At a health care reform conference Wednesday, Taylorsville Republican Rep. Jim Dunnigan recalled meeting with the backers of 2018′s Proposition 3 early in the 2019 legislative session to discuss potential changes to the voter-approved full Medicaid expansion plan.
“We tried to find a sustainable path,” said Dunnigan, House sponsor of the Prop 3-replacement bill SB96. “We got a working group of a variety of stakeholders together, including some of the strong proponents.”
Dunnigan’s comments surprised some of the individuals involved in the Prop 3 campaign, who opposed SB96, and who say there was never any meaningful effort to work with the initiative organizers on a compromise.
Jessie Mandle, a health policy analyst with the Prop 3-sponsoring Voices for Utah Children, said she wasn’t sure what Dunnigan was referring to.
“We were not part of any stakeholder meetings,” she said.
Matt Slonaker, executive director of Utah Health Policy Project, said there was a meeting in the weeks before the legislative session. But, he said, lawmakers at the meeting pitched their plan to replace full expansion with a program that would rely on unprecedented federal waivers, work requirements and spending caps to offer Medicaid coverage to fewer low-income Utahns.
“There was a plan, very well-established and cooked and ready for the Legislature,” Slonaker said. “It wasn’t in bill form. But it was already where it was going to be, and lo and behold that was SB96.”
Slonaker said his group proposed an alternative, keeping intact most of Proposition 3 while addressing the program’s high projected costs that lawmakers cited in defense of SB96.
That suggestion ultimately took shape as an alternate bill — HB210, a form of which will become law only as a multi-step fallback should SB96 fail — and which was initially dismissed by legislative leaders, Slonaker said.
“That wasn’t well received,” he said, “or received at all.”
Asked to clarify his comments, Dunnigan said a meeting was held to explore the potential for an agreement, akin to the way lawmakers and the Proposition 2 campaign came together on medical marijuana legislation that replaced a voter-approved law.
He said there was common ground on mitigating the costs of full Medicaid expansion, but the two sides were too far apart on the other elements of what would become SB96.
“Early in the session the [House] speaker assembled a meeting of several of the proponents of Prop 3,” Dunnigan said, “to see if we could accomplish something similar to what we did with medical cannabis.”
He said his comments about a working group on SB96 referred to meetings that did not include the sponsors of Proposition 3, but included individuals and groups who had indicated support for the Medicaid initiative ahead of last year’s election.
“It was a separate working group,” he said.
Proposition 3 won the support of 53 percent of Utah voters, and would have allowed roughly 150,000 Utahns earning up to 138 percent of the federal poverty level to enroll in Medicaid.
With SB96, lawmakers reverted to the framework of a 2018 limited expansion plan that was superseded by voters in November. It allows between 70,000 and 90,000 Utahns earning up to 100 percent of poverty to enroll in Medicaid, with the expectation that federal administrators will agree to pay 90 percent of the state’s costs — compared to the current federal cost share of 70 percent.
The Legislature’s plan also seeks a per-capita funding cap for Medicaid enrollees, meaning a fixed amount of federal assistance based on enrollment, independent of patients’ health care needs. Supporters of full expansion say per-capita caps, if approved by federal administrators and upheld by the courts, could see the state facing outsize costs without the guarantee of matching federal dollars.
“The ballot initiative was used to facilitate and further conservative goals that are well outside the intent of the initiative,” Slonaker said.
But Dunnigan said providing capped funding to states will reduce the cost increases of U.S. health care.
“We have an incentive to help the federal government control the inflation on that,” he said.
Sen. Gene Davis, D-Salt Lake City, appeared on stage with Dunnigan at Wednesday’s conference. He expressed skepticism of the per-capita caps, saying that type of federal “block grant” funding has a troublesome track record in health care and other federal programs.
“It might be a good idea," he said, “but I don’t know of any block grant money that has been sustained over a long period of time and actually grown in the federal budget over time.”