SALT LAKE CITY — Simply put, the problem is this: Last November, Utah voters contradicted themselves.
On the one hand, they voted to pass Proposition 3, which expanded Medicaid coverage to people earning up to 138 percent of the federal poverty line, as called for under the Affordable Care Act.
On the other hand, they voted to put people in charge of the Legislature who, generally speaking, dislike the so-called Obamacare and view Medicaid expansion as fiscally irresponsible.
What did you expect would happen?
Democracy’s ultimate check-and-balance is the voting booth. But since Utah voters rarely deviate from choosing Republicans, and since this is not an election year, the result of this collision was easy to predict.
Metaphorically, the Legislature is driving a tractor-trailer. Voters are in a small economy car.
Lawmakers plowed ahead with a watered-down version of Proposition 3, which passed Monday. Voters were sent careening and spiraling off the road.
This isn’t some grand political statement or an argument to choose one party over another; just an observation. Voters make decisions based on a variety of factors. But if you’re trying to zero in on Medicaid expansion to understand what happened, the contradiction is hard to miss.
During the hearings and floor debates, much was said about how some lawmakers never, in their wildest dreams, would have considered passing a Medicaid expansion bill of any sort, even one that is significantly less than what Proposition 3 called for, before last year’s election.
Sen. Jacob Anderegg, R-Lehi, said over and over again on the Senate floor Monday how much he hated the bill, just before he voted for it. He didn’t have a choice, he said. Voters wanted expansion, and if lawmakers didn’t pass the watered-down version, Utah would be left with Proposition 3.
So in that strange sense, the Legislature heard the people.
But make no mistake — what they passed is not what people voted for.
Proposition 3 would have covered everyone earning up to 138 percent of the federal poverty level. Utah’s new law covers those earning up to 100 percent and leaves the rest to find private insurance on a heavily subsidized exchange, where they will have to pay some money out-of-pocket for monthly premiums, depending on their income.
The plan is more complicated than that, relying on Washington to approve waivers. But that is its essence.
The arguments for changing what voters approved seemed to coalesce around two themes.
The first is a series of questions that came up again and again: Do we really want to make Medicaid, or health care for the state’s poorest residents, a priority of state government? If so, should it compete with education for funding?
The second came in assurances that the private insurance exchange would take care of those not covered by Medicaid.
The first is a gamble, and the second miscalculates what it means to be poor. But both are consistent with the political philosophies of the people voters chose as representatives.
It’s impossible to know exactly what voters were trying to say when they approved Medicaid expansion, but it wouldn’t be a stretch to say they wanted care for the poor to rise among lawmakers’ funding priorities.
As for subsidized insurance, it’s important to note that an adult earning 138 percent of the poverty level makes $16,643. After rent, food and transportation costs, even $20 a month must be hard to find.
A thread running through both themes is the notion, mentioned out loud more than once, that people didn’t really understand what they were voting for. That sounds like a dangerous thing to say when your position depends on the approval of voters, but history shows it may not be much of a political gamble.
On Monday, Senate leadership reminded reporters the state is a republic, not a democracy, and that lawmakers constantly amend and change laws.22 comments on this story
Senate President Stuart Adams passed around a chart showing how Proposition 3 would have resulted in an $83 million budget hole by 2025, and how the new version will result in a surplus. This also fits the fiscal conservatism voters apparently want in their leaders.
It’s true Utah is a republic, except that Utah’s Constitution also allows for citizen initiatives, which is a form of direct democracy.
If that seems like a contradiction, it’s no more so than voting for a law and the opponents of that law at the same time.
Which reminds me, some at the Legislature now are talking about changing Proposition 4.