Legislative Republicans Again Can't Find a Solution for Medicaid Expansion

As expected, no Medicaid expansion for Utah – at least not now.

Utah House Republicans came out of a four-hour closed-door meeting Tuesday night to say they don’t have the votes for the latest idea: Utah Access Plus.

In fact, House Speaker Greg Hughes, R-Draper, said out of the 63 House Republicans only seven – including himself and Majority Leader Jim Dunnigan, R-Taylorsville, voted for the plan put together by the so-called Gang of Six.

Meanwhile, Senate President Wayne Niederhauser, R-Sandy, told UtahPolicy Tuesday evening that he polled all 29 Senate members – Republicans and Democrats – and there aren’t 15 votes for UAP. He declined to give specific numbers.

To say this plan – pushed by the Gov. Gary Herbert-led GOP leaders in the House and Senate – fell flat is an understatement.

Hughes, in a night press conference, and Niederhauser, in his UtahPolicy interview, said it is back to the drawing board.

There won’t be a special session for Medicaid expansion this fall, said Niederhauser. Hughes agreed, adding however, “there is the political will” in the House GOP caucus to “help the needy.”

And sometime, someway, providing health insurance/care for the 31,000 low-income Utahns without coverage today will be accomplished.

But neither Hughes nor Niederhauser could say how that would be done exactly.

And the issue will fall to January’s 2016 general session – a default fallback proposal UtahPolicy reported during this past summer.

Hughes says House Republicans have been so beaten up over Medicaid expansion over the last six months, he doesn’t think the added heat of an election year for the governor, all the 75-member House and half of the 29-member Senate will make much difference in the 2016 Legislature.

Niederhauser admitted that some folks are talking about a small sales tax increase to come up with the state’s share of the estimated $50 million a year expanding Medicaid under Obamacare would cost the state.

Under the gang’s Utah Access Plus – which turned out to be a political disaster on Capitol Hill – 16 different categories of health care professionals/industries would have picked up the state’s $50 million share.

And the health care industry would have taken on – through a complicated annually-adjusted formula – any Medicaid expansion cost increases.

It is that financial risk – which the House Republicans don’t want taxpayer on the hook for – Hughes believes sunk Utah Access Plus with the health care community.

Who in turn smashed House and Senate Republicans with massive lobbying.

Last December, noted Hughes, the same health care industry leaders who killed this month Utah Access Plus went on the record in favor of Herbert’s Healthy Utah.

HU put the financial risk of Medicaid expansion on Utah taxpayers. And the health care industry folks were just fine for that, noted Hughes.

But ask them to pay 7 cents on the dollar of new health care reimbursements under Obamacare -- and take on the state’s financial risk – and all of a sudden they turned, killing Utah Access Plus.

So, even if there are hard feelings or not among House leaders and the House GOP caucus, Medicaid expansion is not dead.

It’s just not feeling very well.

House Majority Whip Frances Gibson, R-Mapleton, who works in the health care industry, said he voted no on UAP during Tuesday night’s closed caucus.

So even House leadership couldn’t agree on UAP.

Gibson said there is a way forward, although it may not be acceptable to the same folks who helped kill UAP.

Utah would develop its own plan to take care of the 31,000 low-income folks who don’t have health insurance now and fall between 0 percent and 100 percent of the federal poverty level.

Those between 100 percent and 138 percent could qualify for some other health insurance subsidies and could also be helped by the state.

That plan would have enrollment caps and other safeguards so the state’s General Fund – basically the state sales tax receipts – would not be at risk from Obamacare-like Medicaid expansion growth.

That, however, sounds very much like Utah Cares – the 2015 House GOP caucus’s plan much criticized in the media and opposed by Herbert and Republicans in the state Senate. Herbert’s Healthy Utah and Utah Cares both died at the end of the 2015 Legislature, leaving the state with no Medicaid expansion.

Hughes said his caucus did not discuss a general tax hike for Medicaid expansion.

Such a tax hike “is not an October idea,” said Hughes, and would have to wait for the 2016 Legislature.

Niederhauser said he’s heard of increasing the state sales tax by a mere one-eighth of 1 percent, which would bring in around $50 million a year, or the amount of the state’s share of Obamacare Medicaid expansion.

But Niederhauser said he can’t tell if that would have support in the Senate.

Hughes said the Utah Hospital Association last December was talking about kicking in $25 million a year toward the state’s share of expansion, since hospitals would see the most from the $450 million Medicaid expansion would bring into the state each year.

Utah hospitals are eating hundreds of millions of dollars a year (or passing it along to patients/insurance companies who can pay) in uncompensated care – much of it from their emergency rooms which under federal law must treat all injured or ill person regardless of whether they can pay or not.

“We are having two different discussions,” summarized Hughes.

If Utah finds a way to provide care to the needy without Obamacare’s $450 million a year, then there are those (Herbert among them) who complain the state is turning away federal money.

Or if people talk about money, then lawmakers are criticized for not caring about the truly needy.

GOP House members are in a box.

There needs to be a way out of that box.

And maybe over the next few months – Hughes says House Republicans are committed to find a way – another kind of compromise can be found.

Hughes said he was looking at the UAP defeat as a glass half-full – for the work of helping the needy will go forward.

But for now it has to look like House Republicans are gazing as through a glass darkly.

And Medicaid expansion in Utah remains a real political albatross.