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Though bitterly opposed to the federal requirement that everyone have health coverage, Utah's Republican legislative leaders are considering imposing their own insurance mandate.
In weighing millions of dollars in cuts to Medicaid on Monday, ranking members of the Social Services Appropriates subcommittee debated the merits of requiring college students to purchase health plans that cover maternity.
It's a policy fix that would target the purported problem of affluent college students using Medicaid to pay for their prenatal care and deliveries — one that legislative fiscal analysts estimate could save $1 million in state and $2.5 million in federal funds.
Last year, Medicaid paid for about 600 births to college-age women. The true scope of the problem is unknown because there's no way to determine how many of those mothers came from low-income families.
But Utahns marry young, at an average age of 26 for first marriages, according to 2008 U.S. census data. Also, the state boasts the nation's highest birth rate, and with Medicaid paying for nearly a third of the state's deliveries, moving college students into the private market could be a money-saver, said the committee's co-chairman, Rep. Brad Last.
"I personally know some youth from well-to-do families who probably shouldn't have had their babies paid for by Medicaid but were happy to do it because it was available," said the Hurricane Republican. A college student can be from a wealthy or middle class family and still qualify for the low-income health program because they have no personally reportable income.
Higher education officials oppose placing greater financial burdens on already cash-strapped students.
But the mandate is high on the list of proposed cuts to Medicaid as Democrats and Republicans look for ways to ease the growing program's strain on state coffers.
"We spend $84 million a year on Medicaid births. And we get a lot of questions [from constituents] about that considering pregnancy is optional," said Sen. Pat Jones, D-Holladay.
Medicaid chopping block
A mandate that would require college students to purchase maternity coverage isn't the most controversial penny-pinching strategy to surface this year. Among the cuts lawmakers discussed but hope to avoid:
Eliminate Medicaid coverage for certain transplants, including bone marrow, pancreas and lung.
Cut physical and occupational therapy services for all Medicaid enrollees, and dental and vision services for pregnant women over the age of 21.
Reserve breast and cervical cancer treatment and prevention for only the poorest of Medicaid recipients, those below 133 percent of the federal poverty level.
Eliminate medical interpreter services.