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Steve Griffin, Deseret News
FILE - House Speaker Brad Wilson, R-Kaysville addresses the House of Representatives during the start of the 2019 Legislature at the State Capitol in Salt Lake City on Monday, Jan. 28, 2019.

SALT LAKE CITY — It's only the third day of the 2019 Legislature, but a controversial replacement for the voter-approved ballot initiative expanding Medicaid has already received initial Senate approval.

The Senate voted 22-7 on Wednesday to advance SB96 to a final vote. All six Senate Democrats and Sen. Todd Weiler, R-Woods Cross, opposed the bill sponsored by Sen. Allen Christensen, R-North Ogden.

Rick Bowmer, Associated Press
FILE - This Feb. 22, 2016, file photo, Sen. Allen Christensen, R-Ogden, looks on during a debate on the Senate floor at the state Capitol in Salt Lake City.

Senate President Stuart Adams, R-Layton, said the final vote needed to send the bill to the House will come Thursday or Friday. He said lawmakers are trying to "move it along."

He called the bill "a glass that's almost mostly full."

House GOP leaders are also backing the bill.

“I think we plan on supporting the bill," House Majority Leader Francis Gibson, R-Mapleton, said. “We’ve worked with Sen. Christensen both in the House and the Senate. I think the bill will provide medical coverage for those that have traditionally been in the gap. I think it fills our needs for what we’re going to be doing."

SB96 would replace the ballot initiative set to take effect April 1 with a plan providing expanded coverage to fewer Utahns, at least initially at a lower federal-to-state funding match than full expansion.

The bill also imposes a work requirement on recipients and enrollment caps. It keeps the 0.15 percent sales tax increase from Proposition 3 and adds another $30 million, including a $15 million hospital tax.

One by one, Democratic senators called for the Senate to respect the will of voters.

Jeffrey D. Allred, Deseret News
FILE - Sen. Karen Mayne, D-West Valley City, looks at her computer during the final day of the Utah Legislature in Salt Lake City on Thursday, March 8, 2018.

"We're going around in circles," Senate Minority Leader Karen Mayne, D-West Valley City, said after questions about the price tag for the alternative expansion plan went unanswered because a fiscal note has note yet been released for the bill.

"We need to look at the face of who we're helping," Mayne said. She spoke about the health care issues faced by two of her nieces, then told the chamber, "We need to make our citizens whole so they can work."

Sen. Jake Anderegg, R-Lehi, expressed frustration at not getting a vote for his bill that would repeal Proposition 3. A committee hearing was scheduled for SB97 Tuesday, but the bill was not considered.

Ravell Call, Deseret News
FILE - Rep. Mia Love, R-Utah, takes a photo with Julie and Jake Anderegg as she arrives at an election night party in in South Jordan on Tuesday, Nov. 8, 2016.

Anderegg lashed out at the media, saying voters would have opposed full Medicaid expansion if they had been told how much it could end up costing over time according to the numbers he's been given.

"Let's stop pretending this is the will of the people because the will of the people is not based on all of the facts. Let's be very clear," Anderegg said. "I’m sorry, I don’t want to take away the rights of the people but I have to balance the budget."

Weiler did not address why he voted against the bill on the floor but later said voters in his Senate district passed Proposition 3.

The vote came after the release of a letter signed by more than 40 organizations urging lawmakers and Gov. Gary Herbert to implement the full Medicaid expansion in Proposition 3 that was approved by voters.

"For the health and well-being of all Utah residents, we must fully expand Medicaid on April 1 so Utahns can get the care they need to work, take care of their families and succeed," the letter states.

Lawmakers, according to the letter, should be making "only essential technical changes" to the ballot initiative, describing concerns raised about escalating costs as "hypothetical" at this point.

"Voters did not choose to add restrictions or caps that will only delay implementation," the letter states.

Those signing range from health care-related organizations such as the Utah Health Policy Project to other advocacy groups including the United Way, AARP, League of Women Voters of Utah, Utahns Against Hunger and Voices for Utah Children.

In order for the revised program detailed in SB96 to go forward on April 1 as intended, the federal government will have to grant waivers for what Christensen is calling a bridge plan.

Under that plan, the state would provide Medicaid coverage for Utahns earning up to 100 percent of the federal poverty rate, about $12,000, at a 70-30 federal to state funding match.

Additional approval would be needed for the state to receive the 90-10 split offered for full expansion under the Affordable Care Act. Left out are some 41,000 Utahns earning between 100 percent and 138 percent of the federal poverty rate.

Those Utahns, who would be covered under full expansion, already qualify for subsidized insurance plans from the federal government at a cost estimated by Senate GOP leaders at less than $30 a month.

The Trump administration took no action last year on a similar waiver request for the limited expansion program passed by the 2018 Legislature. No waivers are needed for the full Medicaid expansion passed by voters.

Christensen said he has received assurances the waivers will be approved this time.

Rep. Ray Ward, R-Bountiful, isn't convinced that will happen.

"It's just a shot in the dark whether it will be approved by the federal government," he said, noting Utah is one of four states that have tried and failed to secure the higher federal funding match for covering fewer people than full expansion.

So Ward has come up with an alternative bill, HB210, that would allow Proposition 3 to take effect April 1 and then be replaced with a modified plan when and if waivers do come through.

It also sets aside money from a variety of sources to supplement the $91 million expected to be raised from the sales tax increase in the ballot initiative, including up to a $25 million hospital tax increase if those revenues start falling short.

However, his bill has not been assigned to a committee and Gibson said it will not get a hearing. He also said he expects SB96, the bill supported by GOP leadership, to get through the House next week with a veto-proof majority.

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Gov. Gary Herbert has not commented directly on the bill being fast-tracked through the Legislature. Herbert tried and failed in past sessions to win approval of his own version of Medicaid expansion.

In his annual State of the State speech delivered Wednesday evening, the governor said "the much needed Medicaid expansion passed by the voters needs to be implemented in a fiscally sustainable way."

But he did not offer specifics about what changes that could mean for Proposition 3, saying only that "with some common-sense adjustments, I know that we can implement this program without delay."

Contributing: Katie McKellar