Matt Gade, Deseret News
Utahns for the Medicaid Expansion held a rally in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City. The group rallied to show Gov. Gary Herbert he has support if he decides to expand Medicaid.

SALT LAKE CITY — House Republicans unveiled a state-funded alternative to taking federal funds to expand Medicaid coverage in Utah that will cost an estimated $30 million to $35 million annually over the next two years.

Under the plan, presented to the House GOP caucus Tuesday, the state would forgo more than $500 million in each of those years in federal dollars available under the Affordable Care Act, also known as Obamacare.

The plan is aimed at helping only the medically frail and parents with children among the nearly 60,000 Utahns who fall below the federal poverty limit and don't qualify for insurance premium subsidies or Medicaid without the expansion.

Those targeted by the plan would get help paying for insurance or medical care.

Just how many people would be covered — and to what extent — is yet to be determined, the authors of the plan, Rep. Jim Dunnigan, R-Taylorsville, and Rep. Dean Sanpei, R-Provo, told the caucus.

But the pair pitched the plan, called Access, as a way to keep the state from becoming entrenched in the federal program between now and 2017, when waivers become available for more flexible health care plans.

The House GOP caucus did not take a position on the plan, which had been touted by House Speaker Becky Lockhart, R-Provo, as a "Utah solution" to dealing with the expansion issue without accepting federal dollars.

"It's not just a political point. It's a politically responsible point," Lockhart told reporters. "We're trying to avoid getting more and more attached to an unsustainable revenue source coming out of the federal level."

The plan, which would not take effect until 2015, was made public before Gov. Gary Herbert announces his intentions on Medicaid expansion. Herbert has only said that "doing nothing" is off the table.

Lockhart, who is seen as a potential challenger to Herbert in the 2016 governor's race, kicked off the 2014 Legislature by criticizing him as an "inaction figure" and warning that participating in Obamacare was a trap for the state.

The speaker said she briefed the governor on the plan put together at her request. Herbert's office said the governor is waiting for more details and will review the House plan then.

Senate President Wayne Niederhauser, R-Sandy, said Senate Republicans will take up the issue at their caucus Thursday. He said they are also considering taking no action, as well as supporting a plan to partially expand Medicaid.

"Our body has not settled on anything at this point," the Senate leader said.

Niederhauser labeled the House plan "expansion lite" and said it raises a number of questions.

"There's a lot of questions to be answered with this plan," said RyLee Curtis, Medicaid policy analyst for the Utah Health Policy Project, after hearing the caucus presentation.

Curtis said not accepting the Medicaid expansion money available from the federal government "makes you kind of wonder. It doesn't make sense. It's putting political ideology ahead of health care coverage for those 60,000 Utahns."

Linda Hilton of the Coalition of Religious Communities called the plan "just maddening. The best program there is is Medicaid. We don't need to reinvent the wheel. We don't need to create a new program."

Lincoln Nehring, senior health policy analyst at Voices for Utah Children, said the price tag for the state plan is not enough.

"It's not going to work," Nehring said, estimating the state plan would provide just $600 a year for those who need care.

Members of the House caucus expressed no serious concerns about the complicated plan, explained to them through handouts that included a flow chart and a page-long summary.

"Medicaid expansion is a lose-lose issue," said Rep. Stewart Barlow, R-Fruit Heights.

Barlow, a doctor, estimated the state would only need to provide coverage to about 10,000 people, what he termed a "manageable" number.

Sanpei said the House plan is an attempt to increase access to the state's "most vulnerable" residents without the strings attached to Medicaid expansion dollars.

"Federal money is not free," he said.

That's an important message for Republicans to hear, University of Utah political science professor Matthew Burbank said, one that will help Lockhart should she decide to run for governor.

"It's probably very good politics for her," Burbank said of the House plan. "Even if the governor says, 'OK, we’re going to move to expand Medicaid and away we go,' she's at least able to say, 'Well, I had an alternative to that.'"

Burbank said while expanding Medicaid may seem like a "reasonably straightforward idea," many in the GOP view it as backing a Democratic program.

"Clearly, that's one of the reasons the governor has delayed and delayed on this," he said.

The House plan at least acknowledges the issue, Burbank said, in a way that allows Republicans to stay away from the federal government while not appearing "entirely cold-hearted."


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