Rick Bowmer, Associated Press
Utah Gov. Gary Herbert makes remarks during Medicaid expansion news conference Thursday, Feb. 27, 2014, in Salt Lake City.
What the governor has asked the Department of Health to do is watch a few other states closely to see what they have done and what they are proposing," McKay said. "Utah is one of the states they're keeping an eye on. —Renny McKay, spokesman for Wyoming Gov. Matt Mead

SALT LAKE CITY — Gov. Gary Herbert's proposed alternative to Medicaid expansion is getting attention from neighboring states that initially rejected the coverage available under President Barack Obama's health care law.

Herbert is in "active conversations" with fellow Republican governors who are rethinking whether to accept Medicaid expansion, Utah Department of Health Executive Director David Patton said.

"I know Idaho has said no. Wyoming has said no. But they're both talking to the governor, saying, 'What are you guys doing that might be a good idea?'" Patton said.

Idaho is "very interested in what you all are doing and what the governor is proposing over there," Jon Hanian, spokesman for Idaho Gov. C.L. "Butch" Otter, said of Herbert's "Healthy Utah" plan.

"That's more a function where we're more simpatico with the approach you all have taken, not only politically, but regionally and philosophically," Hanian said. "We're very interested in picking and choosing what may work, not reinventing the wheel."

Earlier this month, Otter asked the Idaho Department of Health and Welfare to take another look at Medicaid expansion, including what other states are doing to cover low-income residents under the Affordable Care Act, and report back in September.

Hanian said while Otter "firmly believes that he doesn't want to throw more money into a system he believes is crying out for reform," he is reacting to a recommendation from a state task force that Medicaid be expanded.

Last month, the Wyoming Legislature called on Wyoming Gov. Matt Mead to start talking with the federal government about the state's options for Medicaid expansion.

Mead's spokesman, Renny McKay, said Wyoming's governor still doesn't support Medicaid expansion "as it has been brought forward" but now can determine what the state might be allowed to offer as an alternative.

"What the governor has asked the Department of Health to do is watch a few other states closely to see what they have done and what they are proposing," McKay said. "Utah is one of the states they're keeping an eye on."

After a trip to Washington, D.C., this month to pitch his plan to the Obama administration, Herbert told reporters that states should be given control of the funds available for Medicaid expansion.

"The more the states can have the responsiblity of spending the money, they'll find efficiencies," Utah's governor said. "I do believe other states around the country are watching us in a significant way."

Herbert is seeking waivers to use the $258 million available for Medicaid expansion in Utah for a state-run plan offering private health insurance to 111,000 low-income Utahns.

Nearly 60,000 of those Utahns, those earning less than 100 percent of the federal poverty level, do not qualify for any health care coverage subsidies without the expansion.

He wants to require recipients to work and to contribute to the cost of the plan, through making increased co-payments for services and picking up at least part of the premium.

If Utah succeeds in selling the federal government on what's been called a "block grant approach" to Medicaid expansion, Herbert said other states will want to follow the state's example.

With a Democrat in the White House, states led by GOP governors have a special interest, said Piper Su, vice president for health policy at The Advisory Board Company, a Washington-based health care consulting firm.

"The Republican states are watching one another," Su said. "They're watching to see how the politics of the expansion conversation play out and two, I think they're looking at what specifically other states are negotiating."

Other states, including Pennsylvania, led by Republican Gov. Tom Corbett, either have or are also trying to negotiate more flexibility to require cost-sharing from residents who would benefit from Medicaid expansion, she said.

"We're seeing common themes amongst states where a pure expansion of the public program is perhaps not a palatable option, but a unique take that involved more control over their program and use of a private market approach certainly seems to be appealing and growing like wildfire," Su said.

The president has increased pressure on states to accept Medicaid expansion, which became optional as a result of a U.S. Supreme Court ruling on his signature health care plan, known as Obamacare.

In February, Obama told Herbert and other governors meeting at the White House that his administration could "provide a lot of flexibility" to get coverage for the up to 5.4 million Americans who would otherwise be left uninsured.

But at a press conference Thursday, the president said he was frustrated by "states that have chosen not to expand Medicaid for no other reason than political spite" despite the federal government covering the costs, at least initially.

For "ideological reasons," Obama said, "they have chosen not to provide health insurance for their citizens. That's wrong. It should stop. Those folks should be able to get health insurance like everybody else."

Those statements probably won't have much effect, Su said.

"In these Republican states, admonishments from President Obama probably aren't the biggest consideration in terms of political pressure," she said. The real pressure, Su said, comes from medical providers and patients in those states.

According to an April report by The Kaiser Commission on Medicaid and the Uninsured, 27 states are implementing Medicaid expansion, 19 are not moving forward, and five, including Utah, are still debating what to do.

Decisions made by governors still require legislative approval, and, in Utah, that's not a given. Leaders of the GOP-dominated Utah House and Senate have said Herbert's plan will be a tough sell in a special session expected this summer.

"I think we'll be able to get past some of the ideology," Utah's governor said, calling his plan a "common sense solution" to how best to use the federal funds available.

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Su said it's not going to be easy for governors like Herbert to gain approval from state lawmakers.

"I think the state legislature dynamic is incredibly difficult. It's somewhat difficult for these governors to go out on a limb and accept Medicaid expansion from a political perspective. But they have a statewide constituency," she said.

It can be much harder for lawmakers representing smaller districts to compromise on the issue, Su said. "I don't know that we've seen it completely crush proposals at this point, but probably because they're not far enough along."

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