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Herbert's flawed vision of Medicaid reform
This is an archived article that was published on sltrib.com in 2012, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

By Lincoln Nehring

Gov. Gary Herbert has caught the eye of Washington interest groups because of his attacks on Medicaid and the Affordable Care Act. But a closer look shows that his vision of reform doesn't work for Utah kids.

In a recent opinion piece in the Washington Times, the governor concedes that the ACA's now-optional Medicaid expansion is not a budget buster. Covering 50,000 uninsured Utahns, including men and women who may soon become moms and dads – will increase Utah's Medicaid spending by less than 5 percent. Keeping these neighbors healthy will largely offset this cost, as taxpayers see reduced mental health and substance abuse spending by our counties and corrections system.

Herbert rightly observes that the real state fiscal impact lies with covering thousands of Utah children and parents who are already eligible for Medicaid but not yet enrolled. But the ACA didn't create that situation. Instead, the ACA creates an opportunity for Utah to correct mistakes that have left too many Utah kids and families uninsured for too long.

Utah's cumbersome Medicaid eligibility rules and shortchanged investments in enrollment and retention have cost Utah families dearly. Kids are a tragic example. One-fourth of Utah kids eligible for Medicaid and the Children's Health Insurance Program (CHIP) are not enrolled, because their parents don't know they qualify or can't navigate the bureaucratic maze. Utah ranks third-worst in the nation getting eligible kids enrolled. Nationally, 85 percent of eligible kids sign up for these programs.

The ACA forces the state of Utah to cut the red tape that keeps eligible children uninsured. If Utah does what the ACA requires, the state Department of Health estimates that 35,500 uninsured children who are currently eligible for Medicaid will no longer be uninsured.

Yes, that will cost state government more. But, in exchange, we'll give thousands of Utah kids a better chance to grow up healthy, we'll start using health care dollars more effectively, and we'll create local health care jobs that can't be outsourced. More importantly, we'll solve a real problem for real people right here in Utah.

Faced with those real problems, the governor offers only ideological buzzwords and bumper-sticker slogans. He talks of "market confidence," but that does not mend a girl's broken arm or fight a boy's staph infection. He talks of flexibility, but what does that mean? The flexibility to decide which children get the care they need and which don't? The flexibility for insurance company bureaucrats to override your pediatrician's best medical judgment? For Utah to continue to have one of highest uninsured rates for children in the nation?

He says he can deliver better with less money. But with Medicaid's administrative overhead already far lower than commercial health insurance, there is a disturbing element of flim-flam to his rhetoric.

Utah faces real health care problems that hurt real people. In the last few weeks Medicaid and CHIP celebrated their respective 47th and 16th anniversaries. During their existence they have offered cost-effective solutions to these problems to hundreds of thousands of Utah kids, and the Affordable Care Act offers a chance to make them work even better.

The governor is right. Getting eligible kids and families enrolled is going to cost the state some money. However, Herbert is dead wrong about it being a cost the state cannot afford. Not investing in the health of our kids and families is the cost we cannot afford to pay.

Lincoln Nehring is a senior health policy analyst at Voices of Utah Children.

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