It’s hard to believe that just six months ago, Utah voters, through an initiative, put the state on a course to fully expand Medicaid and, in the process, make profound improvements in the lives of 150,000 low-income Utahns.
Then, naturally, the Utah Legislature intervened, defying public sentiment, stripping down the expansion and planting landmines that could not only blow up health care for thousands here, but could — if adopted by the Trump administration — prove catastrophic for Medicaid enrollees across the country.
Last week, Utah submitted a proposal asking the federal government to pay 90 percent of the Medicaid costs for an estimated 90,000 Utahns living below the poverty line (about $1,000 a month for an individual).
No other state has been granted this deal because, under the Affordable Care Act, in order to be eligible for the full federal funding, states have to cover people who make up to 38% more than poverty wages.
In order to get this special treatment, Utah is taking a major gamble, agreeing to a per-patient cap on the federal dollars the state would be eligible to receive. If the state’s math is wrong, Utah would face a big financial shortfall.
The state also is looking for permission to limit how much it would spend on Medicaid-eligible Utahns. Once it reaches the limit, it could deny coverage to otherwise eligible people — also a provision no other state has been granted.
The spending caps that are in the Utah proposal are not a new idea. They’re the same limits that were part of the Republicans’ “repeal-and-replace” effort last year that failed in Congress. One study based on Congressional Budget Office data said the caps would save $470 million in Utah alone between 2020 and 2026.
Of course, it would be disingenuous to argue the same number of people could get the same coverage for hundreds of millions of dollars less. So ask yourself: Where would the savings come from?
It would mean either medical services would have to be slashed, Utah officials would cap the number of people covered and deny coverage, or Utah taxpayers would be on the hook to pay for the shortfall — or perhaps a combination of all three.
Under any of those scenarios, Utah loses.
For the Trump administration, however, it could be a win. That’s because, after trying repeatedly to annihilate Obamacare and failing, this kind of waiver, if granted, would gut the health care law through administrative action.
The administration has already approved Utah’s request to include work requirements for Medicaid enrollees — a move that sounds good in concept, but in Arkansas work requirements meant more than 18,000 eligible people lost their coverage before the courts stepped in.
National groups are taking note of Utah’s first-of-its-kind proposal, too, because the unraveling of Medicaid won’t stop with the Beehive State.
“If approved by the Trump administration, [Utah’s plan] would set a new precedent that could have catastrophic effects for state budgets and Medicaid programs in the future,” the group FamiliesUSA said in a statement.
“This is a radical, dangerous and unprecedented attempt to undermine the key tenets of Medicaid’s guarantee of health insurance coverage,” Joan Alker, executive director of the Georgetown Center for Children and Families, said in a tweet.
Sixty thousand fewer people covered, more strings attached, reduced federal support, more risk to the state. This is NOT the Medicaid coverage Utahns voted for.
Once again, it will be up to Utah voters to step in — just as they did when they passed Proposition 3 last November.
The state is accepting public comments on the proposed waiver through the end of the month.
There also are two public hearings scheduled on the waiver proposal: Thursday at 2 p.m. at the Cannon Health Building, 288 N. 1460 West, and June 17 at the state office building at 195 N. 1950 West.
“We had the ball in November,” said Stacy Stanford, a policy analyst with the Utah Health Policy Project. “[The Legislature] stole the ball in January. Now it’s our turn to have the ball again. It’s our chance to have our voice be heard again through the public comment period.”
And there’s more than just this waiver on the line. If the administration listens — and that is a big “if” — or if the waiver is successfully challenged in court (and groups are already discussing that option), then the Legislature would have until July 2020 to come up with an alternative.
If legislators were to fail, then Utahns would get what they voted for in Proposition 3 — full Medicaid expansion.
So there’s your call to action, Utahns. Take back your voice and force the state to do the humane and fiscally reasonable thing. Because state policymakers have proven they won’t do it on their own.