Utah will partially expand its Medicaid program in April after the Utah Legislature passed and the governor signed SB96 last week, replacing a voter-approved initiative that earned a 53 percent statewide election victory in November.
Of the 22 senators and 56 representatives — all Republicans — who voted for the replacement bill, 35 represent districts where Proposition 3 earned majority support. But a smaller group of nine Republicans who voted for SB96 were elected in November by a smaller margin than their districts’ support for the full Medicaid expansion initiative.
“We’ll be there to remind [voters] about it in 2020," said Alex Cragun, executive director of the Utah Democratic Party. “We, as a party, have an opportunity to take those seats.”
The nine Republicans are Sen. Dan Thatcher and Rep. Mike Winder of West Valley City, Rep. Steve Waldrip of Eden, Rep. Calvin Musselman of West Haven, Rep. Jim Dunnigan of Taylorsville, Reps. Cheryl Acton and Ken Ivory of West Jordan, Rep. Robert Spendlove of Sandy and Rep. Tim Quinn of Heber.
(Christopher Cherrington | The Salt Lake Tribune)
In some cases, the difference between the lawmakers’ share of the vote and the performance of Prop 3 in their district is quite narrow, like House District 47, where Ivory received 53.6 percent compared with 53.9 percent for the initiative.
But the gap is more pronounced in other areas, like House Districts 43 and 49, where Acton and Spendlove were each elected with less-than-majority support while Prop 3 earned 55 percent and 58 percent of the vote, respectively.
“What the people said they wanted was access for everyone to affordable health care,” Spendlove said. “But also we were able to do it in a way that is fiscally sustainable and prevents any unintended consequences.”
Spendlove sponsored a partial Medicaid expansion plan that was approved by lawmakers in 2018 and ultimately overruled by the voters with Proposition 3. But with SB96, Utah will revert to a partial expansion plan that is reliant on federal waivers to cover a smaller pool of beneficiaries, functionally similar to Spendlove’s proposal.
Legislative leaders argued that SB96 was necessary to protect the state’s budget from estimated deficits under Prop 3. And Spendlove said Tuesday that his decision to vote for the bill was motivated by a desire to both honor the will of his constituents and represent them in the best way possible.
“I’m more worried about what is the right policy,” he said. “Really what I’m focused on is trying to find the right pathway forward.”
The district-specific results for Prop 3 come from an analysis of election results by the Utah Health Policy Project, which supported the Medicaid expansion initiative. The results of that analysis have been previously reported without objection from critics of the initiative.
Half the Republican senators who represent districts that supported Prop 3 were not up for election in 2018 and do not have comparable election results.
Acton said her district had approved Prop 3 by “a small margin” — 55.2 percent compared with 48 percent for herself — but that she supported SB96 because it provides access to health care to all Utahns. She also cited the estimated long-term funding deficit of Prop 3 and said the campaign materials around the initiative contained inaccuracies.
“I’m glad that the people of Utah passed Prop 3,” Acton said, “because it forced the Legislature to focus on the coverage gap and close it. I voted for SB96 because it accomplished the goals of Prop 3 in a more sustainable way.”
Winder voted against SB96 in committee and later supported an unsuccessful Democratic motion to replace the bill with HB210, a competing bill that made comparatively minor adjustments to Prop 3. When that motion failed, he supported the final version of SB96, which included HB210 as a fallback plan in the event federal administrators reject Utah’s waiver requests.
Winder said his constituents supported Medicaid expansion but also favored adjustments that would mitigate Prop 3′s anticipated budget deficit.
“Most thought that when they voted for Prop 3, that the 0.15 percent sales tax increase would cover it all,” Winder said, “and have been very disappointed to learn that it falls far short.”
Thatcher said he has supported previous Medicaid expansion proposals that came before the Senate and that Prop 3 included unsustainable elements that had to be removed.
“I have always supported Medicaid expansion, as long as it is sustainable,” he said. “Prop 3 wasn’t. SB96 is.”
Musselman, a first-term representative, said he heard from many of his constituents during the debate over SB96 and that the final version of the bill, with HB210 as a fallback, was an appropriate way to move forward.
“I didn’t want repeal,” he said of Prop 3. “I think some fair-minded, pragmatic approach to resolving concerns was needed.”
Quinn also cited the push by some to fully repeal Prop 3 in explaining his support for the replacement bill. He said he objected to the original version of SB96 when it passed out of the Senate, but members of the House made significant changes, particularly the fallback provisions that would implement the bulk of HB210 as a last resort.
“It’s much better than, obviously, repealing it, and it is significantly better than the original bill,” Quinn said. “It was the best that we were going to get in a tough situation.”
Prop 3 was supported by 59.4 percent of the voters in Quinn’s district, giving the full expansion initiative a margin 9 percentage points greater than the representative’s electoral victory with 50.4 percent of the vote.
Waldrip, Dunnigan and Ivory did not respond to requests for comment.
Cragun said Prop 3′s ultimate fate is indicative of Republican leadership in Utah. Lawmakers seemed to think they know better than everyday voters, he said.
“If they’re not wiling to listen to their constituents, then somebody else should be there to do that for them,” Cragun said. “In my opinion, the best person would be a Democrat.”
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