Late last week, news broke that the Trump administration will not be approving Utah’s pending Medicaid waiver. This news is kind of confusing, so let me sum it up as briefly as possible.
For advocates of full Medicaid expansion, (i.e. the majority of Utahns who voted for Proposition 3 last year), this is good news! I know that praising anything the Trump administration has done on health care is a difficult concept for many — myself included — to comprehend. And in actuality, the administration’s reasoning behind not approving this waiver is really bad. But the results of that unapproved waiver are good, at least for now. So here we are.
The waiver that was denied, had it been approved, would have allowed Utah to break the federal rules for Medicaid expansion which, by the way, have never been approved for any other state that has asked. This waiver would have allowed us to pay only 10% of the costs while the federal government paid 90%, which is the match offered to every state that follows the rules. This match was initially available to Utah after Proposition 3 passed last year. However, Utah legislators wanted the same financial deal, but wanted to break the rules for how many people we could cover (they wanted to cover fewer), and they wanted to add harmful, illegal stipulations to that coverage and who receives it (neither stipulations were included in the people’s bill).
When federal officials made it clear to Gov. Gary Herbert and legislative leadership that we would not be receiving the partial expansion waiver, it sent the message to the Legislature that no, they can’t only expand Medicaid partially and get the same financial match. And in spite of the fact that, again, no other state had ever received this waiver, conservative members of the Legislature insisted earlier this year that we would be the exception to the rule. Spoiler alert: We weren’t.
The people of Utah voted for full Medicaid expansion and wanted to follow the federal rules to do it. Some conservative members of the Utah Legislature were opposed to full expansion for philosophical reasons that they attempted to disguise as fiscal reasons. They repealed and replaced the will of the people, even while advocates and voters knew it wouldn’t work — and said as much — and last weekend they were shut down. Now the people of Utah are left saying, “OK, you’ve made your protest, can we get what we wanted now?”
An interesting fact about this whole kerfuffle that is often glossed over is that, while the expansive health care impact of Prop 3 was repealed and replaced this past Legislative session, the tax that accompanied it was not. That’s right — since April you’ve been paying the tax to help 150,000 more low-income Utahns get health care, but the Legislature only allowed us to cover approximately half of those Utahns. We’re already paying the tax, it’s time for us to see the life-saving benefit it’s supposed to pay for.
And now, with this decision, there is a ray of hope for Utahns who have been frustrated, not only because they believe to their core in the importance of caring for the least of us through Medicaid expansion, but also because they feel unilaterally ignored by powerful forces in the Utah Legislature. In the Prop 3 replacement bill (SB96), there is a fallback plan that will go into effect should the waivers not be approved. This plan, written and implemented by the Legislature, stipulates that full Medicaid expansion — Prop 3 (with a couple small but really good financial fixes) — will go into effect in July 2020 if the waivers are not approved. And since the big waiver that all the other waivers are contingent on — this partial expansion waiver — was turned down, all the Legislature has to do is keep their hands to themselves and allow their own fallback plan — which is really the people’s plan — to go into effect.
That’s right. If the Legislature just gets out of the way, we can actually get what we’ve fought for years to get: health care to people who need it.
So if you’re frustrated by this rigmarole that these politicians put us through, what should you do? You should call your legislators, asking them to allow full expansion to go into effect now. And if they were a part of the problem on Prop 3, it’s up to you to be part of the solution by voting them out in 2020. Not just for the sake of health care, not just because of what they did, but because of what it would mean for the ballot initiative process in Utah. Our constitutionally-protected right is on the line, and we have to protect it.
Katie Matheson is the communications director for Alliance for a Better Utah.