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Friday, February 1, 2019

Utah Legislators are Hiding the Ball in Effort to Repeal Voter-Approved Medicaid Expansion Ballot

Sophia Tripoli

Director of Health Care Innovations

The Utah Senate approved a bill this week that would repeal and replace the voter-approved Medicaid expansion ballot initiative, Proposition 3, which passed with 54 percent of the vote in Utah’s election this past November. Proposition 3, if implemented, is poised to bring health care coverage to over 150,000 Utahns with annual incomes below $17,236 for an individual and $29,435 for a families of three. The voter-approved ballot initiative included a 0.15 increase in the states sales tax to cover the 10 percent of the state’s costs of expanding Medicaid, with the federal government responsible for contributing the remaining 90 percent of the costs. 

However, Utah lawmakers are now pushing to pass a bill that would repeal the voter’s will to fully expand Medicaid, and instead replace it with a bill that would only partially expand Medicaid, covering half the number of Utahns who would be eligible for Medicaid under a full expansion. And, their plan to pay for the partial expansion is fiscally irresponsible in ways that are being hidden from the legislature and the public. Senate Bill 96 would expand Medicaid for individuals making $12,490 a year and $21,330 a year for a family of three in 2019 – or 100 percent of the federal poverty level. This cut to eligibility actually creates greater financial risk to the state. Under SB96, the state would potentially be responsible for paying 30 percent of the costs of the partial Medicaid expansion and the federal government would cover the remaining 70 percent. Not only would a partial expansion cover fewer people than the full Medicaid expansion, it would come at greater financial burden to the state. 

Utah lawmakers are hiding critical details from the public in an effort to quickly pass a bill that would repeal Proposition 3 and silence the will of the people. 

Those details include:  

  • The nature of commitments from the Trump administration on Partial expansion: To-date, The Centers for Medicare and Medicaid Services (CMS) have never approved 90 percent federal match for a partial Medicaid expansion, despite repeated asks from Utah lawmakers.  Utah Representatives Christensen and Dunnegan have been saying for years that they have the support from Seema Verma, federal CMS Administrator, to partially expand Medicaid with the 90-10 match rate (the proportion of Medicaid costs shared by the federal and state government) which is used for the full Medicaid expansion under Federal law. Utah lawmakers were wrong in 2018, when Governor Herbert signed a partial expansion bill, HB472, that went nowhere in Washington DC.  Now, Utah lawmakers are touting assurances again. But there is nothing in writing from CMS indicating they’ve changed their policy to approve a partial Medicaid expansion with a 90-10 match. Importantly, the same well-reported opponents to this approach are now even more powerful in the White House, notably including Office of Management and Budget (OMB) director and Acting Chief of Staff Mick Mulvaney.
  • To-date, there has never been an estimate of the fiscal impact of either partial expansion bill at either the 90-10 match or 70-30 match. In addition, the Governor’s recently released budget proposal for Fiscal Year 2020 also does not provide an estimate of the fiscal impact of HB472. The only fiscal note that has been produced – the 2018 fiscal note for HB472 – does not include a real estimate of the state’s costs, and completely lacks a clear, transparent explanation about the source of the data it based the estimates on. Using the cost impacts from the fiscal note for HB472, it is very clear that the costs of expanding Medicaid to the state would be much higher using a 70-30 match compared to the full expansion using the 90-10 match rate. 

Throughout Utah’s dysfunctional five year legislative slog on Medicaid expansion, the mantra of expansion opponents has been the fear of extending coverage that will then be unaffordable. But with SB96, that is exactly where the partial expansion bill may be taking Utah if lawmakers approve it.  If SB96 is approved, thereby repealing Proposition 3 and replacing it with a partial Medicaid expansion with a 70-30 match rate, Utahns will certainly end up paying the price. Not only will fewer Utahns be covered under Medicaid, but the state will need to ask CMS for a special Medicaid waiver to accommodate this request. Medicaid waivers can take up to 18 months to go through the full process to meet all of the legal requirements, thereby further delaying access to health care coverage for Utahns. If Mick Mulvaney’s negative view of a 90-10 match for partial expansion wins out, Utah will be stuck with coverage for poor adults at a 70-30 match when the 90-10 match is available, now, with no need for a special Medicaid waiver.