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Kristin Murphy, Deseret News
A truck with rotating messages supporting full Medicaid expansion circles the Capitol in Salt Lake City on Friday, Feb. 1, 2019.

SALT LAKE CITY — Backers of the Medicaid expansion ballot initiative approved by voters are spending more than $100,000 to run TV commercials pushing back against a replacement plan advancing quickly through the Legislature.

"Utahns are outraged that politicians are striking backroom deals designed to overturn the clear will of the voters," said Andrew Roberts, spokesman for Utah Decides, the group behind the initiative known as Proposition 3.

Roberts, who was at the state Capitol Friday lobbying on behalf of Proposition 3, said Utahns "voted to expand access to health care and bring our tax dollars home from Washington, and we won't settle for a bill that does the opposite."

Kristin Murphy, Deseret News
A truck with rotating messages supporting full Medicaid expansion stops near the Capitol in Salt Lake City on Friday, Feb. 1, 2019.

The commercial, set to begin airing Monday on KSL and other TV stations, states that voters "spoke loud and clear" last November but warns that the will of the people now is being threatened.

Special interests and backroom deals are blamed in the spot for "slippery changes that will cost Utahns hundreds of millions a year and strip health care from more than 50,000 Utahns."

Viewers are urged to contact Gov. Gary Herbert and members of the Legislature and "tell them to leave our health care alone."

Senate Majority Whip Dan Hemmert, R-Orem, said lawmakers are already feeling pressure and the TV commercials can only turn up the heat.

"I feel like we're getting beat up," he said, calling the claims by the Proposition 3 proponents frustrating and disingenuous. "It makes it hard to vote a certain way, so they matter."

In the meantime, lawmakers were scrambling to come up with a more acceptable price tag for the bill backed by GOP leadership as a replacement for the full Medicaid expansion approved by voters.

That bill, SB96, continued to be held in the Senate Friday while work was underway to adjust an earlier fiscal note detailing the cost to taxpayers that has not been made public but was higher than anticipated.

Hemmert, assigned by leadership to get the bill through the Senate, said he did not see the original cost estimate from legislative analysts but acknowledged, "I know it came in at a number people weren’t excited about."

He said there is a new version of the bill being drafted to make some technical changes. That version, along with a new fiscal note, could be ready in time to be reviewed over the weekend.

That would mean a final Senate vote could come as soon as Monday. On Wednesday, the third day of the 2019 Legislature, the Senate gave initial approval to SB96 by a vote of 22-7.

Kristin Murphy, Deseret News
A truck with rotating messages supporting full Medicaid expansion circles the Capitol in Salt Lake City on Friday, Feb. 1, 2019.

House GOP leaders have said they hope to have the bill passed by the end of next week with a veto-proof majority. A veto-proof majority — at least two-thirds of both the House and Senate — also prevents a citizen referendum to repeal a law.

The governor has not said what action he intends to take once the bill reaches his desk. His deputy chief of staff, Paul Edwards, said in a statement that it is premature to talk about the governor signing legislation into law that has not been passed.

But, Edwards said, the governor "has long supported the kind of common sense supports and guardrails for Medicaid expansion that are currently being discussed in the Legislature."

The full Medicaid expansion passed by voters covers Utahns earning up to 138 percent of the federal poverty level. SB96 limits Medicaid coverage to Utahns earning below 100 percent of the federal poverty level, about $12,000.

Under the bill, Utah would have to seek a waiver from the federal government to provide what's being called bridge coverage to the limited group beginning April 1, the same date Proposition 3 would take effect.

The bill assumes the Utahns earning between 100 percent and 138 percent of poverty will pay for heavily subsidized insurance coverage available under the Affordable Care Act.

Hemmert said there are 41,000 Utahns in that category who already have insurance but another 24,700 who do not. He said it's possible that they cannot afford the premiums, estimated at less than $30 a month.

"It's also possible they don't know the subsidies exist," he said. "I don’t want to sound like I’m unsympathiec to this population. I know they work hard. They’re good people. But at the end of the day, you've got to pay for it."

Later, Hemmert said Medicaid enrollment is typically 60-70 percent of those eligible, so "it's more likely these groups just don't take advantage of the health care options available to them."

The other big difference between Proposition 3 and SB96 is the size of the federal to state funding match. The federal government pays 90 percent of the cost of full Medicaid expansion, but is expected to pay only 70 percent of the bridge coverage.

Another federal waiver would be needed in order for the state to receive the higher 90-10 match for the more limited expansion program — something that Utah and other states have tried and failed to obtain in the past.

No waivers are needed to implement Proposition 3.

Hemmert said the fiscal note should equal the $90 million or so anticipated from the 0.15 percent sales tax increase in Proposition 3 plus an additional $30 million lawmakers have already said they're willing to spend.

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That additional money, a $15 million appropriation plus what is now being called a temporary $15 million hospital tax, would cover the bridge program through June 30, 2020, Hemmert said.

The sponsor of SB96, Sen. Allen Christensen, R-North Ogden, told the Deseret News Thursday he could not approve the initial fiscal note. He declined to discuss numbers, but said it was in a "state of flux."

Senate President Stuart Adams, R-Layton, said several legislative analysts have been working without sleep on the fiscal note but it won't be released until "we get it right."