Commentary: Reject the top-down Obama era Medicaid expansion that is Prop 3

(Francisco Kjolseth | The Salt Lake Tribune) Sen. Dan Hemmert, R-Orem, opposes Proposition 3, which would expand Medicaid, saying it'll bust Utah's budget.

Recently I joined a delegation to The Tribune editorial board to explain our opposition to Proposition 3, full Medicaid Expansion under the “Affordable Care Act” (ACA). Such was our reception that board member George Pyle later published an “apology” for his rather animated response in the meeting.

His apology included a charge that we lied. We did not. The discussion about emergency rooms was part of a much greater whole and simply acknowledged that our local health care institutions often do an admirable job of securing care for the truly indigent. No one was suggesting that ERs are a desirable solution.

In fact, we were there specifically to counter a pro-Proposition 3 campaign that we believe is withholding from voters a full accounting of its impact.

So far 32 states have opted for full Medicaid expansion under the ACA. We do not need to “guesstimate” the results; they are clearly documented and available.

In every state — all 32 — that opted to expand, here are three things we know for certain:

  1. Actual enrollment and costs have dwarfed estimates made beforehand.

  2. The benefits — reduced emergency room utilization, better health outcomes and therefore reduced costs — fail to meet what is promised.

  3. The upshot is increased budget pressure on state governments that leads to funding cuts to other state services and/or the need to increase taxes.

But more than that, if voters understand nothing else before they vote, I hope that they will understand this: Proposition 3 is not simply a stand-alone, single purpose legislative measure; Prop 3 is a complete restructuring and reprioritization of the state of Utah’s entire budget, every year, from now on.

The key there is “from now on.” From now on, Medicaid becomes Utah’s first and only real funding priority. Education, roads, public safety, aging services, and any other worthy endeavor you can name — Medicaid surpasses them all. That’s because Medicaid under Prop 3 cannot be “appropriated” like other budget priorities. The cost is the cost, and there will be nothing we can do except pay it.

All this as the Utah Legislature has already passed a fairly ambitious Medicaid expansion bill covering the poorest among us. In our bill, we built in cost controls and enrollment caps as circuit breakers, none of which is included in the ACA version.

But for the non-Utah leftist interest groups who are funding Prop 3, that was not enough. Now the choice is between a “Utah Plan” and the top-down, one-size-fits-all Obamacare approach.

Most actual Utahns who favor expansion are motivated by their almost in-born desire to help those in need. At first glance, the question “Should we give free healthcare to poor people?” appears to be a no-brainer.

But here’s another irony: 82 percent of those covered in other states are non-disabled, childless adults. But because of how Medicaid is funded, the very people most of us really want to help – the chronically ill, seniors in need of long-term care, and individuals with physical or developmental disabilities -- actually end up taking a backseat to new enrollees. Right now over 600,000 such special needs individuals are stuck on Medicaid waiting lists behind millions of non-disabled adult recipients.

Even without expansion, Utah has seen a 603 percent increase in Medicaid cost since FY2000. Medicaid currently absorbs 18.7 percent of Utah’s General Fund budget. How much more can we afford without more tax hikes or major cuts in services? 30 percent? 40 percent? That is happening in other states. So what are we willing to cut, or which taxes are we willing to raise, to pay for it? We must ask that question now.

This Legislature has sometimes been criticized for its “pay as we go” policy approach. But that is why Utah is so fiscally sound, surrounded by seas of red ink in other states. Medicaid is a broken system; doubling down on a broken system is foolish. And we know from the documented experience of 32 other states that Utah’s share of expenditures will only grow.

I hope Utah voters will join us in rejecting the failed model of Proposition 3 and developing instead a true “Utah Solution” to provide healthcare to our most vulnerable fellow citizens.

Dan Hemmert, R-Orem, represents District 14 in the Utah Senate.