As Utah’s “Gang of Six” looks for a solution to Obamacare’s Medicaid expansion problem, and does so under the shadow of the looming Supreme Court decision in King v. Burwell, they would be wise to move beyond the failings of previous Medicaid expansion proposals. As you will recall, this “Gang of Six” (Gov. Gary Herbert, Lt. Gov. Spencer Cox, Utah House Speaker Greg Hughes, State Rep. Jim Dunnigan, Utah Senate President Wayne Niederhauser and State Sen. Brian Shiozawa) was formed at the end of the 2015 legislative session to resolve disagreements over how to address the Medicaid expansion problem.
The failings of previous Medicaid expansion proposals have been driven by flawed policy priorities. The design of Healthy Utah, for example, prioritized money first (i.e., getting Obamacare Medicaid expansion funding) to the point that it neglected the human beings currently involved in Medicaid: low-income children, single parents and the disabled.
This is a case of trying to do the right thing (help vulnerable Utahns) in the wrong way (at the expense of Utah’s most vulnerable). Fortunately for Utah, the “Gang of Six” negotiations provide an opportunity to fix these priorities. This means balancing the benefit of expanding Medicaid against the increased harm and suffering that expansion is likely to cause those who are most dependent on Medicaid.
What does this harm look like? Imagine the emotional strain of a parent unable to find a doctor willing to accept her sick child as a new patient on traditional Medicaid, because Medicaid expansion’s superior payments incentivize health care providers to prioritize new expansion patients over new traditional Medicaid patients. Imagine disabled Utahns suffering longer without needed health care services because their traditional Medicaid coverage leaves them on a waiting list rather than getting them good access to health care. You have now imagined a Utah based on the priorities of Obamacare’s Medicaid expansion funding — a circumstance now experienced by states as politically and culturally diverse as Arkansas and Oregon because their elected leaders prioritized money before men, women and children.
How can we ensure that we get our policy priorities right in any Medicaid expansion compromise? Here are four guidelines that should help:
First, a good compromise solution will protect the health care access of children, the disabled and single parents currently on Medicaid. This can be done by crafting a compromise that incorporates current Medicaid enrollees into the program, rather than excluding them, or by setting caps or qualifications that minimize the number of people who can enroll in the compromise plan.
Second, a good compromise solution will not seek Obamacare’s Medicaid expansion funding. Any plan that seeks to qualify for this funding will be required to exclude the vast majority of current Medicaid enrollees, who are not provided for under Obamacare. This unnecessary restriction means that expansion proposals seeking Obamacare funding will jeopardize the health care access of Utah’s most vulnerable. While the promise of money is tantalizing, we should heed the time-tested wisdom that those who do things primarily for money usually live to regret it.
Third, a good compromise solution will not offer coverage to those who already qualify for Obamacare insurance subsidies. There is no sense in creating a new, partially state-funded Medicaid program for individuals who already receive financial assistance under Obamacare without requiring state assistance. Every state tax dollar spent shifting individuals from federally subsidized private health insurance to a state-subsidized Medicaid program is a tax dollar wasted.
Fourth, a good compromise solution will give Utah policymakers flexibility to both establish cost controls on behalf of Utah taxpayers and make needed minor adjustments, without requiring permission from the federal government. As both reason and common sense suggest, policymakers need the ability and flexibility to adjust plans for Utah that make sense on paper but play out differently in reality.
Sutherland Institute applauds the efforts and sincere desire of the “Gang of Six” to do what’s right for the state of Utah. But we also recognize that it is imperative any new Medicaid policy be responsible and reasonable for everyone — taxpayers as well as the low-income children, single parents and disabled Utahns that currently depend on Medicaid. If we prioritize money over people we will get neither responsible nor reasonable policy, and will only be left with regret.
Derek Monson is director of public policy for Sutherland Institute, a conservative think tank in Salt Lake City.