Supporters of full Medicaid expansion in Utah have presented it as a take-it-or-leave-it-proposition. But it is not. There is another way — a more fiscally responsible and flexible way.

Utah has grappled to fill the Obamacare coverage gap. Both full Medicaid expansion proposals (Healthy Utah and Utah Access+) rightly failed because they risked putting too great a tax burden on Utahns for uncapped costs.

To date, 30 states and the District of Columbia have done full Medicaid expansion under Obamacare — most with disastrous fiscal consequences. New Mexico is the most recent state to feel the burn of irresponsible Medicaid expansion. In late October, New Mexico’s Human Services Department told state legislators to budget $1 billion to cover the state’s rising share of Medicaid expansion expenses in 2016 — what one lawmaker described as a “runaway train.”

Utah would be on that same runaway train if not for state legislators who withstood enormous pressure to hand over the key to the public safe. I applaud those legislators’ fiscal foresight and fortitude.

Supporters of full Medicaid expansion in Utah have presented it as a take-it-or-leave-it proposition. But it is not. There is another way — a more fiscally responsible and flexible way.

Starting Jan. 1, 2017, under Section 1332 of the Affordable Care Act (known as the State Innovative Waiver or Super Waiver provision), Utah may request to receive all federal health-related funding (not just Medicaid expansion funding) as a block grant — without many of the federal strings attached to Medicaid expansion dollars. This Super Waiver would give Utah maximum flexibility to improve on our current approach for taking care of the truly needy.

To take advantage of the Super Waiver, Utah must present to the U.S. Department of Health and Human Services and the U.S. Department of the Treasury a Super Waiver plan that includes:

  • any Obamacare provisions Utah seeks to waive;
  • rationale for the specific requests;
  • a plan of how to provide coverage to those who fall in the gap;
  • a 10-year budget showing the plan is deficit-neutral to the federal government;
  • adequate assumptions, data and analysis; and
  • Utah’s enacted legislation giving the state authority to implement the process.
Other states are already developing such Super Waiver plans. Utah should, too.

By using alternative and innovative ways to cover those with legitimate hardship or need, Utah can lead the nation in meaningful reform and improve our current program. For example, Utah’s Super Waiver plan should:

  • incentivize productivity, not merely provide handouts;
  • incentivize lower-income workers to use employer-sponsored plans;
  • include tools to tackle rising costs of health care, not just subsidize insurance plans;
  • require work provisions for able-bodied adults;
  • provide for patient-empowering solutions such as health savings accounts;
  • eliminate penalties for those who don’t purchase Obamacare-approved plans; and
  • give full coverage for children below the poverty line.
Importantly, Section 1332 provides a way to protect Utah’s taxpayers from runaway costs. Utah’s Super Waiver plan should limit expenditures to the federal grant amount — ratcheting up (or down) coverage each year depending on the size of the federal block grant that year. Thus, unlike taxpayers in states that have enacted full Medicaid expansion, Utahns needn’t worry about tax increases or decreases in education funding to cover runaway and uncapped liabilities.

Admittedly, this process is complicated and will take time. But it’s time to stop fighting over Medicaid expansion proposals that are bad for taxpayers.

It’s time for the governor and the Legislature to work together to pass a bill to start the Super Waiver application process so that Utah can help those truly in need while protecting taxpayers.

It’s time to come up with a true Utah solution.

Jonathan Johnson is the chairman of and a 2016 candidate for governor in Utah.