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Medicaid Expansion Rewrite Looks Increasingly Likely Coming Out Of Week Two Of The Session

Erik Neumann / KUER
Protesters have been at the Capitol this week to speak out against lawmakers' rewrite of the voter-approved Medicaid expansion ballot initiative.

The Utah House of Representatives passed the latest version of a scaled-back Medicaid expansion bill on Friday, giving a clear path for the proposal to become law, and supersede Proposition 3, which voters passed last November.

If signed into law, Utah would be the first state to adopt a funding mechanism that caps funding for each enrollee known as a per capita cap. In addition, the bill, known as S.B. 96, includes Medicaid work requirements. Healthcare advocates have warned both provisions could be challenged in federal court.

“April 1, just like the initiative, they start coverage,” said Senate President Stuart Adams. “With the amendments in the House, that’s pretty much guaranteed.”

Before the 56-19 House vote, a critical change was made to the bill. Another bill, H.B. 210, from Rep. Ray Ward, R-Bountiful, was adopted as a fallback plan if the federal government chooses not to grant two waivers to Utah. The waivers are required to allow states to change how local Medicaid programs work. Ward’s bill is more closely based on Medicaid expansion under Proposition 3.

Rep. Jim Dunnigan, R-Taylorsville said his meetings with officials from the Centers for Medicare and Medicaid Services suggested the waivers will be approved.

“They are telling us, three days ago, this is going to happen,” Dunnigan said, referring to a meeting he had with officials from the Centers for Medicare and Medicaid Services. “We have House bill 210 as a fallback.”

The more than two-thirds majority in the House means that voters can’t overturn the Legislature’s decision with a referendum, assuming the House bill gets the same level of support in the Senate. S.B. 96 must go to the Senate before it can be signed into law by Governor Herbert. S.B. 96 was previously supported by state senators. Herbert on Thursday said he supports it.

“This will be unique. It provides flexibility.” Herbert said. “I think Utah’s going to be on the cutting edge of this — coming up with a new, innovative way to expand Medicaid that’s fiscally prudent for the respective states.”

After a hard-fought battle in the first weeks of the legislative session, Proposition 3 supporters were disappointed after the vote but left with few options moving forward.

“We’re just disappointed to see the will of the people become option number two,” said Andrew Roberts, a spokesman for Utah Decides, the group that pushed the Medicaid expansion bill. At the end of the vote, several protesters hung signs above the House floor and protesters blocked the doors to the House and sang songs and chanted outside.

Over the course of two weeks dramatic public outcry led lawmakers to offer a variety of substitutes for S.B. 96, removing one of the strictest provisions of a full Medicaid repeal and replacing it with a more generous fall back plan. Those changes prompted a small victory from health care advocates.

“We would never be at this point, with this type of expansion without the proposition,” said Stacy Stanford, a policy analyst with Utah Health Policy Project. “It’s not perfect, it’s flawed, it’s going to take time to get the waivers and things but it will cover the gap eventually.”

Erik Neumann is a radio producer and writer. A native of the Pacific Northwest, his work has appeared on public radio stations and in magazines along the West Coast. He received his Bachelor's Degree in geography from the University of Washington and a Master's in Journalism from UC Berkeley. Besides working at KUER, he enjoys being outside in just about every way possible.
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