SALT LAKE CITY — Last year's most hotly debated legislative topic is finally heating up in the final weeks of the session, with a Senate committee voting Tuesday to advance a Democratic bill calling for full Medicaid expansion.
The surprise 5-1 vote by the Senate Judiciary, Law Enforcement and Criminal Justice Committee on SB77, sponsored by Sen. Minority Leader Gene Davis, D-Salt Lake City, comes as a new Medicaid plan backed by House leaders is about to be introduced.
A long-awaited proposal by House Majority Leader Jim Dunnigan, R-Taylorsville, expected Wednesday, is being touted as the House GOP's alternative to Gov. Gary Herbert's Healthy Utah plan and its short-lived successor, UtahAccess+.
Healthy Utah failed in the House in 2015 despite backing from the Republican governor and the GOP-controlled Senate. The second plan, from Herbert and GOP legislative leaders, surfaced late last year but had little support.
Unless the state accepts Medicaid expansion or comes up with a plan acceptable to the federal government, some 63,000 low-income Utahns can't qualify for the health care subsidies available under President Barack Obama's health care law.
Dunnigan said his new bill will provide traditional Medicaid coverage to about 16,000 Utahns earning below the federal poverty level who fall into the coverage gap.
"It covers those most in need. It's going to help the homeless; it's going to help those with mental and behavioral health issues," including those in the criminal justice system, Dunnigan said.
He said the price tag for the plan is $100 million annually, but $70 million would be paid by the federal government, and hospitals have agreed to pay 45 percent of the state's $30 million share.
But Davis won a committee endorsement for a bill that would cover all 110,000 Utahns eligible for Medicaid expansion under the Affordable Care Act because they earn less than 138 percent of the federal poverty level.
"This is the right thing to do. Sometimes it comes down to doing the right thing," Davis told the committee after describing how the federal program would end up costing the state $50 million annually but bring back $575 million in benefits.
He also pointed out his bill includes an out for the state should the federal government not live up to its committment to fund 90 percent of the program's cost.
The three Republicans senators who supported the bill in committee indicated they may not back the bill on the floor.
"I don't think we can have a third year pass where we do nothing," Sen. Daniel Thatcher, R-West Valley City, said after noting the Senate's past efforts on Medicaid expansion have been thwarted by the House's inaction on the issue.
"I can't promise I can support this on the floor, and even if we do (pass it), I don't know where we're going to come up with the money in a year where we've got budget shortfalls," he said. "But I do think we need to continue moving forward."
Similar statements were made by other Republicans who voted for the bill, the committee chairman, Sen. Mark Madsen, R-Saratoga Springs, and Sen. Steve Urquhart, R-St. George.
Senate Budget Chairman Lyle Hillyard, R-Logan, cast the sole Republican vote against the bill. Hillyard raised concerns about controlling the program's costs and said he expects the bill to fail on the Senate floor.
"I just think when you look at all the concerns and questions, I just don't think it will have the support," Hillyard said, calling Davis' bill "way too broad" compared with last year's Healthy Utah plan.
Davis said after the hearing he believes his bill has a chance on the Senate floor. Tuesday's vote was the first time full Medicaid expansion has been advanced by a legislative committee.
"At least in the Senate, I feel there may be some shifting of attitude on this," the minority leader said. But he acknowledged even if he can get the Senate to pass the bill before the session ends March 10, it won't go far in the House.
"I know it's DOA when it gets to the House," Davis said.
House Speaker Greg Hughes, R-Draper, supports Dunnigan's bill but had a warning for opponents of a more limited plan.
"This is actually a very difficult and heavy lift. It's important. We believe that it's something we should be doing," Hughes told a reporter. "However, if it is met with contempt and protest, it would be very hard."
The speaker said he's looking for public confidence in the plan before committing limited resources to it. Lawmakers learned earlier this week that revenue growth estimates for the upcoming budget year were too optimistic.
"I want to be careful. I'm not trying to throw any threats out there," Hughes said. "There's been a lot of emotions and a lot of people that have expressed their opinions on this strongly, and we need to get a bill passed. We need support."
Andrew Riggle, policy rights advocate for the Disability Law Center, said Hughes' language is "troublesome" to supporters of Medicaid expansion who are still hoping to see action.
"I think we understand where he's coming from, especially in terms of his frustration. I think we all share that frustration, but it should be really about how can we take steps to solving this very real issue," he said.
Still, Riggle said, because the discussions now "are a little more low key this year and less public, it feels like there may be more of an opportunity to get something done. It may not be what we all hoped it would be."
Sen. President Wayne Niederhauser, R-Sandy, said the Senate has taken a "sidestep" on the Medicaid issue since passing bills the House rejected last year. He said senators now are waiting to see what the House can pass.
"I'm hoping they’ll get something at least incremental for us to consider over here," he said. Niederhauser has previously said passing something this session would be better than doing nothing.
Dunnigan said he's not sure how his bill will fare in the House.
"It remains to be seen among my colleagues. I think some definitely want to do something and some want to take a breather," he said. "Of course, there are people in the public who want to do more."
But, Dunnigan said, "there are also quite a few in the public who want to do something, who want to get started."
Contributing: Dennis Romboy