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Medicaid ‘coverage gap’ a concern for all Utah lawmakers

Lincoln Nehring is policy director for the Utah Health Policy Project.

By kirsten stewart

The Salt Lake Tribune

First published Feb 18 2014 07:24AM
Updated Feb 18, 2014 09:52PM

GOP lawmakers outnumber Democrats in a ranking of Utah legislative districts most affected by the Medicaid "coverage gap."

Republicans preside over six of 10 Senate districts and seven of 10 House districts with the greatest share of constituents in the gap — poor, uninsured adults who will have no access to affordable health coverage if Utah doesn’t expand Medicaid, according to an analysis by the low-income advocacy group Voices for Utah Children.

Among them: House Speaker Becky Lockhart, R-Provo, who has said she won’t approve of any expansion plan that draws on federal funding, Majority Assistant House Whip Don Ipson, R-St. George; and Senate Majority Leader Ralph Okerlund, R-Monroe.

"The report largely confirmed what we already knew, [that] the coverage gap is a problem all across the state, regardless of legislative district," said Lincoln Nehring, senior policy analyst at Voices. "Poverty is pervasive. It impacts every corner of the state regardless of party affiliation."

But by breaking down the data by legislative district, Voices hopes to personalize the issue for lawmakers. "Even for someone like me who works on this issue full time … [it] really helps remind me that this issue impacts real families. I expect it will do the same for legislators."

The Affordable Care Act has been described as the most partisan piece of social legislation in decades — never mind that the idea was hatched by conservatives. And perhaps its most divisive element is the Medicaid expansion, which became optional for states under a 2012 U.S. Supreme Court ruling.

In the states that don’t expand, there is a coverage gap of individuals — nearly 58,000 in Utah — who make too little money to qualify for a discounted health plan on the federal health insurance marketplace. The health law excluded them from subsidies, never anticipating states would deny them Medicaid.

There appears to be consensus among Utah Republican leaders over the need to plug the gap. The question is how.

The actual number of Utahns falling into the gap in any one district is small, according to the Voices’ report, an analysis of U.S. Census data by Notalys, an economic research firm.

Even if there were more people in the gap, their political influence is minimal because voting rates are low among the nation’s poor.

But the financial and social ripple effects of their being uninsured — lost time from work and mounting medical bills that can lead to bankruptcies — are far-reaching, argues Nehring.

A majority of Utah’s poor and uninsured adults are employed and 32 percent are parents, much higher than the national average of 15 percent, said Nehring. "Their lack of coverage just doesn’t impact themselves, it impacts the whole family."

And that’s without considering the health implications detailed in fact sheets that Voices is distributing to each legislator Tuesday.

Of the 1,655 constituents in Lockhart’s district who fall into the gap, two to five will prematurely die next year, says Voices, basing its estimate on studies correlating early mortality with the lack of insurance.

Another 90 of Lockhart’s constituents will need diabetic medications, 151 will suffer from untreated depression, 109 women will miss out on recommended breast- and cervical-cancer screenings and 47 will accumulate catastrophic medical expenses exceeding 40 percent of their household incomes.

Lockhart didn’t immediately respond to a reporter’s request for comment on Monday.

"This is a problem that doesn’t impact families in the county next door, it impacts all of us," Nehring said. "The financial and health costs of not expanding Medicaid will impact every legislator’s constituents ­— not just some legislator in Salt Lake Valley, but families in Vernal, St. George, Richfield, Provo and Payson are harmed as well."

Twitter: @KStewart4Trib

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