Utah Republicans have yet to warm to federal health reform, painting it as a tax and vowing to amend or repeal it.
But don't expect any major announcements about the state's plans for the optional parts of the law, including an expansion of the low-income insurance program Medicaid to cover 139,000 uninsured adults.
Half a dozen governors have said no to the expansion after a U.S. Supreme Court ruling that lets states decide.
Utah Gov. Gary Herbert and legislative leaders are taking a wait-and-see approach, putting any decisions on the Medicaid expansion on hold until after the Nov. 6 election.
Senate President Michael Waddoups said the hope is that Mitt Romney will win the presidential election and Congress will act to repeal the law or let states off the hook from some of the mandates.
"We've decided there are just too many unknowns there, and the state's position at this point is we probably won't do anything until we know what's coming out of Washington," Waddoups said following a meeting with the governor last week. "It's just too volatile of an issue."
House Speaker Becky Lockhart said the concern shared by state leaders is that the expansion will commit the state to long-term funding obligations.
"Personally, I think the expansion of Medicaid under the Affordable Care Act was coercion, so I was glad it was found that way by the Supreme Court. The state cannot afford the expense as envisioned under the act, so I think we have to be very careful," she said, saying it could cost "millions or tens of millions, potentially hundreds of millions of dollars, to fund that expansion."
The high court ruled states can't be compelled to take the expanded Medicaid funding and would forfeit the funds if they do not. However, the court said that the federal government cannot strip existing Medicaid funding from states that do not comply.
The federal government initially would pay 100 percent of the cost to expand Medicaid coverage to include those within 133 percent of the poverty level about $30,700 for a family of four but the federal funding would be phased down, to where it would cover 90 percent by 2020.
The Congressional Budget Office said state Medicaid costs would increase by about 2.8 percent as a result of the expansion.
The first 10 years will cost state taxpayers $240 million, said Utah Medicaid Director Michael Hales. Over the subsequent decade, the state's tab will total $500 million.
"We are still sorting out implications for the state and the possibilities of gaining greater state flexibility when it comes to administration, costs and consumer-driven choice," said Ally Isom, the governor's spokeswoman.
There is currently no deadline for expanding Medicaid, but states that refuse or delay will forgo billions in federal funding.
Hospitals and low-income advocates will, no doubt, have something to say about that, said legislative attorney Cathy Dupont at a state Health Reform Task Force Meeting on Tuesday.
She said, "States could and should use this opportunity to press for reforms."
Utah could, for example, pursue a smaller-scale expansion, expand in phases or seek permission to use the federal funding to subsidize residents' own insurance purchases.
"Whether Congress will try to address that or states will be given the option to do something creative there, we don't know," said Hales.
Deadlines for decisions on other parts of the health law are looming.
For example, states have until Nov. 16 to commit to running their own health insurance exchanges, or the federal government will provide the online sites for purchasing insurance. Utah has one operating now, but would have to tweak it to fit new federal rules.
Whom the Medicaid expansion helps
Being poor is not enough to qualify for Medicaid coverage. In Utah, you generally also must be disabled, pregnant, a child or a parent. Adults without kids, no matter how poor, do not qualify. That changes under a component of federal health reform that is now optional for states to adopt.
To find out how this policy debate affects you, join the Utah Poverty Partnership for a free "meet the candidates" barbecue in the northeast corner of Liberty Park on Wednesday from 6 p.m. to 8 p.m.