Feds’ decision on Utah Medicaid waiver is likely delayed until after the midterm election — and the state vote on full expansion

(Francisco Kjolseth | Tribune file photo) Gov. Gary Herbert laughs after House speaker Greg Hughes, at left, jokes about the governor vetoing bills after his signing of HB 472, Medicaid Expansion Revisions, at the Utah Capitol on Tuesday, March 27, 2018. The bill would expand Medicaid health care coverage to cover an additional 60,000 Utahns below the poverty line — pending approval from the federal government.

Utah’s competing Medicaid expansion plans — one approved by lawmakers and another, more ambitious one pushed by a grass-roots initiative — may continue to be at odds beyond November, according to a report from The New York Times.

On Monday, The Times reported that President Donald Trump has ceased consideration of partial expansion plans in Utah and other states. And approval or denial of those plans is unlikely to resume until after this year’s midterm elections.

The Times also cited a confidential Trump administration memorandum warning of “significant risk” that Utah voters would support the Utah Decides Healthcare initiative — or full expansion — if the state’s plan to impose work requirements and cover only a portion of Utah’s uninsured poor does not receive federal approval.

RyLee Curtis, the initiative’s campaign manager, said the delay does little to change the larger debate over Medicaid in Utah. Voters will have the chance to decide on full expansion, she said, whether or not the state is granted a waiver for partial expansion.

“We were not backing down whether or not this moved forward,” she said. “We’re not waiting for the state Legislature. We get to decide.”

Rep. Robert Spendlove, R-Sandy, sponsored the partial expansion legislation, which seeks increased funding from Washington to provide health care to roughly 70,000 Utahns living at or below the federal poverty line. That funding is typically reserved for states that cover individuals and families earning up to 138 percent of the poverty line, which is why Spendlove’s bill requires a waiver from the Affordable Care Act, or Obamacare.

Spendlove said Tuesday that he has not received any formal notice of a delay from the Trump administration. But he had anticipated the review of Utah’s plan to continue into the middle or late fall, he said.

“It’s always better if we can get a quick answer,” he said. “[But] I’m happy to wait for a ‘yes’ rather than get a quick ‘no.’”

According to The Times, partial expansion attempts like Utah’s have divided members of the administration, with the Department of Health and Human Services advocating for the incremental approach against the objections of White House staff who balk at any broadening of Obamacare coverage.

Reports of a delay beyond November are encouraging, Spendlove said, as it suggests a careful and deliberate consideration of Utah’s and other states' individual plans.

“If the reporting is correct, what it’s showing is that the administration is taking their position of giving states more flexibility very seriously,” Spendlove said.

But a protracted review also raises the potential that Utahns will vote in favor of full expansion, followed by federal approval of the partial expansion plan adopted by lawmakers in March. In June, a Salt Lake Tribune-Hinckley Institute of Politics poll found that 54 percent of Utahns support the ballot initiative, which would combine $800 million in federal funding with a $90 million increase in state sales taxes to provide health care to roughly 150,000 people.

Under that scenario, Spendlove said it is unclear which version of Medicaid expansion would be legally binding.

“That’s the big question; we don’t know,” Spendlove said. “That’s something that I think we need to get more clarity about before Election Day.”

Asked about the uncertainty of Utah’s pending waiver, Curtis said it doesn’t change the decision that voters will face in November: to help their impoverished neighbors or not. If approved, the initiative would function like any other Utah law, Curtis said, and be subject to future amendments, revisions or repeal by Utah’s elected leaders.

“All pieces of legislation are moving targets,” she said. “We never know what’s going to happen.”

Paul Edwards, spokesman for Gov. Gary Herbert, said Utah’s partial expansion plan is a thoughtful and responsible attempt at closing gaps in the social safety net. It would be disappointing, he said, if Utah’s waiver was being held up for any reason other than the substance of the state’s request.

“We hope that this process of seeking that kind of flexibility isn’t being held hostage just for mere political considerations,” he said.

Edwards said it’s encouraging that members of the administration are reportedly supportive of Utah’s plans. But the timing is important, he said, as Utahns will soon be headed to the polls.

“It certainly would be helpful going into the election for Utah voters to understand the kind of precise options that are before them,” he said.