— Leonard McCoy, M.D.


Utah’s elected rulers were determined not just to ignore — but to spite — the will of the voters who last year passed the Medicaid-expanding Proposition 3.

So they passed Senate Bill 96, a measure to set aside the humane and fiscally responsible ballot initiative and replace it with a cruel and wasteful measure that would spend a lot more money to provide health care access to many fewer people.

Baked into SB96 was the assumption that the sitting federal administration, with its open contempt for law in general and the Affordable Care Act in particular, would put partisan interests and studied meanness ahead of the law and humanity to grant Utah the waivers it would need to run its cruel joke of a Medicaid program.

That the feds would give Utah a permit to do a damned illegal thing.

I thought they were right.

Not right to pass SB96. That was one their more horrid ideas.

I thought they were right in assuming the worst of this administration. Right to suppose that because Washington was controlled by people who are nominally members of the same political party, headed by a guy who has shown again and again the he has no regard for the law (“I have an Article 2 where I have the right to do whatever I want as president.”) that HHS would give Utah permission to rip the heart out of the ACA.

And then they didn’t.

We found out Friday that the federal Department of Health and Human Services will be denying the waiver the state wanted.

No, HHS says, you can’t get the full 90/10 federal match to pay for a plan to insure a minuscule group of the very poor and disabled. That level of federal support is reserved for states that do what the ACA tells them to do, what 37 other states have already done, to expand Medicaid eligibility up to 138% of the federal poverty level.

Sadly, perhaps, the denial of the waivers isn’t really based on concern for the law or empathy for people who need access to health care. It’s drawn from the administration’s claim — backed by a platoon of Republican state attorneys general, including Utah’s Sean Reyes — that the whole ACA is really unconstitutional.

So, say the feds, while we are arguing before various judges about that, we aren’t granting any waivers that are supposedly allowed by a law we are trying to kill.

Whatever.

With the waiver request dead, SB96 is swept aside and Prop 3 lives again. Or at least it should.

The claim that we can’t afford is it is false.

The feds pay 90 percent of increased costs. That money doesn’t just fall into a black hole. It pays hospitals and doctors and nurses and orderlies and technicians and cooks for their services. It greatly reduces the unpaid care that hospitals shift along to paying patients and their insurance companies.

All that money revolves through the Utah economy, creating jobs in and out of the health care field. That’s the kind of multiplier effect Utah Republicans are pleased to trumpet when the money goes for military facilities or highways, but try to deny when it provides health care to the working poor on its way out into the wider economy.

If the courts ultimately strike down, or Congress ever repeals, Obamacare, we will deal with it then. In the meantime, refusal to fully implement Prop 3 is not good government or responsible management. It is spite.

George Pyle.

George Pyle, editorial page editor of The Salt Lake Tribune, feels a fair amount of liberal guilt complaining about how much he’s paying for health care when he sees how those costs can bankrupt or literally kill other people.

gpyle@sltrib.com

Twitter, @debatestate