Since the passage of the Patient Protection and Affordable Care Act (Obamacare) more than three years ago, Utah has known that it has a choice to make: participate in the Medicaid expansion or not. That decision has been delayed until now, but the time has now come for the choice to be made.
130,000 Utahns are living just above the federal poverty level, which currently disqualifies them from receiving Medicaid health coverage and leaves them unable to obtain basic healthcare or medications. Under the ACA, states choosing to expand Medicaid coverage to those people would see 100 percent of the costs of doing so covered by the federal government for three years. After the three years federal dollars would taper off slightly in the next decade, but even at its lowest point Utah would only be responsible for 10 percent of the costs.
Arguments over whether to participate in the program have been flying, but until this week it was mostly unknown how implementing the program would actually effect the Beehive State financially or economically. In a moment of clarity several months ago, Utah’s Republican leaders chose not to guess on what the impact would be, and appropriated a large amount of our tax dollars to an independent research company who were tasked with completing an in-depth analysis of what the true costs of the Medicaid expansion would be. That report came back this week.
According to the report, if the expansion were implemented the state would save an estimated $20 million in the first three years alone, and $131 million overall from no longer having to subsidize unpaid hospital bills and emergency room bills. The expansion would also produce 3,552 new jobs, generate $286 million in additional state economic activity, and contribute over $20 million in state and local revenue by year 2022. Hospitals and medical facilities who are currently spending an estimated $331 annually on uncompensated care would also see significant savings from this under-served population obtaining health insurance.
There has always been a moral argument for participating in the expansion. These 130,000 Utahns who live just above the federal poverty line are our brothers and sisters, neighbors and friends, and (for elected officials) constituents. An individual making $1200 per month does not have the option or the luxury of paying $500 per month for private health insurance. Yet illnesses happen, injuries happen, and basic medical needs will always arise. Allowing these individuals and families to obtain Medicaid health coverage is not only morally right, but ethically necessary.
Yet, there are some in Utah’s government who are ignoring their own commissioned report which says the expansion is the economically and fiscally sound thing to do. Instead, they are encouraging Utahns to rely on so-called “charity care” to solve the problem. Charity care refers to a doctor or other medical provider giving away their services for free. During the 2013 legislative session, Representative Michael Kennedy (Republican, Alpine), himself a doctor, touted charity care as a viable alternative solution to providing access to healthcare to these low income citizens, saying he regularly donates his services to people who need it.
While we applaud Representative Kennedy for his apparent goodwill, there is no viable alternative or policy that could turn charity care into a reality for 130,000 people in the state. If Charity care were viable, it would have already solved the problem. Obviously it hasn’t, which means that for it to work the state legislature would need to enact a law requiring medical providers to donate their services to low income families. Even if we ignore the logistical nightmare of medical providers now having to obtain the financial software and systems necessary to determine their patients’ incomes, such a law would be tantamount to indentured servitude. In addition, there is already a growing physician shortage in the United States, and the Association of American Medical Colleges estimates that by the year 2025, America will be short 125,000 physicians. In other words, there is already a burden on our medical providers, and for Utah’s government to push them to work for free is almost laughable.
It was understandable when Utah’s elected officials wanted to delay making a decision on Medicaid expansion until all the facts were known. Even though there is a clear and strong moral reason to expand, it is fair enough to say we should wait until the numbers come back. But now we have the report the legislature and governor commissioned, and it says, without any mincing of words, that expanding Medicaid is sound fiscal policy, and will actually save the state millions of dollars, save hospitals millions of dollars, and create more than 3,500 new jobs for Utahns.
Utah needs to expand Medicaid. It’s the moral, ethical, and economic thing to do. Elected officials who still preach against it run the risk of being seen as putting partisan politics ahead of the desperate needs of those who elected them into office in the first place.
The due diligence has been done. Your move.