In our opinion: Expanding Medicaid

Published: Sunday, Feb. 16 2014 12:00 a.m. MST

Utahns for the Medicaid Expansion held a rally in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City.

Matt Gade, Deseret News

Enlarge photo»

Because of the way the Affordable Care Act (often referred to as Obamacare) has come forward, Utah faces two serious problems that the governor and the Legislature can solve together in a spirit of principled pragmatism.

The first problem raises a question of fairness, the second a question of finances. Both can be addressed by authorizing Utah’s governor to negotiate a sensible expansion of Medicaid in order to help our neediest neighbors while recouping Utah taxpayer dollars now flowing to Washington.

A hole in the safety net

The Deseret News has long expressed grave concern for how the unrestrained growth of entitlement programs threatens our nation’s finances. We have consistently opposed the monstrous overreach and complexity of the Affordable Care Act.

But we have also acknowledged the need for a meaningful social safety net to catch those whose basic needs exceed what family and charity care can practically provide.

In the same 2012 decision that affirmed the constitutionality of the ACA, the Supreme Court invalidated a requirement that every state expand its Medicaid to cover everyone whose income falls below 133 percent of the poverty line. Utah, like many states, has exercised its right to pause and evaluate the costs and benefits associated with what was originally mandated Medicaid expansion.

In the meantime other aspects of the ACA have moved forward, including the extension of subsidies to those whose income is between 100 and 400 percent of the poverty line.

The resulting cruel irony is that more than 50,000 of Utah’s poorest adults — specifically those below the poverty line who don’t otherwise qualify for traditional Medicaid — are without any health care support while better-off workers now enjoy substantial health care subsidies. Moreover, prior programs to help hospitals recoup the costs of uncompensated care extended to these poor have been abandoned under the ACA.

Some of the best analysts in the state have wrestled with how to mend this gaping hole in our health care safety net, exploring, among other things, partial expansion of Medicaid and a more organized system of charitable care. As we have scrutinized the many different proposals and considered their feasibility, we have reluctantly come to the conclusion that the surest, soundest and fairest way to fill this hole is to expand Medicaid to, at the very least, all those below the federal poverty line.

Utah taxpayers are already paying

Many advocates of such expansion have emphasized the attractive cost-sharing — 90 percent federal, 10 percent state — that is freely available to the state if it expands Medicaid to those making 133 percent of the federal poverty line. We, however, find that the cost-sharing arrangement fails to provide the most compelling financial argument for expanding Medicaid. Frankly, we remain skeptical about the long-term viability of any of the ACA’s commitments.

Nonetheless, there is one simple financial reason to expand Medicaid. It stems from what remains all-too-certain about the ACA, and that is how dearly the act already costs Utah’s taxpayers.

In 2012, the Congressional Budget Office and the Joint Committee on Taxation found that between 2013 and 2022, U.S. taxpayers will pay more than $1 trillion in new health care taxes. Extrapolating proportionally by population from that national report would suggest that Utahns could send more than $9.5 billion in new ACA taxes to Washington through 2022, or nearly $1 billion per year.

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