Op-ed: Healthy Utah is still Obamacare and should be rejected

Utah House leadership announced last week that Healthy Utah will not pass the Utah House of Representatives, and offered an alternative approach to the problem of Medicaid expansion. The governor's office, on the other hand, made its case for why the House should reconsider and pass Healthy Utah.

House leadership has it exactly right: It is time to move beyond Healthy Utah and focus only on the uninsured rather than full expansion.

While Healthy Utah is well-intentioned, it is ultimately a flawed proposal with many unintended consequences that make it not worth the federal dollars chased after. One of its fundamental flaws is that so much of the support for it is inconsistent and contradictory. For instance, the first point most often made in support of Healthy Utah is a blanket, unqualified statement about not liking Obamacare or thinking the ACA is a bad law. But, as the Congressional Research Service notes, a functional Healthy Utah program will have "implemented the ACA Medicaid expansion."

So in one breath, support for Healthy Utah voices a broad dislike of Obamacare and belief that it is bad policy, and in the next calls for the Legislature to implement one of that law's major provisions in Utah. But you can't have it both ways. Either the ACA is a bad law that shouldn't be implemented through Healthy Utah, or the ACA is a good law that should be implemented via Healthy Utah. To argue that Obamacare is bad law but that Utah ought to implement it anyway through Medicaid expansion is a contradiction. That is, of course, unless you believe that the state of Utah is and should be the servant of Washington, D.C., paid to clean up the messes the federal government creates.

Lacking fundamental consistency, support for Healthy Utah relies on other arguments for justification, which may fit well in its ad campaign, but ultimately prove lacking. To wit: Highlighting the need to help tens of thousands of uninsured Utahns, while simultaneously ignoring the hundreds of thousands of disabled Utahns, single parents and children currently on Medicaid who will be forced to wait longer for medical care, as they have in other Medicaid expansion states like Oregon and Arkansas. Or, alternatively, focusing on bringing back as many of Utahns' tax dollars as possible while discounting the fact that funding Healthy Utah over time will require the state to harm taxpayers either by raising their taxes or by committing funding that could benefit taxpayers' lives more by being spent on improvements in public education, transportation or public safety.

The primary reason for Healthy Utah's inconsistency is that it seeks to be a form of Obamacare-approved Medicaid expansion for the sake of chasing federal dollars. Healthy Utah attempts to navigate the awkward contradiction of gaining everything possible from Obamacare while trying to avoid its unpopularity. But given the importance and weight of this policy decision, Utahns deserve better than inconsistent policy and contradictory arguments.

This is not to say that the House leadership approach is without the possibility of similar flaws — the devil will be in the details. For instance, depending on the scope of the final proposal, there is the serious possibility that it may make access to health care worse for current Medicaid enrollees: a possibility recognized both by Medicaid expansion opponents, like Sutherland Institute, and expansion proponents, such as the RAND Corporation.

That said, stepping off the full expansion cliff — as House leadership is trying to do — is the best path forward, because it holds the possibility of actually allowing the state to craft a proposal that avoids the harms that an Obamacare-approved Medicaid expansion guarantees. Sutherland, for one, is encouraged by this more thoughtful, consistent and well-reasoned approach to the problem of Medicaid expansion.

Derek Monson is public policy director at the Salt Lake City-based Sutherland Institute.