Utah’s Medicaid expansion hits some headwinds

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

Utah Gov. Gary Herbert

No sooner had we posted an update on the prospects for Medicaid expansion in several states, including the three that passed ballot initiatives in November, than news came of obstacles emerging in Utah.

The state legislature may take one or more of these actions: delay the April start; cover fewer people; add work requirements or other conditions.

“We are going to implement Medicaid expansion. We are going to implement the sales tax increase to help pay for it,” Republican state lawmaker Allen Christensen, who favors scaling back the program, told the Salt Lake Tribune. “But we have to put some bumpers or guardrails around it so that it isn’t going to break the bank.”

The ballot measure, Proposition 3, won with 53 percent of the vote in November, and expansion was supposed to have begun in April with some 150,000 low-income adults eligible. Advocates of expansion say that the proposed funding mechanism — a sales tax — will have enough financial cushion to meet the state’s share of the costs. Moreover, most of the money to cover the expansion population under the ACA comes from the federal government, at least 90 percent.

So far CMS has approved work requirements for several states — with Arkansas already up and running — but neither the Obama nor Trump administrations had allowed states to cover only part of the eligible population. For example, states haven’t been permitted to expand up to only 100 percent of the federal poverty line, instead of the 138 percent full expansion population.

Utah Gov. Gary Herbert earlier had said the state would expand, but at a recent press conference indicated he’s considering changes to contain costs. “I think it would be difficult to completely repeal it,” he said, “But I think it probably is going to be of necessity that we have to modify some of it.”

Expansion proponents predict fierce resistance to any effort by state officials to make it harder for people to qualify for Medicaid. “We think these legislators underestimate the backlash they’re going to receive,” Jonathan Schleifer of the Fairness Project told my Politico colleague Rachana Pradhan. The Fairness Project bankrolled the expansion measures in Utah, Nebraska and Idaho. As of now Nebraska and Idaho are moving ahead (although adding work requirements can’t be ruled out.)

Maine famously voted by a broad margin to expand Medicaid in 2017, but then-Gov. Paul LePage fought it tooth and nail. He was succeeded by Gov. Janet Mills, a Democrat, who has been a strong proponent of expansion.

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