For six years now, Medicaid expansion advocates in Utah have pushed for the state to embrace full expansion. And each year, from 2013 until two weeks ago, the Utah Legislature has actively thwarted even limited attempts to expand Medicaid. In 2018, it finally approved a proposal for partial expansion — one dependent on the executive branch allowing Utah to cut corners on the Affordable Care Act passed by Congress. Unsurprisingly, that waiver never came and that partial expansion was never put into effect.
Over the years, as other states worked out the kinks and full expansion became more cost-effective, support for full expansion grew in Utah. After years of being stonewalled by their elected officials, Utahns took on the expensive, difficult route of a ballot initiative. (The oft-criticized high cost of ballot initiatives results from the herculean effort required to get an initiative on the Utah ballot.) The signatures were gathered and voters turned up in record numbers at the polls. Full Medicaid expansion won, fair and square.
The Legislature had six years to settle with voters on a compromise they could both be happy with, and it failed to do so. As a result, voters took the case of full Medicaid expansion to trial in the form of a ballot initiative, and they won. The verdict was in; the window for a settlement had expired. But that didn’t stop the Legislature from promptly repealing and replacing Proposition 3 with another partial expansion plan.
The honest question I have for Utah lawmakers who voted for the repeal is this: What should those of us who wanted full Medicaid expansion do now? Proposition 3 supporters played by the rules and won. It still wasn’t enough.
To say that everyone can’t always get what they want, or that voters are sore out of luck because legislators are fundamentally opposed to full Medicaid expansion, is not a democratic or sincere response. Though the Legislature has the authority to do as it wishes with ballot propositions, it is disingenuous to treat them as if they are no different from any other piece of legislation.
Propositions, while clumsy at times, are a critical release valve for citizens in the event that their elected officials repeatedly ignore their expressed wishes. Any legislator acting in good faith would uphold the results of a ballot proposition — regardless of how his or her individual district may feel about it — because propositions are, in a very real way, the final word of the will of the state on a specific issue. They require political willpower and public consensus far beyond any ordinary bill passed by the Legislature. The self-serving excuse that “we live in a republic, not a democracy” is only ever used by lawmakers to justify subverting the interest of the people for their own personal preference.
What options remain to those of us who voted for Proposition 3? Lawmakers, comfortable in their incumbency, have nonchalantly suggested we just vote them out, if we’re so unhappy. This is a terribly unfair option. Instead of a majority vote in favor of Proposition 3, achieving full Medicaid expansion now requires replacing 27 individual lawmakers?9 comments on this story
If the only way for a majority of Utahns’ votes to matter is by also gaining a majority in the Legislature, this is a punitively high bar. It shouldn't take flipping seats for legislators to implement something voters approved. This new goalpost is perhaps most unfair to Republicans who voted for full Medicaid expansion, who likely will not want to vote against their representative on one issue alone.
I do not know why legislators were so comfortable repealing a rare ballot proposition passed by the voters. Perhaps too many years in a supermajority have atrophied Republican legislators’ ability to lose graciously. Perhaps it really is time for lawmakers who voted against Proposition 3 to go. But it shouldn’t have to be.