Trump-endorsed Medicaid expansion bill clears first test in Utah Legislature

(Trent Nelson | Tribune file photo) Rep. Robert M. Spendlove, R-Sandy, as seen in the Utah State Legislature on Tuesday January 24, 2017. Spendlove is sponsoring HB472, an expansion of Medicaid that would extend coverage to tens of thousands of low-income Utahns.

A bill expanding Medicaid to cover tens of thousands of low-income Utahns — while also setting work requirements and an enrollment cap on the program — easily cleared its first hurdle in the Utah Legislature on Thursday.

Rep. Robert Spendlove, R-Sandy, the sponsor of HB472, called it “our state’s most comprehensive effort to help people out with health coverage.”

The bill was approved 9-3 by the House Business and Labor Committee and now heads to the full House — with four days left before the 2018 session adjourns next Thurday.

HB472 would expand Medicaid coverage for people whose incomes are below the federal poverty line, which is $12,060 per year for an individual and $24,600 for a family of four.

Spendlove has said the expansion would cover as many as 60,000 Utahns who are currently uninsured — those who make too much to qualify for the state’s current Medicaid requirements and too little to afford coverage under the Affordable Care Act, also known as the ACA or Obamacare.

This “coverage gap” group has gone without health coverage for years, while state lawmakers refused to enact ACA provisions calling for a full Medicaid expansion.

HB472 still falls well short of the Medicaid coverage threshold established under ACA, which calls for coverage of residents making up to 138 percent of the poverty line. Spendlove has said Utahns who make more than the poverty level shouldn’t be covered by Medicaid, because they can obtain subsidized insurance through the ACA’s exchanges.

The bill also would require able-bodied residents in the new coverage group to work, and it would allow the state to set a budget cap on the program, so it doesn’t enroll more people than its budget allows — even if more people are eligible.

Those tweaks proved popular among Republican lawmakers. And, Spendlove said Thursday, officials with the Trump administration have told him and other Utah officials that they would likely approve a federal waiver allowing those changes.

“We are literally being encouraged by the Trump administration to do this,” Spendlove said, adding that he has sent early drafts of the bill to federal officials to gauge their receptivity.

If approved by the federal Centers for Medicare and Medicaid Services, 90 percent of the costs of the expansion would be covered by the U.S. government. Total costs of the program would rise over the next few years, reaching nearly $500 million by 2024, according to a fiscal note on the bill.

Utah’s portion of the price tag, Spendlove said, would be covered primarily by funds already allocated for the state’s Medicaid program, which is currently funded by the federal government at a lower rate of 70 percent.

Gov. Gary Herbert has said he supports HB472.

The Republican governor said he’s discussed Utah’s Medicaid waivers with Vice President Mike Pence and Seema Verma, who leads the Centers for Medicare and Medicaid Services.

“With this new administration,” Herbert said last month, “there seems to be a willingness we’ve not found in the previous administration to have waivers to allow us to do things we’ve not been able to do in the past.”

Several key players testified in favor of HB472 on Thursday. Alan Dayton, Intermountain Healthcare’s director of government relations, said the legislation would “help reduce the number of uninsured people who come into the hospitals” over the long term.

Pamela Atkinson, an advocate for the homeless, agreed, saying many people without coverage end up going to the emergency room as a last resort. ”This is going to save us dollars in the long run,” Atkinson said.

Stacy Stanford, an analyst with the Utah Health Policy Project, said the group opposes HB472. She said its work requirement and spending caps were harmful policies, with potential to leave behind some vulnerable populations.

But Spendlove said HB472 is “our best option possible.”

“It’s what we’ve been asking for, for many years,” he said.

HB472 is one of several Medicaid bills moving forward this Legislative session.

They include HB12, which would expand birth control availability for low-income women; HB325, expanding benefits under the state’s Primary Care Network program, which has fewer benefits than Medicaid and is covered with Medicaid money; and SB172, which would urge the Utah Department of Health to request federal block grants to pay for its Medicaid program, giving the state more flexibility with the funds.

Only one current proposal would expand Medicaid coverage up to the maximum 138 percent of the poverty line, SB47, sponsored by Senate Minority Leader Gene Davis of Salt Lake City. The bill would extend coverage to an estimated 100,000 low-income Utahns.

Davis has sought unsuccessfully to pass full-expansion bills in the last four legislative sessions. This year, the proposal hasn’t received a committee hearing.

Meanwhile, a group called Utah Decides Healthcare is gathering signatures in hope of putting a question of full Medicaid expansion on the November ballot. A recent poll said 62 percent of Utahns support the ballot initiative.