Utah’s voter-approved Medicaid expansion initiative was replaced Monday with a program that is more restrictive, initially more costly, and contingent on a series of uncertain federal concessions.

Utah lawmakers and Gov. Gary Herbert, though, say the bill is more economically sound over the long term.

Senators voted 22-7 to adopt the House version of SB96, which launches a partial medicaid expansion April 1 and would revert to full expansion only in the event that federal administrators reject multiple requests for Affordable Care Act waivers.

“We’re doing the long-term responsible thing,” said bill sponsor Sen. Allen Christensen, R-North Ogden, “which we are bound by the [state] constitution to do.”

By Monday afternoon, the governor had signed the bill into law. In a prepared statement, Herbert said the bill balances compassion and frugality.

“I do not accept the characterization that SB96 ignores the will of the people. I see this as a thoughtful effort to implement the will of the people to care for the poor with quality health care with the added benefit that it can be sustained over the long term with no reduction in other important social services," he said.

“It provides quality coverage to the same population covered by Proposition 3 in a meaningful, humane and sustainable way," Herbert said. “It is now time to set aside differences and move forward to get those in greatest need enrolled on Medicaid and on the federal health care exchanges.”

While SB96 allows the same population of Utahns to access subsidized health care as under Proposition 3, it does not provide coverage to the same number of people. Low-income Utahns earning up to 138 percent of the federal poverty level could have enrolled in Medicaid under the initiative, while SB96 caps enrollment at 100 percent of poverty level.

The remaining expansion population is left under SB96 to purchase subsidized health insurance plans on the Affordable Care Act individual marketplace, with accompanying premiums, copays, deductibles and other out-of-pocket costs for care.

The bill was opposed by all six Senate Democrats and one Republican, Woods Cross Sen. Todd Weiler, matching Senate votes on earlier iterations of the Medicaid expansion replacement bill.

Democrats and supporters of Utah’s Proposition 3 have criticized the bill as repealing Utah’s Medicaid expansion initiative, which passed in November with 53 percent of a statewide vote.

“We’re still not giving the people of Utah what they voted for,” said Sen. Luz Escamilla, D-Salt Lake City. “We could do this the other way.”

But some Republicans who oppose Medicaid expansion see the bill as the lesser of two evils. On the Senate floor Monday, Lehi Republican Sen. Jacob Anderegg repeatedly stated he “hates” SB96 and said those who support expanding Medicaid are really motivated by a desire to establish universal public health care.

And universal health care, Anderegg said, would be “the worst thing that could possibly happen to us.”

“I hate [SB96], but I’m going to vote for it because I don’t have any other options,” Anderegg said. “And yet, on the same account, I fully acknowledge and concede that this will, in spirit of the law, meet most of what Prop 3 meant to people.”

Debate over SB96 has dominated the initial weeks of the 2019 session, with various demonstrations occurring on the Capitol grounds and inside the legislative chambers during deliberations.

Andrew Roberts, spokesman for the Prop 3-sponsoring group Utah Decides, said initiative supporters are keeping a close eye on a pending lawsuit challenging Utah’s referendum law, and that “all options are on the table.”

Utah Health Policy Project executive director Matt Slonaker attended Herbert’s private signing of the bill, despite his organization’s support of Proposition 3 and previous opposition to SB96.

In a prepared statement, Slonaker said the limited expansion program is not perfect, but that he looks forward to helping qualifying Utahns enroll in Medicaid.

“Let’s all look forward to working together to get our family, friends and neighbors enrolled starting April 1, 2019,” Slonaker said. “But let’s also continue to work to improve the program.”

(Courtesy Governor's Office) Utah Gov. Gary Herbert, center, signs SB96, Monday, Feb. 11, 2019. Looking on are lawmakers who supported the bill, along with Matt Slonaker, of the Utah Health Policy Project, far left, and Rev. Scott Hayashi, of the Episcopal Diocese of Utah, standing right of governor.

Monday’s vote was criticized as “insulting” by the United Utah Party, a centrist political organization that aims to appeal to disaffected voters from both major parties.

In a statement, United Utah Party Chairman Richard Davis said lawmakers had ignored research showing the economic value of a healthy population and that their action on SB96 would erode voter confidence.

“If anyone wonders why so many people become cynical about politics,” Davis said, "all they have to do is look at what the Legislature did to Proposition 3.”

Utah voters approved three initiatives in November, dealing with medical marijuana, Medicaid and independent redistricting. With Monday’s vote, lawmakers have significantly altered two of those initiatives, with the third — Prop 4 — likely to face legal challenges, legislative amendments, or both.

Asked when lawmakers would turn their attention to Proposition 4 and redistricting, Senate President Stuart Adams, R-Layton, said it’s already a subject of discussion but that there is time before the next round of electoral map-drawing, which occurs after the 2020 census.

“There are questions about Prop 4 and constitutionality,” Adams said.

It is to be expected, he added, that any law, whether passed through legislation or a ballot initiative, will undergo adjustments, potentially in perpetuity.