Utah lawmakers get creative with Medicaid expansion

Published: Sunday, Jan. 24 2016 4:20 p.m. MST

Despite years of discussing the issue, Medicaid expansion and various plans to implement it in Utah are again on the docket for this legislative session.

Matt Gade, Deseret News Archives

Enlarge photo»

SALT LAKE CITY — Despite years of discussing the issue without resolution, Utah lawmakers will again take on Medicaid expansion and various plans to implement it for the thousands of Utahns who remain uncovered by health insurance.

And, while some lawmakers are taking approaches that have been tried before, others are trying new things — an indication of a potential desire to bring health care benefits closer to Utahns who can't afford them.

"We're moving slowly in the direction of getting it. It's frustrating how long it takes, but I believe we're moving in that direction," said Rep. Ray Ward, R-Bountiful, who is backing a bill (HB18) with an underlying concept similar to that of UtahAccess+, which failed to gain favor of the house majority and never made it before the whole body for consideration last summer.

There are nearly 70,000 Utahns in the coverage gap — earning too much to qualify for existing Medicaid coverage, but not enough to qualify for subsidized health insurance through the Affordable Care Act's federal marketplace. The majority of them have no option for health care and usually end up looking for help in the emergency room, with insured Utahns making up for those costs.

Ward wants health coverage options for every Utahn in the coverage gap, up to 138 percent of the federal poverty level, seeking waivers to get there and then pay for it with a hospital assessment and a new tax on e-cigarettes.

"My bill is what I want and what I feel would be best for this state," Ward said.

The same hopefulness is had by Senate Minority Leader Gene Davis, D-Salt Lake City, who has twice steered the discussion toward full expansion "the way the Affordable Care Act intended it" in the past two years. His substitute bills have been shut down, and this year, he's bringing back the same idea in its own bill, SB77.

"I want access for all Utahns to health care, not a selected few," Davis said, adding that he doesn't like bills that discriminate based on income or ability or other factors. He said he won't vote for anything that singles anyone out or isn't fair.

In his bill, Rep. Robert Spendlove, R-Sandy, is looking to bypass the current federal administration and start working with "the next one" on a plan for Medicaid expansion in Utah. He's hoping for more flexibility for the state — though nothing could happen until after the election.

His bill would extend coverage for those up to 100 percent of the poverty level, but it would seek the full reimbursement available from the federal government, requiring a waiver. The full match has been offered only to states that expand to 138 percent, per the Affordable Care Act rules. Spendlove is also eyeing a work requirement and other ideas that federal officials have already balked at.

"It's a difficult issue," he said, adding that the three main issues surrounding potential options are the cost, quality and access. "It's easier to just go after one and really hard to get all three."

But Spendlove, who ran a similar bill last year, said he's "committed to doing something."

Utahns hanging in the balance are also hoping for some movement, though it remains unclear where the most support will be, as the various proposals for partial expansion stand to help only specific populations of people in need.

One thing for sure, said RyLee Curtis, senior health policy analyst with the Utah Health Policy Project, "it's become clear over the years that the need is there."

But the proposals introduced and some not yet numbered (with likely more to come from other lawmakers), Curtis added, may not meet the real need.

Try out the new DeseretNews.com design!
try beta learn more
Get The Deseret News Everywhere