The three state leaders said in a joint statement that they were “deeply disappointed by this latest development,” while assuring residents that the state’s existing Medicaid benefits will continue, and that work would be ongoing to find cost-effective ways of providing health care to low-income Utahns.
“In the coming days and weeks, the governor and Legislature will work in close partnership to evaluate the current situation to ensure Utah continues to provide a Medicaid program with long-term fiscal sustainability,” read the statement, signed by Gov. Gary Herbert, Kaysville Republican Rep. Brad Wilson and Layton Republican Sen. Stuart Adams.
And while state law still requires submission of the waiver request, a health department representative said Saturday that no decision had yet been made on whether, or how, to proceed in light of the administration’s preemptive rejection.
Sen. Allen Christensen, R-North Ogden, said he still holds out hope that portions of Utah’s waiver could be approved.
“We probably have to implement the thing,” Christensen said.
“That’s what we acted on, and we told everybody they were wrong and we were right,” Christensen said. “And then when ours doesn’t come through — if, in fact, it doesn’t come through — then they were right and we were wrong.”
Critics not surprised
Under full Medicaid expansion, the federal government covers 90% of the health care costs for individuals earning up to 138% of the federal poverty level, with states responsible for the remaining 10% of costs.
On Saturday, Utah Health Policy Project analyst Stacy Stanford said that while the failure of SB96 had arrived sooner than expected, the result is not a surprise.
“In a way, it changes things,” she said, “but, in a way, it really doesn’t.”
Stanford said she’s grateful that lawmakers included fallback provisions in SB96, which allows full expansion to proceed automatically.
Under SB96′s terms, the failure of the per-capita cap waiver will be followed in January by a new request for 90-10 funding covering the full expansion population up to 138% of poverty, but with the imposition of work requirements. If that request is also denied, and assuming the Legislature takes no further action to alter the Medicaid program, a final fallback provision will see a traditional expansion — comparable to Prop 3 — take effect in July 2020.
“I hope that they will keep their word and uphold the legislation that they drafted and that they approved,” Stanford said of Utah lawmakers. “However, I’m not naive, and I know that it’s probably an uphill battle to hold them to that.”
In their joint statement, the governor and legislative leaders allude to additional work on Medicaid, while also signaling toward the fallback provisions of SB96. None of the three men was available for additional comment Saturday, but staffers suggested a special legislative session is not currently being considered.
The issues around the expansion costs have been addressed by the fallback elements in the law, Stanford said, and it’s time for lawmakers to listen to the evidence and provide Medicaid to the state’s poorest residents.
“We absolutely can afford it, and we can’t afford not to,” she said. “Right now, they’re paying three times more than they would be under a full expansion.”
‘Glad we have the fallback in place’
Rep. Ray Ward, R-Bountiful, is one of a handful of physicians serving in the Legislature, and his alternate bill preserving the bulk of Prop 3 was effectively folded into SB96 as the law’s fallback element.
He said Saturday that his adjustments put full expansion on a sound financial footing for the foreseeable future.
“When you go further out than that," he said, “it’s hard to predict what will happen with any of the choices we make.”
Asked for his reaction to the Trump administration’s decision to reject Utah’s plan, Ward said the specifics of the federal government’s denial will be revealing but that it ends some of the mystery surrounding the state’s proposal.
“For better or for worse,” Ward said, “the Trump administration has answered us — if this is the answer — far faster than the Obama administration ever did.”
In a prepared statement, Reyes’ spokesman Richard Piatt said the attorney general expects the case to be resolved at the Supreme Court, where the “impermissible unconstitutional overreach” of Obamacare will be “exposed.”
“Utah’s executive and legislative leaders were united with our office in the decision to proceed,” Piatt said. "We look forward to assisting the Utah Legislature in preparing for this outcome and begin working now on a new system of health care that makes Medicaid sustainable and accessible into the future, safeguards preexisting conditions and assures coverage doesn’t lapse while the legal case is resolved.”
He added that he expects some legislators to mount new attempts to delay or subvert the fallback to Prop 3.
"You’re going to see a not-insignificant number of lawmakers who say, ‘Let’s take another run at dismantling Medicaid expansion,’” King said.
Every Democrat in the Utah Legislature, as well as a few Republicans, voted against SB96. King said he expects his caucus to continue advocating for the adoption of a fully expanded Medicaid program.
“We should accept that and recognize that it is the will of the people in the state of Utah,” King said. “There are going to be a lot of individuals who benefit from that.”
Ward said he would not expect a special session to be convened, but, beyond that, he was unable to speculate on how his legislative colleagues might react to the failure of SB96 between now and the expansion of Medicaid next year.
“I’m glad we have the fallback in place,” he said. “That’s really my short answer.”