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Dan Liljenquist: Act responsibly by rejecting Medicaid expansion

Published: Thursday, March 14 2013 12:00 a.m. MDT

By far the most troubling argument I have heard in favor of Medicaid expansion is the idea that Utah will not be getting its "fair share" of the federal pie if we choose not to expand.

T.J. Kirkpatrick, Deseret News

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Today marks the end of the 2013 legislative session. For the most part, our leaders have done an admirable job balancing the budget and exercising appropriate judgment and restraint. I congratulate my former colleagues and friends for their hard work on behalf of the residents of Utah. As the session ends, however, there is one major policy consideration that has yet to be decided — should Utah exercise its option to expand the Medicaid program? That decision appears to rest squarely on Gov. Gary Herbert's shoulders.

Medicaid began in the 1960s as a joint federal and state health care safety net program for children and families living under the federal poverty line. The Affordable Care Act (ACA; also known as Obamacare) significantly expands Medicaid eligibility in 2014 to millions of new people nationwide. Last year, the United States Supreme Court upheld the ACA legislation, but ruled that states could not be forced to expand Medicaid eligibility. Now Utah, through Gov. Herbert, is deciding whether or not to accept Medicaid expansion.

I believe that expanding Medicaid is a bad idea.

First, the expansion of Medicaid would cost Utah taxpayers a fortune over the next few decades. Proponents of expansion argue that the federal government will pay 100 percent of the expansion costs for the first three years and 90 percent of the costs thereafter. Setting aside the fact that additional federal Medicaid spending will undoubtedly increase federal tax liabilities for Utah citizens, the 10 percent portion that the state will be required to fund directly will cost billions of dollars that could be used for public education or other worthy purposes. There is no such thing as a free lunch, and Medicaid expansion is no exception.

Second, Utah just implemented new Medicaid reforms that are designed to curb runaway health care costs for our existing Medicaid population. Our Medicaid reforms were just barely implemented in January and must be allowed to take root. Expanding Medicaid at this time would put unnecessary stress on Utah's recent Medicaid reforms, and could derail them altogether. These Medicaid reforms are expected to save taxpayers $2.5 billion over the next seven years alone.

Finally, Medicaid expansion is central to the Obama administration's long-term strategy to migrate to a single-payer system, where federal bureaucrats would have ultimate control over health care decisions. Medicare and Medicaid expenditures already account for more than 50 percent of all health care spending in this country. Driving millions of new Americans into Medicaid could collapse the private insurance market altogether. While Utah may not be able to stop this strategy by itself, we need not be complicit in making it a reality. I think it is appropriate to note that the strongest advocates for Medicaid expansion in Utah are also in favor of a move to a single-payer system.

By far the most troubling argument I have heard in favor of Medicaid expansion is the idea that Utah will not be getting its "fair share" of the federal pie if we choose not to expand. After all, if Utah does not expand Medicaid, Utah taxpayers will still be on the hook for some of the Medicaid expansion costs in other states. Frankly, we cannot control what other states choose to do with Medicaid expansion. We can only hope to control ourselves. The "get all you can when you can" approach to federal spending is destroying the full faith and credit of the United States.

States have been complicit in creating the seemingly endless cycle of deficits and debt. Congress clearly will not govern itself. Somebody must be the adult in the room, and Utah is in a position to lead by example.

Dan Liljenquist is a former state senator and U.S. Senate candidate.

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