To be clear, Rep. James Dunnigan’s HB437 is not Medicaid expansion. In fact, calling it expansion is both disingenuous and misleading.
The Affordable Care Act originally proposed a mechanism to ensure that all Americans have access to health care. For most of us, that is the so-called “individual mandate.” For those earning less than 138 percent of the federal poverty line, access was supposed to be given by expanding Medicaid. By ruling that the federal government could not force states to expand Medicaid, the Supreme Court left that choice to the states, stripping away the assurance of coverage for that population.
For three years, the Utah Legislature has debated if and how to cover the over 130,000 Utahns who do not have access to affordable care. Some of these are in the “coverage gap” that falls between 100 percent and 138 percent of the FPL. Others, who fall below the FPL, lack coverage because of other Utah Medicaid exclusions (for example, childless adults who are ineligible for Medicaid in Utah).
Dunnigan’s proposal does nothing to address those in the “gap” and targets only a small percentage of those falling below the FPL — those with extreme mental health issues, the homeless and the recently incarcerated. All of those covered by Dunnigan’s plan could have already been eligible for Medicaid under the traditional 70/30 federal/state split, the same as Dunnigan’s proposal, if Utah leaders had not previously chosen to exclude them.
Equally disingenuous is the false narrative that the bill is fiscally responsible. By 2021, Dunnigan’s plan would cost the state approximately $40 million to cover 17,700 Utahns. In contrast, true expansion as promoted by Sen. Davis’ SB77 would cost approximately $44 million by 2021 to cover 105,500 Utahns. Dunnigan’s proposal costs approximately $2,259 per person, whereas Davis’ would cost approximately $417 per person. As Scott Anderson wrote in May 2014 (Medicaid gap: the governor’s plan is common-sense solution), it is “a mistake to forego $258 million a year in tax dollars that Utahns are paying into the federal system.” Utah is leaving those dollars on the table and not addressing a key need for our state. That is not fiscally responsible.
Additionally, Dunnigan’s proposal does not take into account the economic impact or reduced burden on the state that would come from true Medicaid expansion. Tens of thousands of Utahns go month to month paying for rent, utilities, child care, transportation, food, education and other daily needs on less than $500 per person. They are, quite literally, one medical emergency from bankruptcy and joining the ranks of those reliant on other taxpayer-funded programs just to survive. Further, for those without access to health care, non-emergency medical care is too often delayed or provided through the emergency room — a cost assumed by the hospitals, the state and the rest of us through higher costs.
Rep. Dunnigan is the leader of the majority party in the Utah House of Representatives. It is his job to lead. It is not his job to take the easy way out. After years of work, trips to D.C., countless hours in committee hearings and countless meetings, all on the Utah taxpayers' dime, Rep. Dunnigan has failed to lead. Sen. Davis’ plan reflects leadership. Gov. Gary Herbert’s Healthy Utah plan, passed by the Utah Senate, reflected leadership. Rep. Dunnigan’s plan does not.
This is not a failure of Rep. Dunnigan’s caucus, the doctors or hospitals, or those who will support this bill. This is a failure of Rep. Dunnigan’s leadership, and he should be held accountable for it when voters go to the polls in November.
Chase Thomas is policy and advocacy director for Alliance for a Better Utah.