that, whatever comes next, that aid survives.

The need for it is just too great.