Robert Gehrke: Getting health care to low-income Utahns never should have taken so long or cost so much

Robert Gehrke

Gov. Gary Herbert was helping to pass out holiday turkeys at Crossroads Urban Center on Monday when he got a call from Washington: The federal government approved Utah’s application for full Medicaid expansion.

It was great news, meaning as many as 120,000 low-income Utahns will have access to health insurance with the feds paying 90 cents of every dollar in cost. And they can sign up on Jan. 1.

Bill Tibbitts, an anti-poverty advocate who has fought for the expansion, thanked Herbert for his work to get it done.

“If only they had adopted my Healthy Utah plan five years ago,” the governor replied.

That is the bittersweet reality of Monday’s announcement. The plan that was ultimately approved is, in almost every way, identical to the expansion plan the governor proposed back in 2014, only to have it shredded by the Republican Legislature.

For more than five years since, these legislators relentlessly fought to block Medicaid expansion and to deny care to those who desperately needed it. They succeeded, until voters revolted.

But even after voters, more than 555,000 of them fed up with the ideologically driven intransigence, took the nearly unprecedented move of backing a ballot initiative, lawmakers immediately dismantled portions of it, and opted for a scaled-back partial expansion.

Ignoring the will of the people has meant that, since April, Utah has been covering tens of thousands fewer people than otherwise would have been eligible and at a substantially higher cost while being gaslighted by legislators who claimed it was in the name of fiscal conservatism.

It was surreal watching legislative leaders patting themselves on the back Monday for a job well done.

“The [approval] will provide more Utahns with the coverage they need while saving Utah taxpayers millions of dollars in potential costs,” said House Speaker Brad Wilson.

Wilson was among the legislators who voted to kill Herbert’s Healthy Utah plan back in 2015, which, again, is nearly identical to the proposal Wilson is now championing.

The five-plus years of delay had a significant cost.

Over the past nine months — when lawmakers were clinging to their scaled-back partial expansion — Utah has foregone more than $530 million in federal Medicaid support, according to calculations by Joe Weissfeld of Families USA. Spread over the course of the past six years, it has cost the state an estimated $5.5 billion — money you and I paid into the Medicaid program but which Utah lawmakers refused to accept when it was supposed to come back to help the poor.

That’s the dollars and cents — or nonsense — side of it. Then there are the lives lost.

In 2017, a study at Harvard found that mortality rates fell in states that had adopted Medicaid expansion and climbed in states — like Utah — that had not. Based on those figures, the Center for American Progress projected last year that getting access to insurance could have saved 241 Utahns’ lives, including four infants.

Even if you think that estimate is inflated, go ahead and cut it in half and it is still a heartbreaking toll.

Stacy Stanford, an analyst with the Utah Health Policy Project, said she got involved in the fight for expansion because she was one of those who spent five years in the so-called coverage gap. Along the way, she said, she encountered a lot of people in the same circumstance — and a lot of them died without ever getting the coverage they needed.

“There are just so many stories like that,” she said. “Now we don’t have to tell those stories anymore.”

Now the challenge becomes getting people signed up. Since the partial expansion got underway in April, enrollment has fallen well short of the projections — about 40,000 now covered, rather than the 70,000 expected.

Now, tens of thousands more will be eligible for coverage and — at long last — have access to preventative care, and possibly early life-saving diagnoses. They’ll be free from the threat of one health crisis leading to financial ruin. Finally, those people have the prospect for a healthier, happier new year.

To find out if you’re eligible for Medicaid and to enroll, visit medicaid.utah.gov.