Despite protests, Utah House secures two-thirds majority for replacement Medicaid plan that allows full expansion as a last resort

Under the eyes of a capacity crowd, and with protesters inside and outside their chamber, members of the Utah House voted Friday for a partial Medicaid expansion program that would revert to full expansion in the event federal administrators reject the state’s plans.

Representatives voted 56-19 for SB96, securing the two-thirds majority required for immediate implementation, and which would prohibit supporters of Utah’s Proposition 3 — a full expansion initiative approved by voters — from overturning the legislation by referendum. All 56 “yes” votes came from Republicans, while three GOP members joined all 16 Democrats in opposition.

“Worst-case scenario, April 1, everybody in the coverage gap gets coverage,” said Rep. Jim Dunnigan, R-Taylorsville, the bill’s House sponsor. “We have House Bill 210 as a fallback. It’s expansion, it’s the same money, let’s pass this.”

Friday’s vote bookended two weeks of debate over Utah’s Medicaid program and how the state should proceed in the wake of Prop 3, which earned 53 percent of the vote in November but is forecast by state analysts to run a budget deficit in future years.

SB96 had previously earned more than a two-thirds majority in the Utah Senate, again mostly along party lines, but the bill must return there for another vote on the House’s changes. On Friday, Senate President Stuart Adams, R-Layton, was optimistic that senators would quickly give final approval to the bill next week.

“Yes, I think so,” Adams said. “We’ll see on Monday.”

Critics of the bill made their presence known Friday. During the House proceedings, Speaker Brad Wilson, R-Kaysville, interrupted outbursts in the public gallery and warned that disruptors would be escorted outside.

Despite that warning, three demonstrators were later removed from the gallery by Utah Highway Patrol troopers after draping a painted sheet down into the chamber and shouting, “Respect our vote.” Those demonstrators were not arrested, and they relocated to the lobby outside the House chambers, where faith leaders had gathered to kneel in prayer, read scripture and sing patriotic songs while representatives debated SB96.

Olyvia Burbidge, a Bountiful resident and one of the protesters removed from the gallery, said she was moved to action by the Legislature’s refusal to respect the results of the November election.

Proposition 3 is the second successful 2018 ballot initiative to be targeted for overhaul by lawmakers, who in December voted to enact a negotiated medical marijuana program as a replacement to Utah’s Proposition 2. A third initiative creating an independent redistricting commission — Proposition 4 — is expected to face legal challenges or future legislative roadblocks.

Burbidge was critical of SB96, saying lawmakers found a Medicaid solution that works for them but doesn’t work for Utahns.

“They live different lives than most of the people in the state.” Burbidge said. “They can say they represent us, but I don’t think a lot of them really understand what below-poverty looks like or acts like or sounds like.”

Under Proposition 3, Utahns earning up to 138 percent of the federal poverty level would be allowed to enroll in Medicaid beginning April 1, with the federal government paying 90 percent of the state’s Medicaid costs.

But if SB96 is approved by the Senate and signed by Gov. Gary Herbert, Medicaid enrollment would be capped at 100 percent of the federal poverty level, with Washington paying 70 percent of Utah’s costs and the remaining expansion population left to buy subsidized insurance from the Affordable Care Act individual marketplace.

The bill seeks a waiver from federal Medicaid administrators to pay the 90 percent cost share for the lower expansion threshold, and appropriates roughly $50 million for an 18-month “bridge” program as replacing Proposition 3 will initially cost the state more money to provide health care coverage to fewer people.

Legislative leaders say they’ve been given assurances the waiver will be approved.

“They are telling us three days ago, this is going to happen,” Dunnigan said of his conversation with administrators from the federal Centers for Medicare and Medicaid Services.

SB96 includes a contingency plan that would expand Medicaid eligibility to 138 percent of poverty if Utah’s proposal is denied.

The fallback provisions are largely the work of Rep. Ray Ward, R-Bountiful, a physician who has supported Medicaid expansion and who sponsored competing legislation — HB210 — to implement Proposition 3 with comparably minor tweaks to the initiative’s cost structure.

On Friday, Ward spoke in support of SB96, an early indication that the House’s proposed changes were sufficient to win decisive support in the chamber.

“We’ll be able to keep the promises that we have made to our constituents,” Ward said.

The three House Republicans who joined the chamber’s Democrats in opposing the legislation all represent districts where voters approved Prop 3: Reps. Craig Hall of West Valley City, Steve Eliason of Sandy and Eric Hutchings of Kearns.

Democrats argued that SB96 was a needlessly complicated and costly attempt at partial expansion after voters approved Prop 3.

“Full expansion is a jobs bill,” said Rep. Sue Duckworth, D-Magna. “It’s going to increase jobs because most [medical] providers are going to have to hire more workers.”

House Minority Leader Brian King, D-Salt Lake City, suggested that Republicans were using taxpayer dollars to gamble on people’s health care.

“We’re requesting a waiver on something that has never been done before, literally, in any other states,” King said.

King also pushed back on the characterizations of subsidized insurance on the individual marketplace, saying that low-income individuals who would otherwise have access to Medicaid will be expected to pay premiums, copays and deductibles under SB96.

“When you’re making that little money,” he said, “it makes a big difference.”

Rep. Brad Daw, R-Orem, argued that requiring individuals to pay some medical costs would discourage the “over-utilization” of health care, and that the low premiums for a subsidized marketplace plan are affordable to most anyone — “even my son who works at Five Guys can probably swing that.”

But Daw’s son is just 17, works part time and lives at home, so he has few of the expenses a near-poverty wage adult would face.

House Majority Leader Francis Gibson, R-Mapleton, asserted that partisan interests had impeded Utah’s waiver requests under Democratic administrations. The current Republican administration, he said, is more receptive to the state’s desire to shape and manage its Medicaid program.

“We owe it to ourselves to at least go to an administration who looks like us and is willing to look at conservative states and what they want to do," Gibson said. “We owe it to ourselves to say, ‘This is our plan, this is what we want.'”

Gibson added, “We do meet the spirit of Proposition 3, and we do it in a way that is uniquely Utah.”

Chase Thomas, executive director of the left-leaving Alliance for a Better Utah, called the vote on SB96 “absolutely shameful” and warned of electoral consequences in a prepared statement.

“No matter the amount of lipstick they put on it, S.B. 96 is still a pig and not the plan Utahns voted for in November,” Thomas said in a prepared statement. “Given the demonstrations today, we doubt Utahns will forget these votes come 2020. We will do everything in our power to make sure they don’t forget.”

But the Utah Health Policy Project (UHPP), which supported Proposition 3, said there was “some hope” in the revisions made to the bill, as its backup plan now includes full Medicaid expansion.

“SB96, after many revisions, does attempt to close the coverage gap and more people will be able to get care later this year,” said UHPP executive director Matt Slonaker. “We plan to hold elected officials’ feet to the fire to uphold the their commitment to April 1, 2019.”

Immediately after the vote on SB96, the House held a moment of silence in recognition of Utahns killed while serving in the military.