Alex Slitz, Lexington Herald-Leader
Kentucky Gov. Matt Bevin announces federal approval of Kentucky's Medicaid waiver in the Capitol Rotunda in Frankfort, Ky., Friday, Jan. 12, 2018. Kentucky became the first state to require many of its Medicaid recipients to work to receive coverage, part of an unprecedented change to the nation's largest health insurance program under the Trump administration.

When my predecessor as governor unilaterally expanded Kentucky’s Medicaid rolls in 2013 to include able-bodied adults with no children, promises filled the air: expansion would come at almost no cost to the Commonwealth’s taxpayers; fewer than 200,000 new enrollees would sign up; everyone in the program would benefit from greater access to health care.

None of it was true.

Medicaid was designed for providing health care to low-income pregnant women, children, the elderly and the disabled. Expanding it beyond its original purpose is driving a nearly $300 million hole in the Kentucky state budget. The rosy predictions about sign-ups were off by 134 percent — instead of the projected 188,000 enrollees, 439,000 signed up in the first two years. Further, expansion made it harder for Medicaid’s core users to get the care they needed, and harder to reduce waiting lists of children with developmental disabilities who need critical therapeutic services.

These outcomes are not unique to Kentucky. Nationwide, the per-person cost of expanding Medicaid has exceeded projections by 76 percent. Enrollment has nearly doubled original estimates. And predictions about the total cost missed the mark by 157 percent.

If Utahns approve Proposition 3, they’ll be signing up for the same financial disaster.

Official estimates suggest that Prop 3 would add about 200,000 able-bodied, childless adults to the program. Experience tells us the real number will far exceed that estimate.

But the booming cost and higher taxes needed to fund it are only part of the story. The Obamacare Medicaid expansion, sold as a panacea for the uninsured, has not made meaningful improvements in health or wellness outcomes.

Expansion has pushed millions of able-bodied, working-age adults with no children into a program designed to benefit the most vulnerable. It has sidelined individuals who have the ability, but no longer have the outright need, to be self-sufficient.

Passing Proposition 3 would means Utah’s most vulnerable individuals would be competing with better-off, healthier Utahns for the already limited Medicaid resources and for access to providers who see Medicaid patients.

Bottom line, Proposition 3 is a lose-lose proposition. Taxpayers are stuck with the tab for a program that, in many states, has quickly grown to consume more than a third of the state budget. Worse, the patients who most need the program will be squeezed out because of the perverse incentives created by the expansion.

If that seems crazy, well, welcome to government logic. In Kentucky, under Obamacare, the federal government currently pays 94 percent of the tab for the able-bodied newcomers, but only about 70 percent for the traditional Medicaid population. That means state government gets $9.40 for every additional dollar of spending on the expansion population, but only $7 for every additional dollar spent on the traditional Medicaid population. If someone else is picking up the tab for 94 percent of one group, but only 70 percent of the other, which do you think will get priority when legislators are writing their next budget? And don’t forget. … If you pay taxes, you (and your children and grandchildren) are the source of the federal funds we are talking about.

Kentucky is far from the only example. Nationally, from 2013 to 2016, Medicaid spending grew nearly twice as fast in states that expanded eligibility as in those that did not.

The limiting language of Proposition 3 is also concerning. Instead of giving your elected leaders the ability to design a program that is tailored for the unique needs of Utah, it may lock Utah into the one-size-fits-all Obamacare expansion. For example, in Kentucky, we’re taking steps to address our Medicaid-induced budget problems, including seeking a federal waiver to require able-bodied recipients to get a job, volunteer, work or get additional training. This is expected to save our state at least $300-$400 million over five years, and more than $2 billion for federal taxpayers over the same period. But a federal judge has blocked the reforms. As evidenced by the ongoing lawsuits to stop our commonsense proposals, it is clear that questions remain as to a state’s legal authority to unexpand once Medicaid expansion is in place.

Utah is waiting on a similar waiver for a limited expansion enacted earlier this year, but Proposition 3 would block even that option for Utah.

8 comments on this story

Utah voters, please take the experience of Kentucky and other states into consideration when you go to the polls Nov. 6. Don’t believe the outlandish promises, and don’t sign up for the rosy scenario that will never come to pass. Proposition 3 will cost more and do less than you’re being told.

Instead, seize the opportunity to say “no” to crippling your state’s budget, “no” to raising taxes on those least able to pay, “no” to providing a disincentive to self-sufficiency and “no” to limiting access to health care for the most vulnerable among us.

Vote “no” on Proposition 3.