The Utah Senate is one vote away from approving a partial Medicaid expansion that would be more costly in the short-term for a smaller pool of beneficiaries than the voter-approved Proposition 3.
Senators voted 22-7 on Wednesday, largely along party lines, during a preliminary vote for SB96, which would allow individuals earning up to 100 percent of the federal poverty line to enroll in Medicaid, compared with 138 percent for Prop 3.
Utah would initially pay 30 percent of the Medicaid costs for new enrollees under SB96, a cost share three times larger than what the state would face under the voter-approved initiative. But bill sponsor Sen. Allen Christensen, R-North Ogden, said he’s received verbal assurances that the federal government would eventually agree to fund 90 percent of the state’s Medicaid costs, ultimately reducing Utah’s health-care expenses.
“I’m willing to bet,” Christensen said. “I am betting that we will get the 90-10 match.”
Jonathan Monroe, a spokesman for the federal Centers for Medicare and Medicaid Services (CMS), would not confirm or deny that any such assurances have been given to Utah elected leaders.
“CMS works with each state individually to evaluate Medicaid 1115 demonstration projects,” Monroe said. “To protect the integrity of that process, we do not comment on pending or potential state applications.”
Christensen’s bill, which requires an additional vote before moving to the House, was opposed by every Democratic member of the Senate as well as Republican Sen. Todd Weiler, of Woods Cross.
During debate, members of the minority caucus questioned the speed of the bill, which has not yet received a public financial analysis despite earning committee support on Tuesday and an initial vote on the Senate floor. The legislative session began on Monday.
“This is a big piece of legislation,” said Sen. Luz Escamilla, D-Salt Lake City. “This is changing the will of the people.”
Sen. Gene Davis, D-Salt Lake City, said the bill is indicative of a problem in Utah, with the state Legislature hesitant to support the needy while acting to promote Utah’s more affluent residents.
“We have no problem giving money to the rich. We have no problem giving money to corporations to help them out — to help them grow," Davis said. “But we can’t find the dollars in this state to be able to provide health care to the working poor.”
And Sen. Jani Iwamoto, D-Holladay, criticized her Republican colleagues' willingness to preserve only the portions of Prop 3 that bring revenue into state coffers.
“I think it’s wrong to keep the sales tax increase if we’re not going to deliver what was approved by the voters,” Iwamoto said.
But Republican senators argued that in SB96, they are enacting the intention behind Prop 3 in a fiscally responsible manner. The bill imposes work requirements and spending caps, while also returning would-be beneficiaries to the Affordable Care Act individual marketplace in an effort to reduce costs for the state.
“We are voting to expand Medicaid,” said Sen. Dan Hemmert, R-Orem. “We’re going to cover the neediest among us.”
And Sen. Jacob Anderegg, R-Lehi, dismissed the outcome of the November election, during which 53 percent of voters statewide approved the full Medicaid expansion initiative. He said he is “100 percent convinced” that a majority of Utahns would not have cast a ballot in favor of full expansion if they understood its cost to the state.
“Let’s stop pretending like this is the will of the people," he said, "because the will of the people was based on not all the facts.”
Supporters of the initiative and full expansion have described Christensen’s bill as a “repeal” of Prop 3. On Tuesday, following the Senate Health and Human Services Committee’s approval of the bill, Utah Health Policy Project analyst Stacy Stanford said that Utahns had voted for full expansion, without caps, delays, red tape or federal waivers.
“Voters got it right. Proposition 3 is a better law,” Stanford said. “If there truly are cost concerns, then that is a conversation we can have. There are things we can look at to address future costs without cutting care.”
An analysis of November election results by the Utah Health Policy Project found that 17 senators — out of 29 — represent areas where the initiative earned majority support. Among those 17 senators, 10 voted Wednesday to replace Prop 3 with SB96: Christensen; Senate President Stuart Adams, R-Layton; and Sens. Wayne Harper, R-Taylorsville; Kirk Cullimore, R-Draper; Daniel Thatcher, R-West Valley City, Curt Bramble, R-Provo; Ann Millner, R-Ogden; Lyle Hillyard, R-Logan; David Hinkins, R-Orangeville; and Ronald Winterton, R-Roosevelt.