After years of fussing, Legislature must bite the bullet and provide health coverage for all

02-06-2019

The Utah Legislature has been debating, cutting, adding and equivocating about Medicaid expansion for at least five years.
It’s time to get the job done and make health coverage available to 100 percent of our citizens, including thousands in Sanpete County who do not have and cannot get insurance at a cost they can remotely afford.
There is growing sentiment in the nation as a whole that healthcare is a human right and should be available to all.
That sentiment was reflected in the November election, when 550,000 people, 53 percent of voters, passed Proposition 3. They voted to raise their own sales tax to enable Utah to fully participate in the Affordable Care Act (ACA).
As written, Proposition 3 would qualify Utah to fully participate in the ACA provision that brings people whose incomes are up to 138 percent of the poverty level under Medicaid. In Utah, that’s about 150,000 people.
If Utah implemented Prop 3, the federal government would pay 90 percent and the state 10 percent of costs for the additional Medicaid enrollees.
People with incomes below 138 percent of poverty are not permitted to buy insurance on the ACA exchanges. But everyone above 138 percent who does not get insurance through a job can go online, during enrollment periods, and sign up for insurance. And if the insurance costs more than they can afford, they can receive federal subsidies. For thousands of families, that translates to health coverage for less than $100 per month.
The program as a whole offers the potential of 100 percent coverage. That’s a goal we not only can live with but must work toward.
In fairness, we conceded that Sanpete County did not vote for Prop 3. And the Messenger has always advocated fiscal responsibility. The state shouldn’t take on expenses it can’t afford.
And it hasn’t. That’s why Utah state government is showing a $1 billion surplus this year, with additional millions already socked away in half a dozen rainy day funds.
But now the Legislature is starting to gut Prop 3 in unconscionable ways. The Utah Senate has passed, and sent to the Utah House, a measure that would add 50,000 people to the Medicaid rolls and leave 100,000 with no access to coverage.
Ironically, the reimbursement from the federal government for those extra 50,000, at least to start, would be the same as what the state gets for current Medicaid recipients. Instead of a 90-10 percent match, the federal government would pay 30 percent and the state 70 percent of the costs.
Some aspects of the Senate bill have merit. It calls for an assessment on hospitals, which would be big beneficiaries of Medicaid expansion, because they would start getting paid for people they are now treating for free. The revenue would go to the Medicaid program.
The bill also requires the added recipients to work if they are not disabled, or unemployed but looking for work.
Robert Gehke, an editor of the Salt Lake Tribune, recently pointed out that if you combine Prop 3 with certain aspects of the bill the Senate just passed. you have a program that is pretty much a twin of something called Healthy Utah that Gov. Gary Herbert proposed in 2014.
The Utah Legislature must quit batting around the healthcare ball. The goal, as reflected by the vote on Prop 3, must be 100 percent coverage. And Utah, which is becoming a rich state, can and must find a way to afford it.