Bill To Modify Voter Approved Medicaid Could Kill Expansion Plans Without Federal Approval
State Senators at the Capitol on Monday passed the latest version of a plan to change voter-approved Medicaid expansion, known as Proposition 3.
The changes rely on the state getting approval from the federal Centers for Medicare and Medicaid Services. If federal waivers don’t come through, the bill stipulates that Medicaid expansion in Utah is dead. In that case Republican backers of the bill, S.B.96, say the legislature will come back into session and try to figure out another way to expand Medicaid.
The bill passed in the Senate after an hour of debate, with Democrats criticizing Republicans for undermining the will of the voters after they posed changes to the ballot initiative.
Proposition 3 imposed a 0.15 percent sales tax increase to expand health coverage to an estimated 150,000 low-income Utahns.
But Republicans argued that the tax hike included in Proposition 3 won’t raise enough money to cover all those Utahns.
“They [Proposition 3’s backers] wanted a tax increase. They wanted Medicaid expansion. And that’s what we’re doing. They didn’t fill in the proper blanks. We are filling in those blanks for them. They are not obligated to balance the budget. We are,” said the bill sponsor, Sen. Allen Christensen, R-North Ogden.
Christensen argued that his proposal strikes a balance between expanding low-income health coverage that voters wanted while maintaining fiscal responsibility.
The pared-down legislation would expand Medicaid in Utah to 100 percent of the federal poverty level — about $25,000 for a family of four. That leaves 41,000 people who would have been covered under Proposition 3 uninsured without more help. Christensen’s bill would take care of those remaining individuals by directing them to obtain highly subsidized health insurance on the Affordable Care Act (ACA) marketplace exchanges.
The ACA allows states to expand Medicaid to individuals who make up to 138 percent of the poverty level —the level Proposition 3 intended to do with its sales tax hike. But doing so for the bill currently moving through the legislature would require two waivers from the federal government. Past Medicaid waiver requests in Utah have taken over a year to be approved by the Centers for Medicare and Medicaid Services. Some have not been approved at all.
Christensen said he is confident that one of the waivers will be approved by the planned Proposition 3 start date of April 1.
“We’re betting on it. The best sources tell us yes,” Christensen said.
Republicans were less certain of the speed of approval for the second waiver. But critics, including Proposition 3 spokesman Andrew Roberts, say the federal government is unreliable when it comes to waiver approval.
“You know, the legislature’s starting point here is not, ‘How do we make Prop 3 work?’ it’s ‘How do we repeal Prop. 3.?’ And I think one sure-fire way to do that is to pursue this federal waiver that nobody else has ever gotten,” Roberts said.
Christensen’s bill passed 22-7 in the Senate, with only one Republican — Sen. Todd Weiler — voting against it. Next it goes to a House of Representatives Health and Human Services committee.