SALT LAKE CITY — A bill extending Medicaid health care coverage to some 16,000 Utahns who are chronically homeless, involved in the criminal justice system, or have substance abuse or mental health issues was passed by the House on Friday.
HB437 is "providing a hand up," the bill's sponsor, House Majority Leader Jim Dunnigan, R-Taylorsville, said. "I think this is the right policy and an appropriate step for Utah."
After more than a half-hour of debate, the House approved the bill 55-17, without any Democratic support. The bill now goes to the Senate, where its Senate sponsor, Sen. Allen Christensen, R-North Ogden, predicted it will pass easily.
A Senate bill calling for Utah to accept the full Medicaid expansion available under President Barack Obama's health care law, SB77, sponsored by Senate Minority Leader Gene Davis, D-Salt Lake City, is also awaiting action on the Senate floor.
With Friday's vote, Dunnigan's "Health Improvement Initiative" seems to be the likely successor to Gov. Gary Herbert's more expansive Healthy Utah plan for full Medicaid expansion that last year passed in the Senate but failed in the House.
Some 110,000 Utahns are eligible for Medicaid expansion under the Affordable Care Act. That includes 60,000 Utahns in the so-called coverage gap who earn below the federal poverty level but currently don't qualify for federal health care subsidies.
"Last year, we had an open-ended entitlement program before us. We had no control. We had no input," said Rep. Norm Thurston, R-Provo. "This year, we have a limited-scope program that addresses the needs of the most vulnerable among us."
Thurston said Dunnigan's plan is part of the existing Medicaid program. "It's not Obamacare," he told House members, suggesting lawmakers should have been willing to limit coverage last year to ensure the neediest received care.
They are people, Thurston said, "we always could have covered and we probably should have covered, quite frankly. If we hadn't wasted our time trying to go for the home run, we could have gotten some people on base."
By tapping traditional Medicaid, Utah would forfeit the higher match rate available under the Affordable Care Act, but Dunnigan said the state would gain more control over enrollment and other factors affecting costs.
The price tag for his bill is $100 million, but the federal government will pick up $70 million. Hospitals have agreed to pay up to $13.6 million of the state's $30 million share.
No Republicans spoke against the bill, which has the backing of House Speaker Greg Hughes, R-Draper, although six Republicans voted against it. Democrats, however, raised concerns about the Utahns who won't be helped by the bill.
"I rise in conflict with this bill," Rep. Sandra Hollins, D-Salt Lake City, said. "Do I vote yes and support the 16,000-plus individuals who will be covered? Or do I stand with the 94,000-plus people who we're leaving behind?"
Hollins, a social worker, asked what she should tell a 61-year-old man recently laid off from his job who is suffering chest pains. "Should we tell him, 'Go to the doctor, get a big bill, lose your home,'" she said, so he can eventually get help.
House Minority Leader Brian King, D-Salt Lake City, had encouraged Democrats during a caucus meeting Wednesday to vote against the bill if the Republicans had the 38 votes needed for it to pass.
Eleven of the 12 Democrats in the House voted against the bill. Rep. Marie Poulson, D-Cottonwood Heights, who said during the debate she was "so saddened and disappointed" over what she called a "watered-down" plan, did not vote.
Rep. Jake Anderegg, R-Lehi, said he didn't want to see lawmakers "dig ourselves into a financial hole" by providing coverage and still worries about what more might be asked for next year.
But Anderegg said he could support Dunnigan's bill.
"We do have a moral obligation to this group of people. It may not be everything everybody wants. But this is a good, measured first step," Anderegg said.
House Majority Whip Francis Gibson, R-Mapleton, also backed the bill "with much shocking to my soul" because of his past opposition to Medicaid expansion. Gibson is sponsoring legislation to fund services to the homeless.
"I realize that this bill may not be what some of my colleagues in this room would like or many of the citizens, who feel like they need more," Gibson said, calling for the state to continue helping "those people who are the truest in need."
Rep. Paul Ray, R-Clearfield, the House chairman of the Social Services Appropriations Subcommittee, said Dunnigan's plan will provide services to the "poorest of the poor" at a lower cost than other programs.
"It's the right thing to do, and it certainly helps protect our budget," Ray said.
Before the vote, Dunnigan read a statement from Keith McMullin, president and chief executive officer of Deseret Management Corp., the parent company of the Deseret News and KSL, made during the committee hearing on the bill.
McMullin, who has served as managing director of The Church of Jesus Christ of Latter-day Saints’ welfare services activities, had cited his decades of experience with "this most vulnerable population" in Utah and abroad.
Dunnigan quoted McMullin saying he understands "a society grows and prospers as it attends to those who are most vulnerable within it. I believe this particular initiative addresses that need within our state."
The governor, who had said Dunnigan's plan to cover only a portion of the Utahns in the coverage gap was "certainly better than zero," was pleased to see a plan progress in the Legislature.
"From the very beginning, the governor and legislative leaders have said that doing nothing was not an option," Herbert's spokesman, Jon Cox, said in a statement. "Today, we are one step closer to making good on that promise."
Contributing: Emily Larson