SALT LAKE CITY — The Senate gave final approval Monday to a replacement plan for the voter-approved full Medicaid expansion after more than an hour of debate — and a last-minute update to the price tag.
Health care advocates called the bill — which would forgo $1 billion in federal matching funds — a "bridge to nowhere."
The 22-7 vote — with all six Democrats and Sen. Todd Weiler, R-Woods Cross, opposed — didn't change from the initial vote on SB96 last week, on the third day of the 2019 Legislature.
What is new is the fiscal note spelling out the cost to taxpayers. Also, the latest version of the bill now includes a provision that would wipe out Medicaid expansion if the federal government doesn't come through with needed approvals.
Sen. Allen Christensen, R-North Ogden, the sponsor of SB96, said the goal of amending the November 2018 ballot initiative known as Proposition 3 is to ensure long-term stability for what would be a more limited Medicaid expansion plan.
Christensen said under his plan, the state does have to spend more money up front than called for under Proposition 3. But he said full Medicaid expansion is not financially sustainable.
SB96 provides Medicaid coverage to Utahns earning only up to 100 percent of the approximately $12,000 federal poverty rate initially at a federal to state funding match of 70 percent to 30 percent as a "bridge" while a higher match is sought.
The full Medicaid expansion approved by voters in November covers Utahns earning up to 138 percent of the federal poverty rate at a federal to state funding match of 90 percent to 10 percent.
Proposition 3 included a 0.15 percent sales tax increase to pay for the state's share of full expansion, but Christensen's bill adds an initial $38.2 million appropriation and $15 million annually in future years plus $15 million from a hospital tax.
Senate Democrats argued voters want full expansion.
"The majority rules, supposedly," Sen. Gene Davis, D-Salt Lake City, said, noting no state has been granted the type of waivers sought. "I think it's time that we do what the people asked us to do and not play games."
Another Salt Lake Democrat, Sen. Derek Kitchen, said he "worried about sowing seeds of distrust" among voters, especially with "a plan that appears to cost more and cover fewer people."
Republicans said the state can't afford Proposition 3.
"A majority of voters cannot overrule the laws of mathematics," Sen. Lincoln Fillmore, R-South Jordan, said.
Sen. Jake Anderegg, R-Lehi, who has a bill repealing Medicaid expansion that has yet to have a committee hearing, said voters didn't understand Proposition 3 was "a bait and switch."
Anderegg said other states that have expanded Medicaid coverage have called it a "nightmare."
Sen. Daniel Thatcher, R-West Valley City, said lawmakers don't have much choice.
"The question is, 'What is the least bad of the bad options in front of us.'"
Andrew Roberts, spokesman for Utah Decides, the group behind Proposition 3, said the Senate vote "threw the baby out with the bathwater. They presented a false choice here" that could end up doing away entirely with Medicaid expansion.
"That’s quite the gamble to take," Roberts said. "You know I don’t know about you, but I don’t want to risk my family’s health insurance in the hands of a federal bureaucrat in Washington."
Utah Decides has launched a campaign including more than $100,000 in TV commercials aimed at pressuring lawmakers to back off of replacing full Medicaid expansion.
Advocates for full Medicaid expansion held a news conference Monday afternoon, displaying some of the more than 500 notes written to lawmakers urging them to leave Proposition 3 alone.
"People know what Medicaid expansion is. They know what they voted on," said Matt Slonaker, executive director of the Utah Health Policy Project. He said Utahns chose to raise their taxes for full expansion, rather than count on federal waivers.
Slonaker said SB96 is a "bridge to nowhere" and that lawmakers should instead look at HB210 as an alternative he believes could keep full Medicaid expansion solvent for years to come.
That bill, sponsored by Rep. Ray Ward, R-Bountiful, has not been assigned to a committee for a hearing. It would let Proposition 3 take effect as scheduled on April 1 and then be replaced with a modified plan when and if waivers are granted.
No waivers are needed to implement full Medicaid expansion, but federal approval would be needed for the bridge program as well as the higher federal to state funding match, enrollment caps and a work requirement.
If those waivers don't come through, the new provision in SB96 would end Medicaid expansion in the state. Past tries by Utah and other states for similar waivers have been rejected.
The first fiscal note on SB96 disappeared from the Legislature's web site Monday morning before being replaced a short time later by an updated analysis that included similar revenues numbers but apparently a lower overall cost.
Christensen, who last week rejected an earlier try at calculating the cost to taxpayers that was never made public, said he's never seen such a complicated fiscal note.
House Majority Leader Francis Gibson, R-Mapleton, has said he expects the bill to pass the House and be headed to Gov. Gary Herbert by the end of the week, with a veto-proof majority.
"I know it's been a moving target. I know that a lot of people are concerned about the fiscal note up front. Long term we feel like we're going to save money," Gibson said.
The governor has not indicated whether he'd sign SB96.
"While lawmakers work though these complex issues, we will refrain from commenting on specifics," Herbert's deputy chief of staff, Paul Edwards, said in a statement.
He said the governor appreciates efforts "to expand Medicaid without delay for those in poverty bereft of federal coverage while preserving the state's ability to seek common-sense adjustments from the federal government that would protect our state resources over the long term."
Both public fiscal notes from by the Legislative Fiscal Analyst's Office for the plan backed by GOP legislative leadership showed the state could end up forgoing a total of well over $1 billion in available federal funding.
Compared to current law, the current fiscal note now says Utah could forgo federal funds of $103 million in the current budget year, $407 million in the budget year that begins July 1, and $630 million ongoing by the 2024 budget year.
Senate Majority Whip Dan Hemmert, R-Orem, said "that's misleading unless you match it with reduced expenses." He said starting in the budget year beginning July 1, 2020, the voter-approved program was expected to be in the red.71 comments on this story
Hemmert has said there are 41,000 Utahns making 100-138 percent of the poverty rate who already have insurance offered at a federally subsidized rate of less than $30 a month, but another 24,700 in that category don't.
He counts the federal insurance subsidizes as money coming into the state even though it is outside the Medicaid expansion plan, estimating the amount at between $311 million and $625 million.
"So yeah, the money doesn't run through the state budget, but the federal money is still coming here. No one is forgoing anything," Hemmert said. The federal insurance subsidy is not part of the fiscal note.
Contributing: Katie McKellar