For an extra penny on the price of a movie ticket, RyLee Curtis said, Utahns can provide essential health care to 150,000 of their neighbors, friends and family members.

But state leaders warn such an expansion of Medicaid could eventually overtake much of the state budget, crowding out other needs.

It’s a choice voters will make in November when they consider an initiative to fully expand Medicaid in the state. The proposal would combine roughly $90 million — through a state sales tax increase of 0.15 percent — with $800 million in federal funding to provide medical coverage to Utah’s poor.

“That’s money that we’ve been sending to D.C. for the last five years,” said Curtis, campaign manager of Utah Decides Healthcare, which pushed the initiative after state leaders refused to expand Medicaid on their own. “This allows us to unlock those funds and bring them back to work for the people of Utah.”

A new poll, by The Salt Lake Tribune and the Hinckley Institute of Politics, shows a majority of voters are on board.

Christopher Cherrington | The Salt Lake Tribune
Christopher Cherrington | The Salt Lake Tribune

Full Medicaid expansion was supported by 54 percent of poll respondents, compared with 35 percent who opposed the initiative.

The initiative also received support from both men and women, Democrats and Republicans, and all ideological groups except the “very” conservative.

“It solidifies there’s more yeses that outweigh the nos,” Curtis said of the poll results. “The issue of having access to health care coverage is so important.”

The poll was conducted by the Hinckley Institute between June 11 and June 18. It included responses from 650 registered Utah voters and has a margin of error of plus or minus 3.8 percentage points.

Utah has incrementally expanded Medicaid since the passage of the Affordable Care Act, known as Obamacare. The 2010 federal law created a coverage gap in states that opted out of full expansion, with some making too much money to receive Medicaid under the old requirements but too poor to qualify for Obamacare’s insurance subsidies.

The state received a waiver in 2017 to partially expand coverage to 6,000 poor adults without children. And in March, lawmakers approved HB472 — in part, a response to the full-expansion ballot initiative — which seeks a new waiver and additional funding to cover families earning up to 100 percent of the federal poverty line.

Full expansion would cover families earning up to 138 percent of the poverty line, and the federal government has been resistant to requests by other states to impose caps and restrictions like those called for by Utah lawmakers.

Sen. Brian Zehnder, R-Holladay, sponsored HB472 and made Utah’s pitch to federal health officials last week with a group of state leaders.

“We encouraged them to be expeditious,” he said. “They are aware that there is also a ballot initiative.”

Zehnder said his bill would expand coverage to roughly 70,000 people if the waiver application is approved. It would also do so without the need for a tax increase, as it would redirect some federal and state dollars.

“We’re taking money that we’re already spending,” he said.

Zehnder said he’s invested in his bill and would like to see it implemented. But he added that he’s comfortable with Utah voters weighing in on the issue in November and that’s he’s currently undecided as to how he will cast his vote.

As a family physician and lawmaker, Zehnder said he understands and feels the desire to take care of everyone regardless of ability to pay for services. But, he added, doing so comes with real costs to the state.

“It could very well increase the percentage of our own budget [supporting health care] so much that it would be difficult for us to be able to cover other things,” he said. “Whatever the voters decide, I will work every single day to make sure that we continue to be wise and responsible and accountable to the laws that we have.”

But Curtis, manager of the initiative campaign, said lawmakers like Zehnder have had years to debate and consider the best approach to Medicaid. During that time, she said, the state has turned its back on sick and impoverished residents.

“We left it in their hands for five years,” she said. “There wasn’t enough progress made.”