SALT LAKE CITY — A bill to repeal and replace the Medicaid expansion ballot initiative approved by voters is now being revised to reverse a possible delay in getting health coverage for at least some of the low-income Utahns.
"We changed our minds," the bill's sponsor, Sen. Allen Christensen, R-North Ogden, said Thursday. "The people around me — and myself included — felt like we could do something now."
Earlier this week, Christensen told the Deseret News he intended the bill to hold off on additional coverage until the federal government approved a waiver needed for a scaled-back version of Medicaid expansion with a lower cost to the state.
Now, the bill will create what the senator called a "bridge plan," partially expanding Medicaid to Utahns earning below 100 percent of the federal poverty level using money raised by the 0.15 percent sales tax rate increase in the ballot initiative.
Christensen's new approach comes the day after Lt. Gov. Spencer Cox said he and Gov. Gary Herbert are not anticipating any delay in implementing expanded Medicaid coverage.
Proposition 3 puts in place the full Medicaid expansion available under the Affordable Care Act that provides coverage to those earning below 138 percent of the federal poverty level, starting April 1, the same time the tax increase takes effect.
Christensen said under his bill, both the sales tax increase and the partial plan would also start April 1. He said about 100,000 Utahns would be covered under his proposal, compared to 150,000 under full expansion.
The plan would stay in place, he said, while Utah officials try to negotiate the same 90-10 federal funding match offered for full Medicaid expansion. A similar effort last year failed.
He said the state would have to pay the traditional 30 percent share of Medicaid for the partial plan and there may only be enough money available to keep the program going for six months.
The sales tax increase is anticipated to collect some $88 million annually, money that's supposed to cover the state's share under a 90-10 match while bringing in more than $800 million in federal funding.
Under a 70-30 match, the additional revenue would not last as long or result in as much federal funding.
Just how the state would continue to pay for the bridge plan if the federal government doesn't agree to cover a bigger share of the costs is yet to be determined, Christensen said.
"We don't have the details worked out but it'll stay," he said. "We're not going to kick them off."
The governor's deputy chief of staff, Paul Edwards, said in a statement that given the impact of Medicaid on the budget, it's not surprising lawmakers "would want to examine the fiscal soundness" of expanding the program.
"Any modifications would need to be done in a compassionate and responsible way," Edwards said. He said the governor's office will be watching closely for "reasonable efforts to improve and sustain" the voter-approved expansion.
"We trust that all involved in this review understand the importance of honoring the voters' desire to see coverage expanded to those previously excluded from federal support," he said.
Cox said Wednesday the administration doesn't "think there's going to be a delay in implementation on Medicaid expansion. I could be wrong. (In a) 45-day legislative session, anything can happen."
But the lieutenant governor said the administration is "moving forward as if it's going to be implemented under the original timeline as expected." Cox said, however, money is an issue with full expansion.
"It's very clear that tax increase is not going to cover the entire amount of the expansion," he said, adding the governor's office and lawmakers are grappling with "how are we going to pay for this."
Christensen said that legislative analysts have calculated that it would take $105 million to pay for full expansion next year, not the $88 million expected from the sales tax increase and that by 2023, the program would fall $45 million short.
Legislative leaders have expressed concerns about the price tag for the Medicaid expansion approved by voters, but promised any alternative plan would be similar to what Proposition 3 provided.
Under Christensen's original proposal, the full expansion passed by voters would have in effect been repealed and his more limited plan would not have been put in place until the 90-10 funding match was approved.
The 2018 Legislature approved a partial Medicaid expansion plan but was unable to get the Trump administration to approve the waiver needed for the additional federal match.
"I don't understand why people in any way think this would be different," said Rep. Ray Ward, R-Bountiful, a medical doctor and longtime supporter of expanding Medicaid coverage.
He said if the state wants to pursue a waiver for a more limited plan, it makes more sense financially to let Proposition 3 take effect and then replace it should the federal government OK the 90-10 match.
"I just cannot understand, in the name of trying to save the state's budget, why we would choose a plan that would force us to pay 30 percent instead of 10 percent," Ward said.11 comments on this story
Christensen has said it would be difficult on the 50,000 Utahns who earn between 100 percent and 138 percent of the federal poverty level to first be eligible for Medicaid expansion and then have the program taken away.
But Ward said if there is finally federal approval for the higher match for a more limited program, those same Utahns are still able to purchase heavily subsidized insurance through the Affordable Care Act.
"To me, it seems pretty simple," he said, acknowledging that the proposed bridge plan would be better than a delay. "Honestly, I'm glad people are talking about this in the context of making sure people have coverage."
Contributing: Katie McKellar