Since Medicaid expansion became optional for states in 2012, the Rev. Scott Hayashi said Monday, poll after poll of Utahns showed support for closing the so-called coverage gap and providing health care to low-income residents.

Hayashi, bishop of the Utah Episcopal Diocese, said the state Legislature repeatedly failed to represent their constituents on the issue, finally leading supporters to launch a successful ballot initiative, Proposition 3, to provide “conclusive evidence” to lawmakers.

“Utah decided,” Hayashi said. “You decided that we need this Medicaid expansion for the people in our great state who sorely need it.”

Hayashi was one of several speakers who addressed a crowd of roughly 300 at the state Capitol on Monday, the first day of the 2019 legislative session. His remarks, like those of the other speakers, were aimed at a pair of bills and ongoing closed-door discussions that seek to either repeal Utah’s Medicaid Expansion outright, or significantly alter it through some combination of delays, spending caps and enrollment restrictions.

“Make no mistake,” Hayashi said, “this is a poison pill — literally. Because of the delay that would happen, people would die.”

Legislative leaders on Monday emphasized their desire to respect the will of the voters — Prop 3 earned 53 percent of the statewide vote in November — while also expressing concern over the long-term cost of expansion.

In the Senate, members of GOP leadership suggested that neither of the chamber’s two repeal bills — sponsored by Republican Sens. Jacob Anderegg of Lehi and Allen Christensen of North Ogden — had their endorsement, but that some modification of Prop 3 is likely during the 45-day session.

"There’s probably something in the middle we settle on,” said Sen. Dan Hemmert, R-Orem, the Senate majority whip.

House Speaker Brad Wilson, R-Kaysville, said by approving the tax increase built into Prop 3, Utah voters sent a clear message of support for narrowing the coverage gap.

Wilson said there’s a “high probability” the state will be able to achieve full expansion by the April 1 deadline — when the initiative takes full, legal effect — although the details of the Legislature’s approach are still under discussion.

“We’re operating in that space where we want to provide coverage to folks inside the revenue that the Medicaid expansion tax increase generated,” Wilson said. “There’s a number of things we feel we can do to actually increase the amount of funding that would go into that and provide coverage for more people and maybe better coverage for other programs, as well.”

Alan Ormsby, director of AARP Utah, said the inclusion of a tax increase in Prop 3 shows how serious Utah’s majority-conservative voters were about expanding Medicaid.

“When have you ever heard of voters in Utah approving a tax increase?” Ormsby said. “We did it, we got it done, and why? Because Utah voters saw the value, the value that is Medicaid expansion.”

Under Proposition 3, a sales tax increase initially generating roughly $90 million will be combined with $800 million in federal funding to provide health care coverage to 150,000 low-income Utahns, including those earning up to 138 percent of the federal poverty level.

But estimates by the Governor’s Office of Management and Budget suggest the initiative’s revenue would fall $10.4 million short of the cost of Medicaid expansion by 2021, and $64.5 million short by 2024.

Supporters dispute those figures, and argue that the election results show the public’s support for sustaining Medicaid expansion over time. And despite the debate over costs, both Gov. Gary Herbert and Wilson have proposed tax cuts of more than $200 million.

“Proposition 3 is the law of the land,” Ormsby said. “Certain legislators want to thwart the will of the people, but we are not going to let that happen.”

Stacy Stanford, a policy analyst at the Utah Health Policy Project, said she personally experienced the health coverage gap — in which a person earns too much for traditional Medicaid but too little for subsidized health insurance — after getting sick and losing her job.

Utah’s federal taxes are currently helping to pay for health care in other states, she said, and Medicaid expansion would bring that money back home to help people in need.

And unlike previous partial-expansion plans approved by the state Legislature or some of the proposed changes floated by lawmakers, she said, Utah can move forward on Proposition 3 without seeking waivers from the federal government.

“Proposition 3 is a better law and a better expansion than anything that’s on the table,” Stanford said. “We made this easy for them. All they have to do is let it happen and let people enroll April 1st.”

One attendee at the rally, Cottonwood Heights resident Frido Lyn Hicks, said a problem with government is that lawmakers forget they were elected to represent the views of their constituents.

“We did not elect them because they know better,” she said. “I think it’s a crime that they are not listening to what the people have stated.”

Tribune reporter Bethany Rodgers contributed to this report.