By Courtney Bullard

After six long years of unsuccessfully encouraging the Legislature and governor to expand Medicaid, advocates knew they needed to work around policymakers as much as possible. That is why when designing Proposition 3, the successful ballot initiative that expanded Medicaid in Utah, they crafted it unlike any of the other 33 (now 35) states that approved Medicaid expansion. Advocates asked voters not only to approve expanding Medicaid to more low-income people, but also to slightly increase their own non-food sales tax to do it.

We had already seen Maine pass a Medicaid expansion ballot initiative in 2017 and shortly afterwards get tied up in a legal battle with their governor who refused to pay for the program — all the while low-income people went without health care. Mainers solved their issue by voting that governor out and electing someone who respected their will better. We preemptively tried to solve a Maine-like debacle from happening by asking Utahns if they would opt into paying for the policy themselves with that small, non-food sales tax. We went back and forth with fiscal analysts to make sure it would generate enough money long term to cover the program. We used high enrollment numbers and accounted for low sales tax generation.

Many people doubted our methods — who in Utah, or anywhere, would vote to increase their own sales tax? We followed our hunch and campaigned on the premise that full Medicaid expansion is an investment of our tax dollars. Under full expansion, the federal government pays 90% of the program, rather than the 70% that it pays now. You’ve probably heard it before: pay 1 cent more on a movie ticket and get $800 million back in a federal return, pay three times less for the program and cover up to 150,000 low income Utahns. Seemed like an obvious deal to take, and Utahns agreed. A majority of Utahns in a majority of House and Senate districts throughout the state approved of Proposition 3 and it passed with the highest margin of any of the 2018 ballot initiatives.

Just a few days after the election, I remember receiving the first phone call with concerns that the cost of the initiative didn’t have long-term solvency and there might be legislative meddling during the 2019 legislative session. This was shocking as we had done what no other state had done: provided our own funding with voter support!

Ultimately, during the 2019 legislative session, Proposition 3 was butchered and replaced with a new law, SB96, that required the Trump administration’s approval on several of its changes. It is important to note, however, while almost every part of Proposition 3 was taken away, the sales tax was not. You and I have been paying this tax increase since April, the tax that was meant for full Medicaid expansion and that was attached to a financial return. We’re paying the tax, but we’re not getting any of our investment’s return. In fact, we’re losing money on it.

When I talk about Medicaid expansion publicly, I often get the question: What can the state do now to lower the cost of Medicaid? My answer is always a resounding: They can expand Medicaid. It might seem counterintuitive, but the voters understood it, and we hope the state and governor will join us.

The Legislature’s plan is now under federal public comment before the Trump administration makes their decision on the changes. It’s easy to voice your opinion; we’ve had a lot of practice after six years. Help us one more time: Full Medicaid expansion now.

Courtney Bullard is the director of Education and Collaborations at Utah Health Policy Project.

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