Updated 3:44 p.m. MST 11/9/8
Voters in Utah have approved Proposition 3, a ballot initiative to expand the Medicaid health insurance program to an estimated 150,000 Utahns.
The bill will expand health coverage to those in the “Medicaid gap” – people who make too much money to qualify for the low-income health insurance program, but don’t make enough to qualify for federal tax credits to pay for health insurance under the Affordable Care Act.
“Working on Medicaid expansion has always been about elevating the voice of Utahns in the coverage gap,” said Rylee Curtis, campaign manager for Utah Decides Healthcare, the group behind Proposition 3.
At an election night watch party in Salt Lake City health care advocates, patients with chronic conditions and Proposition 3 organizers waited with anticipation as votes trickled in from around the state.
Jim Rounds was one. He was diagnosed with multiple sclerosis in 2012. Rounds is currently on disability and is in the coverage gap. Without insurance, he says, he has accumulated over $100,000 in medical debt.
“Multiple sclerosis has no cure. It doesn't go away. So I will have this disease for the rest of my life. That means I will be treating it for the rest of my life,” Rounds said.
He said his medication bills run $6,800 per month. In the meantime, he’s going into debt. He said he’s supporting Proposition 3 to prevent others from going through his experience with the medical system.
By approving the ballot initiative, Utah voters will pay a 0.15 percent sales tax increase, excluding food sales.
Public support for the health insurance expansion has been met with broad opposition from members of Utah’s majority Republican legislature.
Rep. Robert Spendlove, R-Sandy, has said he worries costs to fund the program would surpass the estimated $90 million per year sales tax increase.
“The struggle as a policymaker and a lawmaker is how do we sustain it long term? And how do we prevent the kind of problems that are happening in other states?” Spendlove said.
As other states around the country have expanded Medicaid, evidence is mounting, however, that the expansion does not have adverse economic effects on state budgets.
In 2018 the nonpartisan Kaiser Family Foundation conducted a literature review of more than 200 studies on the impact of state Medicaid expansion programs. The study found expansion had largely positive results on “economic outcomes, including impacts on state budgets, uncompensated care, costs for hospitals and clinics, and employment and the labor market.”
Norman Waitzmen, a health economist with the University of Utah’s Health Society and Policy Program agreed with the Kaiser report. According to the academic literature, he said, the 0.15 percent tax increase is more than enough to cover state costs.
“Based upon all the evidence from around the country and in states with similar tax structures as Utah, there would likely be a net state budgetary savings from the expansion in Utah,” Waitzman said.
Medicaid Expansion In The Midterms
Voters in Nebraska and Idaho also passed Medicaid expansion through ballot initiatives on Tuesday night. Of the 33 states and the District of Columbia that have expanded Medicaid, only Maine has previously done so by ballot initiative. The implementation of that law has so far been blocked by Maine Governor Paul LePage, who said the state’s legislature funding plan was insufficient.
Under mounting public pressure, Utah’s legislature passed a narrow Medicaid expansion during the 2018 legislative session. That law would expand low-income health insurance to 70,000-90,000 Utahns who earn up to 100 percent of the federal poverty level, or a little over $12,000 for an individual. Legislators also included a “work requirement” mandating that recipients must complete job training or classes to create a pathway out of the program.
However, both Utah’s limited 2018 expansion and the work requirements must be approved first by the Centers for Medicare and Medicaid Services, the federal agency that oversees the program.
Utah’s Proposition 3 was one of three ballot initiatives before voters across the state this year. Other measures include the creation of a state-sponsored medical marijuana program, which also appeared to have enough voter support, and a bipartisan redistricting panel to evaluate Utah’s districts during the 2020 census, which was too close to call.
Looking Ahead: Medicaid Expansion In Utah
According to Rylee Curtis, the Utah Department of Health will now submit an amendment to the Centers for Medicare and Medicaid Services to change the current Medicaid program. That will expand Medicaid coverage to individuals up to 138 percent of the federal poverty level, or a little less than $17,000 for an individual. Both the sales tax increase and the period when eligible individuals could apply for Medicaid and begin receiving health care will start in April 2019.