House passes weaker Medicaid expansion than one proposed by a more generous voter initiative

Scott Sommerdorf | The Salt Lake Tribune Rep. Robert Spendlove, R-Sandy, left, and Rep. Mike Schultz, R-Hooper, right, in the Utah House of Representatives, Wednesday, January 28, 2015.

With a ballot initiative looming that could fully expand Medicaid to cover 150,000 more low-income Utahns, the House passed a weaker version Monday that would cover about 72,000 instead — with a strict work requirement for recipients.

That did not even remotely tempt Utah Decides Health Care to stop its initiative, and time will tell if the bill is enough to help convince voters to reject it.

“The campaign is moving forward. We’re on track to collect our signatures, and we’re looking forward to have this on the ballot in 2018,” said RyLee Curtis, campaign director for Utah Decides Healthcare.

“Anything that doesn’t go up to 138 percent of the poverty level,” or full possible Medicaid expansion, “doesn’t solve the problem for us,” she said.

HB472 passed by the House covers only those who earn up to 100 percent of the federal poverty line, which this year is $12,140 for a single person or $25,100 for a family of four.

It passed on a 47-27 vote, and now goes to the Senate. Democrats who argue it does too little opposed it as did some conservatives who argue that it does too much.

Rep. Robert Spendlove, R-Sandy, sponsor of HB472, said he is not pushing it as an alternative to the initiative.

“We were contacted by the Trump administration, saying, ‘We want Utah to be an example of a state that previously had said no [to Medicaid expansion] and is now trying to find a state solution.’ So that’s why we did it. And we’ve been working with them actively throughout this process,” he said.

The bill instructs state health officials to seek a waiver to federal rules to cover Utahns who earn up to 100 percent of the poverty level, and to impose work or volunteering requirements on able-bodied adults. The federal government would pay 90 percent of the costs, and the state would cover 10 percent.

The House action comes on the same day that the Trump administration granted a waiver to Arkansas for a similar work requirement — the third granted nationally. Arkansas also is seeking a 90-10 split for covering 100 percent of poverty like Utah. That portion of the waiver was not yet granted, but officials said it is under consideration.

“There is a fundamental difference between the Arkansas waiver vs. the Utah waiver request. Arkansas wants to go down from 138 percent of poverty to 100, so they want to move people off Medicaid. Ours is to go from effectively zero to 100 percent, so we are expanding coverage,” Spendlove said.

Spendlove said estimates predict the bill will cover about 72,000 more Utahns in its first year, and by 2025 it would cover more than 94,000.

“No new state money will be used for this program. We are able to do that by repurposing existing funds that are going to other programs,” he said, such as the Primary Care Network that funds basic doctor office visits for the poor and earlier Medicaid expansion passed two years ago for the very poor, such as the homeless.

He said it will save money by putting Medicaid recipients into managed care programs, while most now go to expensive hospital emergency rooms for all care.

Other provisions would automatically cancel the bill if the federal government changes terms. It would also put a cap on state expenditures, making it possible who might qualify for coverage would not receive it if spending raises too much.

Spendlove doubts the spending cap would ever come into force, and projections show it would not in its first five years. But other groups worry. For example, Utahns Against Hunger opposes the bill because of that cap — and the work requirement, and for less than full coverage.

Spendlove said the House rejected in past years proposals from the Senate and Gov. Gary Herbert for more generous expansion of Medicaid for fear that it could allow uncontrollable spending, but said this version would not.