Read: Medicaid expansion’s troubled future

On Monday, hundreds of protesters descended on the state capital, intent on preserving the exact letter of what voters approved with Proposition 3 in November. That ballot initiative expanded Medicaid coverage to all non-elderly adults with an income under 138 percent of the federal poverty line and would pay for that expansion with an increase in the state sales tax, which state analyses found would raise about $90 million in revenue. If the initiative were implemented as expected, it would go into effect on April 1, extending free coverage to about 150,000 people, including many like the low-income workers who showed up Monday to protest.

Republican lawmakers, who control both houses and the governor’s mansion in the state, were never keen on the plan to begin with. But faced with undeniable public support in polls for Medicaid expansion, in 2018 the state legislature passed a bill that would expand Medicaid to some adults below poverty, an expansion of some 70,000 covered lives, but less than half of what proponents of Proposition 3 pitched. But that bill required a novel waiver from the federal Centers for Medicare and Medicaid Services (CMS).

Read: How to stop Medicaid expansion

It was clear then that Republicans viewed their partial expansion as a way to circumvent public sentiment. In a June 2018 confidential memo to the White House and to President Donald Trump, the state warned that “there is significant risk that Utah will vote to expand fully with a November ballot initiative” and that “allowing partial expansion would result in significant savings over the 10-year budget window compared to full Medicaid expansion by all.” But in the end the Trump administration viewed a decision to grant waivers for partial expansions as a capitulation to Obamacare. CMS did not make a decision on granting that waiver by the time Utah voters on November 6 went out and passed the much more expansive version of the expansion.

Now, as the start date for Utah’s Medicaid expansion approaches, proposals in the state House and Senate that mirror some parts of the original partial expansion are back on the table. Last week, State Senator Allen Christensen told the Deseret News, “We’re going to make the program work within the money the proposition provided.” The bill Christensen introduced that’s currently under consideration in the state Senate would apply only to people in poverty, establish caps on spending, make eligibility and verification more complicated and restrictive for applicants, establish work requirements for beneficiaries, and introduce lockout periods for people who violate the conditions. A bill under consideration from the state House would roll back the Proposition 3 version of the Medicaid plan so that Christensen’s could take its place. Both bills were under consideration by the Senate Health and Human Services Standing Committee on Tuesday.