SALT LAKE CITY — Senate Republicans are considering a proposal to partially expand Medicaid with available federal dollars, putting them at odds with the House GOP, which wants to reject the money.
The latest plan comes as Gov. Gary Herbert said he will announce his own intentions for dealing with the Medicaid expansion offered by the Affordable Care Act, also known as Obamacare, by the end of the week.
"I'll have my own proposal," Herbert told reporters after returning from meetings in the nation's capital that included discussions on the expansion. "I've learned some things while I was back in Washington."
The governor, who has only said "doing nothing" is not an option, said he's just about ready to roll out "what I think we should be doing when it comes to dealing with these people who are falling through the safety net."
Sen. Brian Shiozawa, R-Cottonwood Heights, pitched a proposal to his Senate colleagues in a closed meeting Tuesday. The GOP Senate caucus has not taken a position on any plan but is scheduled to discuss the issue again Wednesday.
Under Shiozawa's proposal, the state would seek a 90/10 funding match from the federal government to cover the estimated 54,000 Utahns who don't qualify for subsidies under Obamacare or Medicaid without an expansion.
Those Utahns fall below the federal poverty level, but that match is now only being offered to states that accept a full expansion of Medicaid to residents earning up to 138 percent of that level.
Utah would have the option to withdraw if the federal funding stops, under the Senate proposal.
"There's so much concern in the Legislature about entitlements getting too big and accepting federal funds. This was a compromise. We cover those patients who are under the federal poverty line. This addresses the coverage gap," Shiozawa said.
The proposal would direct people to private insurance coverage as much as possible, said Shiozawa, an emergency room doctor at St. Mark's Hospital.
If the Legislature approves the Senate plan, he said the governor would take it to Health and Human Services Secretary Kathleen Sebelius.
"We'll be able to go the feds with a bill and say, 'Secretary, we've already passed this. All you have to do is buy off on this and it will go forth. It's not theoretical. This is real,'" Shiozawa said.
That's easier said than done. The Obama administration has rejected the state's request for Medicaid-related waivers in the past.
Shiozawa's plan differs greatly from the House GOP proposal that would reject federal dollars and cost the state about $30 million to $35 million over the next two years as part of a pilot project.
"I think this is more comprehensive. It's better depth for the patients and, for sure, costs the state less and gives us much more federal funding," Shiozawa said.
The House plan, pushed by Speaker Becky Lockhart, R-Provo, passed a House committee Monday on a party-line vote. Supporters say it lets the state keep control of health care, offering coverage only to the neediest residents.
The governor has criticized the House plan as "illogical" because it costs Utah taxpayers more money to cover fewer people. Herbert said Tuesday the House plan offers "false hope," especially to the medically frail.
He was more enthusiastic about the Senate proposal.
"I have had a chance to talk to Sen. Shiozawa," the governor said. "He’s a doctor. He understands the costs of medicine and has his own ideas about what we should do when it comes to Medicaid expansion."
Sen. Jim Dabakis, D-Salt Lake City, called the House plan a "catastrophe."
"The Republican members of the House Business and Labor Committee made a decision to turn back federal health care dollars. It was a horrible vote and a bad decision. It appears to me a decision that can only be justified on ideological grounds," Dabakis said.
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