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, 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.”

Cathy McKitrick is a freelance journalist. You can follow her on Facebook or Twitter (@catmck). She can also be reached at

(4) comments


To Weiler, it's only a penny on a 10 dollar movie ticket---but thank you at least for being a yes vote here, or at least saying you are.

To the other legislator touting the "all or nothing" logical fallacy of we're locked in and can never get out of a medicaid expansion? You got out of the Count my Vote initiative and when the people approved that statewide, and then you watered it down too, and then took it off the propositions for this year's vote as well. See beyond an outrage already!!

We need to cover our population dying, suffering greatly, dying in great debt, being debt garnished at 25% since that's outrageous but totally legal here, having to file for chapter 7 bankruptcy multiple times in their lives but being garnished while they're having to save for that and starving themselves in the process, etc. etc. You the legislature and Governor have dithered with this for years, so time for expansion as intended. Time for the people to majorly and vastly vote YES on this and LEAD since the Governor has not---see one Greg Hughes--- and for the government to totally honor the people's will, finally and at last!

The Dark Knight

As someone who ahs spent the past 5 years meeting and documenting the people in the coverage gap in multiple states, I can tell you authoratively that the above comment is about as far from accurate as a comment can get. Very few of the people I've met in the coverage gap even have cars, a nd none of them have new F-150s. They don't have the latest expensive tech gadgets or anything like that. They're struggling to make ends meet and are scrimping in ways most people can't even comprehend. I wish people would open their minds and hearts and learn the facts before they speak.


"Struggling to make ends meet"..probably so...On the horizon, cannot afford medicaid, there is a proposed bill - medicaid is available to you but you have to volunteer so many hours a month, and verify it with the provider. I just do not see it happening, they will just go to ER..for free!!



"“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.”

But....They all have $600 phones, a new F150 and an extra $5000 from buying the truck...cannot afford insurance! Huh, Houston..we have a problem!

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