SALT LAKE CITY — Recent actions in Washington, D.C., may be reason enough for Utah lawmakers to reignite attempts to expand Medicaid, but some are still more hopeful than others.
Sen. Gene Davis, D-Salt Lake City, has again proposed full expansion, aiming to accomplish what he believes the Affordable Care Act sought to do — insure all Americans.
"Somehow we keep kicking this thing down the road, saying it's about the indigent poor," Davis said. "People are working. People are existing, and they can't afford the product they deserve."
It's a move he's tried for years to no avail.
Utah's conservative majority has sidestepped full expansion, opting instead to extend Medicaid benefits to a portion of "the most vulnerable" population, specifically homeless people with drug addiction and/or mental health issues, but eligibility is limited, and few actually meet the stringent qualifications.
Richard Haddan, of Rose Park, lost the lower part of his left leg about a month ago — a complication of diabetes that he has battled more than a decade. He's been turned down for numerous federal and state programs over the years and was surprised last week when he was told he'd been accepted for Medicaid.
"I'm going to let that settle," he said, a little skeptical of his new reality.
"I need help with these bills," said Haddan, 47, and homeless.
Being a new amputee has its challenges, he said, and he'd like to get back to being mobile soon.
In addition to a prosthesis and physical therapy that comes with it, Haddan needs assistance with quitting a 20-year heroin addiction, too.
The Targeted Adult Medicaid program, Utah's version of partial expansion that became available Nov. 1, will give Haddan access to health care for the first time since he was "a kid," he said.
Haddan is one of about 500 people who have met new requirements for Medicaid, though lawmakers initially aimed to enroll thousands by now.
"It was never designed to be an extension for everybody," said Karen Rodriguez, outreach and enrollment coordinator at the Fourth Street Clinic.
Rodriguez said the new program expansions have been "phenomenal" in facilitating health care for people who really need it, the most vulnerable population — statutorily defined as the chronically homeless with substance abuse and mental health problems.
"We can help them get access to care and then connect them to work resources to get them on their way to better lives," she said.
Still, nearly 60,000 Utahns fall into the so-called coverage gap, making too much money to qualify for Medicaid but not enough to afford health plans offered through the federal marketplace.
"In trying to reach such a narrow population, you end up with rules that are restrictive enough that it's hard to even cover that population," said Bill Tibbitts, associate director at Crossroads Urban Center, which assists low-income and disabled people with various resources.
He said it is great to give more people access to health care, but the uptake is slower than expected.
With a Republican majority in Washington, Tibbitts said it would behoove Utah lawmakers to ask for more of what they want and ultimately cover more needy Utahns but also get more federal subsidies for the program.
But some remain wary of going too far.
"Full Medicaid expansion probably is not going to pass the Legislature," Senate President Wayne Niederhauser, R-Sandy, said during an event highlighting legislative priorities.
Niederhauser said the extension approved last year is just a "first step" in covering people who need it the most and the remainder can access the federal health exchange and tax incentives available there.
"The flaw is in the federal law," he said. "The federal law doesn't address the most vulnerable."
Niederhauser mentioned, however, that if Utah could "get a waiver" to cover people making up to 138 percent of the federal poverty level, it might be worth talking about.
He agreed it is a more likely possibility with the current administration.
President Donald Trump weeks ago gave federal permission to states to impose work requirements, which was a facet of Gov. Gary Herbert's Healthy Utah plan, an alternative to Medicaid expansion that was developed and failed to pass the Legislature in 2015.
The resulting extension passed last year was "the best we could do under the Democratic administration," Utah Lt. Gov. Spencer Cox said.
Cox said he's "in talks" with House Speaker Greg Hughes, R-Draper, who was a kingpin in striking down previous deals for greater expansion.
The fact that work requirements are again on the table may be enough to encourage more support for the measure.
It falls in line with Utah's initial plans when Medicaid expansion first became an option under Obamacare.
In addition to Davis' all-or-nothing approach in SB47, at least one other bill is in the works, as Rep. Robert Spendlove, R-Draper, intends to revise current efforts. Other lawmakers are seeking to make amendments to Medicaid, some requiring waivers to permit various services, such as family planning.
Spendlove has said he is confident that the Trump administration will work with them and provide the flexibility state leaders desire.
They must collect at least 113,143 registered voter signatures by April 15 for it to happen, and it would result in a 0.15-percent tax increase.
The money, matched by $800 million federal dollars, would cover the cost of expanding the program to low-income Utahns who earn up to 138 percent of the federal poverty level — less than $2,727 a month for a family of four, or less than $1,337 a month for a single adult.
Hughes told the Deseret News the plan wouldn't work and could end up compromising the entire state budget.
"Utahns are fiscally conservative," he said. "We don't want our tax dollars obligated toward things we can’t control or can't afford."
Utah Decides reported widespread support for Medicaid expansion following a December Utah Policy poll conducted by Dan Jones & Associates. About 36 percent of Utahns oppose expansion, according to the poll.
Health care reform was signed into law in 2010, with its major provisions taking effect in 2014. It gave states the option to expand federally subsidized but state-run Medicaid programs to cover more low-income adults — and 32 states did just that, adding 11 million beneficiaries to their rolls.
Though, 18 states, including Utah, are holding out for various reasons.
Some states that have expanded access to benefits have expressed regret or are reeling with excessive costs resulting from unpredictable data as more people enrolled than was expected.
Utah lawmakers have had similar concerns, debating what is called "the woodwork effect" that results from a former federal mandate that every American must have health insurance or pay a fee.
That mandate was repealed in the recent tax bill approved by Congress and signed by Trump just before Christmas.
That could mean that fewer residents will sign up for Medicaid even when it is made available to them, which might also mean a smaller price tag for the state.
But further expansion, as some have said, might be another battle on the hill.
Targeted Adult Medicaid, House Minority Leader Rep. Brian King, D-Salt Lake City, said, "is better than nothing.
"But it's about one-tenth of the people covered that would have been covered by full Medicaid expansion at a much greater cost per person covered," King said.5 comments on this story
The effort, he said, has left many "very vulnerable" people out.
Utah Democrats will support any effort to expand coverage and still aim for full expansion, King said.
"It's going to be a real challenge," he said.
For Haddan, however, the newfound access, he said, "will be lifesaving."
"I've applied for help off and on for years," he said, adding that last week was the first he'd heard of the program. "I heard about it in the waiting room.
"I'm going to get me a leg."