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“Don’t tie my hands,” was the message Gov. Gary R. Herbert sent to state legislators during a panel discussion on Thursday. Herbert hosted the discussion at the Fourth Street Clinic in order to promote his alternative to Medicaid expansion, a plan he calls “Healthy Utah.”
The Utah State House of Representatives has been resistant to the idea of accepting federal money to expand Medicaid coverage in Utah, noted Herbert. Medicaid expansion would bring health benefits to those who don’t qualify for Medicaid under the current guidelines and also don’t qualify for subsidized insurance premiums through the national exchange.
In Utah, 57,850 people fall into that coverage gap, according to the Kaiser Family Foundation. That represents 21 percent of the state’s uninsured, non-elderly adults. Currently, childless adults do not qualify for full Medicaid coverage, no matter their income; parents may qualify if they earn less than 44 percent of the federal poverty level, or $8,400 for a family of three.
Under the Affordable Care Act, Medicaid expansion would bring coverage to those who fall into the coverage gap, whether or not they have children. The federal government would pay for 100 percent of the costs of Medicaid expansion for the first three years, and then its portion would gradually diminish to 90 percent.
“Our taxpayers sent back to Washington, D.C.—as a result of the Affordable Care Act, also known as Obamacare—about $680 million dollars. And it’s money that we’re obligated to pay as taxpayers of Utah, and we sent it back to Washington. And under the Medicaid expansion program, $258 million is going to be sent back to Utah,” said Herbert.
A proposal in the House would reject those federal dollars and instead appropriate $35 million in state tax dollars to bring health coverage to some Utahns.
Under Herbert’s plan, the state would ask the federal government to issue the $258 million as a block grant for “maximum flexibility, no strings attached,” he said. The state would then create some sort of private-sector premium support plan to provide coverage to those in the gap.
“We’d direct the money into the private sector exclusively in working with the insurance markets and insurance providers,” said Herbert. “We’ll find, I think, a better bang for those taxpayer dollars.”
With the 2014 Legislative Session set to end in a matter of days, Herbert is hoping the Legislature will authorize him to work with the U.S. Department of Health and Human Services, along with the Obama Administration, to request the Medicaid expansion money in the form of a block grant.
“The Senate has its own thoughts about [Medicaid expansion]; the House has [a plan] that I don’t think really represents the taxpayer very well—but they have a thought process and a position. I’m hopeful within the next few days we’ll resolve the differences amongst the three—the House, the Senate and the executive branch—and they’ll give me some direction moving forward. I hope they don’t tie my hands,” said Herbert.
In addition to media, audience members at the panel discussion included Fourth Street Clinic staff, clients and volunteers. The first question from the audience was when, exactly, benefits would be available through Healthy Utah. “There are homeless people that are waiting, and they need the care now,” said a man who identified himself as a member of the clinic’s consumer advisory board. “How long do they have to wait?”
Herbert said he will need to receive legislative approval to begin working with the U.S. Department of Health. From there, he said it could take three to six months to obtain the necessary waivers, get the details of the plan solidified and then set up agreements with insurance providers.
That’s if the federal government agrees to the block-grant plan. Other states, including Indiana and Arkansas, are pursuing similar plans.
Davina Spotted-Elk, a Medicaid enrollment specialist at Fourth Street Clinic, said, “In my office I have stacks and stacks of applications. … Sometimes our patient ends up passing away [before qualifying for Medicaid].”
“I don’t think anybody disputes, certainly you can’t keep a straight face, that the money we’re sending back to Washington, D.C. under the Affordable Care Act is Utah dollars. It’s coming from our taxpayers,” said Herbert. “My hope is the Legislature sees it my way.”