This November, Utah voters will decide the fate of Proposition 3, a ballot initiative that would bring the state in line with 33 others (including Washington D.C.) who have fully expanded Medicaid in accordance with the federal Affordable Care Act.
The nonprofit Utah Health Policy Project projects that Prop 3 would provide health care access to 150,000 low-income Utahns, generate 14,000 new jobs and bring in about $800 million annually in federal tax dollars earmarked for that purpose. Under the ACA (aka Obamacare), 90 percent of full Medicaid expansion is federally funded and 10 percent is funded by the state.
“The choice before voters is simple. Are we going to bring our tax money home from Washington, D.C. to create jobs and help hard-working Utahns get healthcare or whether we are going to continue to watch our money go to other states to pay for their healthcare to help their economies instead,” Rep. Ray Ward, a Bountiful Republican and family physician said in a recent statement.
But fans and foes of Prop 3 view its potential impact quite differently.
Unlike Ward, many of his Republican counterparts in the Utah Legislature have repeatedly balked at embracing Obamacare, which took effect in January 2014. Full Medicaid coverage would extend health care coverage to individuals earning up to 138 percent of the Federal Poverty Level, or roughly $17,000 per year.
Their concerns centered on long-term costs and viability. State Sen. Daniel Hemmert, an Orem Republican, views it as a slippery slide toward fiscal calamity.
“Obamacare Medicaid expansion includes no cost or enrollment circuit breakers, and once we are in, we will never get out,” Hemmert said in a recent opinion piece published in the Deseret News and also read aloud on his behalf at a recent Weber State University forum.
Medicaid currently absorbs 18.7 percent of Utah’s General Fund budget, and Hemmert asked, “How much more can we afford without more tax hikes or major cuts in services?”
Instead, Hemmert prefers a “Utah style” limited Medicaid expansion, referring to House Bill 472 passed by lawmakers in March 2018. That new law extends coverage to individuals earning up to 95 percent of the Federal Poverty Level and includes an enrollment cap and work requirement where applicable. Those deviations from the ACA prompt the need for federal waivers that are hard to come by.
Stacy Stanford, health policy analyst with the Utah Health Policy Project, believes Prop 3 makes sense for several reasons. For starters, full expansion would mean not having to wait on waivers that might never materialize.
“No one is signed up for Medicaid through HB472, nobody is getting care,” Stanford said in a recent phone interview. “That’s what we have to look at. People will get care through Prop 3 on April 1. That’s when we can start signing people up.”
For those who fall in the gap between 95 and 138 percent, access to affordable health care remains largely out of reach.
“They could qualify for (subsidized) plans on healthcare.gov, but they wouldn’t be doable with their really tight budgets,” Stanford said. “That’s the reality for a lot of these families.”
So the working poor generally do without.
“They don’t get checkups, regular screenings and preventative care. Chronic health issues go untreated until they become emergent,” Stanford said. “When things become emergent or problematic so they can’t just put off care anymore, they end up in our emergency rooms.”
That crisis care is costly, “the most expensive health care in the world and we all pay for that," said State Sen. Todd Weiler, a Republican from Woods Cross. “That’s the best argument FOR medicaid expansion because it’s a lot less expensive for us as a society as a whole to get people medical care they can use without going to the emergency room.”
Even so, Weiler has mixed views on Prop 3 but is grateful voters will get a chance to have their say.
In part, Weiler worries about the .15 percent sales tax increase that Prop 3 will use to fund the state’s portion of full Medicaid expansion. That tax would only apply to non-food purchases.
“It’s a regressive tax on the poor, but also the poor are the ones that would benefit the most from medicaid expansion,” Weiler said. “But there’s also only so much ‘head room’ in sales tax, and I do get concerned about using it for things that are not directly tied to a sales tax.”
Weiler also pointed to Utah’s pride in personal productivity.
“Obviously if someone is disabled, elderly or can’t work, that’s not an issue. But most Utahns expect someone who is able-bodied and capable of working … to provide for themselves before they get more government handouts,” Weiler said.
But Stanford contends that people in the coverage gap pay in so many ways.
“It definitely isn’t a free lunch,” Stanford said. “There’s this culture of bootstraps and making a better life for yourself, but we don’t let people do that. Even if they do get access to care and get a better job, they’re still penalized through huge debt loads, destroyed credit and bankruptcy. The repercussions of being uninsured last for years, decades, a lifetime.”