The Senate plan to replace voter-approved Proposition 3 with a more restrictive — and initially more costly — Medicaid expansion plan is headed to the House floor after earning committee approval Wednesday.

But the 9-6 vote in the House Business and Labor Committee for SB96 included three defections by Republicans, including Rep. Jim Dunnigan, R-Taylorsville, the bill’s House sponsor.

Dunnigan declined repeated requests for comment after the committee hearing, including whether he intends to withdraw as floor sponsor. But he exchanged a fist bump with North Ogden Republican Sen. Allen Christensen, the bill’s primary sponsor, as the hearing ended.

An analysis of election results by the Utah Health Policy Project found that 58 percent of voters in Dunnigan’s district supported Proposition 3. He previously told The Tribune that the results from his district inform his thinking on Medicaid expansion.

"I’m aware of how my district voted,” Dunnigan said. “I recognize that they want to help people and extend a hand — as do I.”

Also opposed to SB96 were West Valley City Republican Reps. Craig Hall and Mike Winder, both of whom represent areas where Prop 3 earned majority support, as well as the committee’s three Democratic members.

Winder cited his constituents’ election results when asked about his vote, adding that SB96 does not strike the right balance between expanding access to Medicaid and controlling costs to the state.

“We’re getting close,” Winder said. “But we’re not there yet.”

Under Proposition 3, which earned 53 percent of the vote statewide, individuals earning up to 138 percent of the federal poverty level would be able to enroll in Medicaid, with the federal government covering 90 percent of the state’s Medicaid costs. The initiative included a $90 million sales tax increase to help fund the state’s expansion costs, but estimates from the Governor’s Office of Management and Budget suggest Prop 3 would run a $10.4 million deficit by 2021, and a $64.5 million deficit by 2024.

Those estimates are cited in the Senate’s and House leaders’ support for SB96, which instead expands Medicaid to those earning up to 100 percent of the federal poverty level, with the remaining expansion population left to purchase subsidized insurance plans through the Affordable Care Act individual marketplace.

Utah would initially pay 30 percent of its Medicaid costs under SB96 — compared with 10 percent under Prop 3 — with the bill’s sustainability predicated on federal administrators agreeing to a 90-10 cost split despite a smaller population of beneficiaries. No other state has received that type of federal waiver.

“I’m betting the farm that we’re going to get it,” Christensen said.

When the Senate approved SB96 on Monday — in a 22-7 vote with one Republican opposed — it included language that would automatically repeal all Medicaid expansion in Utah if the state’s federal waiver applications are denied. But that language was removed by the House Business and Labor committee on the motion of Dunnigan.

“It takes away the automatic cliff that there’s been some concern about,” Dunnigan said.

But the amendment also means that if Utah’s waivers are denied, SB96 would commit Utah indefinitely to covering far fewer patients at three times the cost share of Proposition 3.

“By interfering with the will of the voters, politicians risk bankrupting our state or kicking tens of thousands of Utahns off their health insurance,” said Andrew Roberts, spokesman for the Prop 3-sponsoring Utah Decides. “Either way, this isn’t what voters asked for. Fully implementing Proposition 3 is the only responsible path.”

The option of purchasing subsidized Obamacare plans for those earning above 100 percent of poverty was also criticized by Stephanie Burdick, a Salt Lake City resident who experienced a traumatic brain injury in 2015 and subsequently lost her job and employer-sponsored insurance.

Burdick said her disability benefits place her slightly over the federal poverty line, but her attempts to purchase Obamacare insurance have failed because the health-care exchange — and the broader Affordable Care Act — assumes that people like her will be covered under full Medicaid expansion.

“Very few of the policymakers understand this at all,” Burdick said. “I’d love for legislators to sit with me and fill out the paperwork and try to apply for the exchange and tell me how I’m going to afford the deductibles and the copays.”

She said she currently qualifies for Medicaid by paying back roughly $200 of her monthly disability benefits, which creates a “maze” of paperwork as she is newly disqualified and re-enrolled each month.

“I know people who don’t pay [back] because they can’t afford it,” she said. “They’re choosing to give up that health-care benefit — that they need because they are disabled. They’re giving that up because they can’t make their payments. That’s their rent.”

If the Legislature were to pass SB96 — which includes per-capita spending caps, work requirements and enrollment restrictions — Burdick said it could force her to move out of state to maintain her treatments.

“I might not be able to get speech therapy or vision therapy or migraine treatment,” she said. “I’m 30 years old. I’m intelligent, I still have a lot of capacity and potential.”

During the committee debate, Christensen said there would be some “personal responsibility” for Utahns earning more than 100 percent of poverty. But he said people in that situation should be able to find the money — around $25 each month depending on their income — to pay an insurance premium.

“It’s frustrating, it is absolutely frustrating,” he said. “We can’t pay for everything for everyone.”

And a member of the public, Meaghan Miller, argued in support of SB96, saying a hardworking family above the poverty line should be able to budget to afford insurance.

“We should encourage them to pull themselves up by their bootstraps,” she said.

Democrats on the committee spoke against the bill, saying there are less dramatic revisions that could address the cost of Prop 3, and that the budget estimates suggest there are two years before deficits must be addressed.

And Rep. Sue Duckworth, D-Magna, argued that the federal money brought to the state by Prop 3 would be an economic driver, paying the salaries of hospital and other medical staff who reside and pay sales taxes in the state.

“It’s taxable money that can go into our economy,” she said.

Another House bill, sponsored by Bountiful Republican and physician Rep. Ray Ward, would largely preserve Proposition 3, with alterations that generate a funding surplus for the state’s Medicaid costs. Ward said he does not expect his bill, HB210, to be released for a debate, but added that its framework adds to the dialogue surrounding SB96.

“Already there has been a lot of attention to the numbers in the bill, which show that there is a way to put the Medicaid expansion on a sound financial footing,” Ward said, “and I am hopeful that will make a difference to the discussion.”

Asked whether HB210 is part of any closed-door negotiations on SB96, Greg Hartley — chief of staff to House Speaker Brad Wilson, R-Kaysville — reaffirmed leadership’s support of Christensen’s bill, but added that “many conversations” are taking place over how to implement Medicaid expansion while protecting the state’s budget.

“SB96 provides coverage options to the same amount of people as Prop 3 with an enrollment date that mirrors the proposition,” Hartley said. “The proposal is a compassionate approach that ensures the long-term sustainability of Utah’s Medicaid program and we expect a robust debate on the House floor.”