Matt Gade, Deseret News
The problems with the ACA are abundant and troublesome. Yet Utah legislators should view the national showdown over the law as opportunity to craft a sensible compromise on Medicaid, expanding reach while retaining flexibility in its administration.

In tackling hard problems, Utahns of all political views can rightly point to the state’s collaborative and consensus-based approach to resolving differences. Unfortunately, our state’s attempt to establish a prudent safety net providing health care for the poor has gotten all tied up in the politics of the Affordable Care Act.

This shouldn’t stop the Legislature from supporting a sensible expansion of Medicaid. And the impact of Utahns coming together on a solution could be nationally significant.

Utah can provide a way for the Obama administration to put substance behind the president’s statement last week: "States that don’t expand Medicaid are going to be leaving up to 5.4 million Americans uninsured. And that doesn’t have to happen. Work with us to get this done. We can provide a lot of flexibility," Obama said at the meeting of the National Governors Association. Gov. Gary Herbert deserves credit for accepting that challenge.

The basic problem here lies in the way the ACA has rolled forward. 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.

We applaud leaders in the House for coming forward with important initiatives that would expand charity care for poverty-level individuals through Utah-specific programs. Each of the initiatives put forward by House members — the Utah Premium Partnership, Primary Care Network and Flexible Spending Accounts — rely upon a 70 percent match of federal funds together with 30 percent from state funds.

Similarly, we thank the members of the Senate for putting forward common-sense effort to expand Medicaid to individuals in poverty. Those above 100 percent of the poverty line would be able to purchase subsidized health care through the ACA’s website, This plan also relies upon a 70 percent match of federal funds.

Herbert’s proposal seeks to retain more of Utahns’ federal tax payments for health care. Instead of 70 percent, Herbert seeks to negotiate with the Department of Health and Human Services to provide the 100 percent benefit (over three years) that is promised under the ACA. But instead of a blanket expansion of Medicaid, Herbert’s “Healthy Utah” offers subsidized premium for individuals below poverty, and a subsidized benefit for those slightly above poverty, or up to $15,500 of annual income.

Those who insist that Herbert has no chance of wresting concessions from the Obama administration aren’t recognizing that Herbert has done exactly that on two other high-profile matters.

In the early phase of state health insurance exchanges, states were expected to establish marketplaces for uninsured individuals. Utah officials instead sought — and received — federal permission to operate Avenue H, a health insurance exchange offering insurance for small businesses with up to 50 employees. It fills a crucial need.

And don’t forget the federal government shutdown last October. When Congress couldn’t get its act together, Herbert proposed to the Department of the Interior that Utah pay for operating the national parks in Utah during the shutdown. Utah benefited handsomely from taking that initiative, according to a report released Monday by the National Park Service.

The problems with the ACA are abundant and troublesome. Yet Utah legislators should view the national showdown over the law as opportunity to craft a sensible compromise on Medicaid, expanding its reach while retaining state flexibility in administration.

We also call on the Obama administration to live up to the president’s commitment and negotiate a good-faith waiver allowing Utah to prudently expand health coverage to the poor.