Rick Bowmer, Associated Press
The Utah State Capitol is shown Thursday, March 8, 2018, in Salt Lake City.

SALT LAKE CITY — Following a tense debate Thursday, the Senate passed a Medicaid expansion bill that could potentially expand coverage to an additional 65,000 to 70,000 Utahns, but health advocates are skeptical about whether the move will be approved by the federal government.

HB472 passed the Senate 20 to 8, making it the largest expansion of Medicaid passed by the Legislature since the Affordable Care Act came into law. The House of Representatives passed it earlier this week by a 47-27 vote.

Functionally, the bill is a request made to the State Health Department to seek a federal waiver expanding Medicaid benefits to certain Utahns whose household income is 100 percent or less of the federal poverty level.

HB472 also stipulates that "certain qualified adults ... meet a work activity requirement," according to a summary of the bill.

The coverage of those newly eligible under the expansion would be funded 10 percent by the state and 90 percent by a federal match.

The bill's sponsor, Rep. Robert Spendlove, R-Sandy, has said the state would spend no new money on the program. It would also undo the expansion if the federal funds matching rate falls below 90 percent.

Sen. Brian Zehnder, R-Holladay, the floor sponsor of the bill who introduced it Thursday, said the bill is "a safety net program that reflects our unique Utah values."

However, HB472 has its critics from all sides. The Utah Health Policy Project, a health care think tank, insurance enrollment hub and advocacy organization, told the Deseret News in an email that the bill has "an extremely unlikely chance of approval."

Stacy Stanford, a policy analyst for the Utah Health Policy Project, said that "there is (zero) legal support for allowing 90/10 match for partial expansions" and that a federal approval of such a request would be unprecedented.

"HB472 would provide false hope for hardworking Utahns desperate for health care," Stanford said.

Upon meeting similar skepticism on the Senate floor, Zehnder said there are "encouraging" signs that Utah's request could succeed.

"We have been invited to apply for this waiver by the current administration in Washington. That is very encouraging to me and many others in this room," he said.

Sen. Jim Dabakis, D-Salt Lake City, proposed an amendment to the bill on the floor to enhance the requested Medicaid expansion to 138 percent of the federal poverty level, which is considered the fullest expansion possible under the Affordable Care Act, if the waiver requested in the bill isn't granted by Jan. 1, 2019. The amendment was voted down.

"Let's come to our senses, let's leave our politics aside, let's provide for those who are the least among us who just can't afford health care. Let's not take half a loaf," Dabakis said.

Sen. Gene Davis, D-Salt Lake City, said that in lawmakers conceding they are fiscally capable of expanding Medicaid coverage up to 95 percent of poverty level, there is no reason for them to arbitrarily stop short of full expansion.

He said doing so "discriminates" against uninsured Utahns hovering just above poverty who are also too poor to buy coverage on the federal exchange.

"There's about 160,000 people who don't have coverage currently in the state of Utah who could be currently eligible," Davis said.

Sen. Jacob Anderegg, R-Lehi, criticized Dabakis' amendment, saying "I know people are suffering, but we cannot be all things to all people," and that a full expansion would be "crippling."

Anderegg said HB472 had good ideas in it, but he couldn't ultimately support it because he doesn't believe the federal Medicaid matching rate will stay at 90 percent and that revoking expansion after that changes would be a catastrophe.

Ending Medicaid coverage for those who it had been given to, he said, would mean "it's going to be World War III up here."

"You do not grant an entitlement and then take it back," Anderegg said. "It just doesn't work. ... The political fallout will be disastrous. It will be disastrous, and to that end I am a no vote."

HB472's supporters were vocal, too. Sen. Todd Weiler, R-Woods Cross, spoke of the reasoning of some legislators in years past that passing Medicaid expansion was not a good idea because the Affordable Care Act would be repealed or dismantled following the 2012 and 2016 elections, among other things.

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But, Weiler said, elections have come and gone and the Affordable Care Act is still a reality.

"For the foreseeable future, Medicaid expansion is here to stay," Weiler said. "So I think we ought to stop sticking our heads in the sand."

Despite HB472's passage, Utahns could opt to expand Medicaid coverage fully in November if the ballot initiative seeking to do so, run by the Utah Decides Healthcare, garners enough petition signatures by April 15 in order to place the issue before voters in November.