Last week, Governor Gary Herbert’s Healthy Utah Plan passed the Utah Senate by a vote of 17 to 11 and was sent to the House for consideration. Under the Affordable Care Act (ACA) passed by Congress in 2010, the federal government provides tax credits, on a sliding scale, to people making between 100 percent and 400 percent of the federal poverty level ($23,000 to $91,000 per year for a family of four) to assist these people in purchasing health insurance.
Medicaid is a long-standing federal program by which the federal government pays 70 percent and the states pay 30 percent to provide free health care to low-income people. For many decades, Medicaid in Utah has covered all children in households earning less than $57,000 for a family of four. But adults in households with children have been covered by Medicaid only if their household income is under $11,500 for a family of four. And adults with no children have been ineligible for Medicaid regardless of their income.
The ACA was designed so that all adults making less than 138 percent of the federal poverty level ($32,913 for a family of four), with or without children, would be covered by Medicaid. To make this new, expanded coverage affordable to the states, the federal government agreed to pay 90 percent of the cost of the new people who would be covered by Medicaid expansion, with the states paying 10 percent. The U.S. Supreme Court ruled in 2012 that the federal government cannot force states to expand Medicaid as contemplated under the ACA. Compliance with the ACA’s Medicaid expansion has therefore become voluntary for each state. Approximately half of the states so far have opted for Medicaid expansion.
Opponents of Medicaid expansion argue that Medicaid is an expensive, inefficient government program that fails to pay medical providers a fair rate for services. For this reason, many providers simply refuse to see Medicaid patients. Based on these concerns, Gov. Herbert proposed to use the federal money that would be paid under Medicaid expansion to instead pay health insurance premiums so that the expansion population can purchase private health insurance. After nearly two years of negotiating, the federal government has agreed to allow Gov. Herbert’s plan.
Utah House members who oppose Healthy Utah worry that, even with the federal government paying 90 percent of costs, the program will still be too expensive for the state. House members also argue that because more than 50 of the 75 representatives oppose Healthy Utah, it would be futile to hold debate on the bill.
As I have stated publicly for months, I support the Healthy Utah Plan. I believe it provides the greatest benefits to Utah at the lowest overall cost. Because the discussions by the Utah House on this issue to date have been held in closed Republican caucus meetings, the public has not been able to hear and understand the issues being debated. The debate is fundamentally about whether we should create a new government benefit for low-income people that is admittedly going to cost Utah taxpayers additional money.
I realize that reasonable Utahns can disagree on that question. My discussions with my constituents lead me to believe that most Utahns are willing to accept and pay for Healthy Utah. Public debate of the plan by the House will allow legislators and their constituents to make this decision in an informed and deliberative manner.
I respectfully urge the Utah House of Representatives to hold a public debate and discussion on the Healthy Utah Plan and on any other possible alternatives to the question of Medicaid expansion.