Health Department: No Health Care Expansion Until at Least 2016

healthyUtahThe state’s Health Task Force met again Thursday to discuss options for the expansion of Medicaid. That meeting was the seventh in the interim session with another planned on December 18th.

Dr. David Patton, the Director of the Utah Department of Health, testified that the window for the implementation of the Governor’s “Healthy Utah” plan, one of the leading options being considered by the task force, was likely now shut on 2015.

This implies that the state is losing some of the federal participation on administrative costs that apply only for 2014 through 2016. The governor’s office and Dr. Patton’s staff worked closely with the Obama administration and received specific concessions on the funds being returned from the federal government to cover more of Utah’s Medicaid users. One of the concessions described on Thursday was that children receiving Medicaid funds would be able to transfer to private insurance (like Healthy Utah) as a consolidation with the state’s design.

“Do you have your [Federal Section 1115] waiver yet?” asked Representative Robert Spendlove (Republican – Sandy), seeking clarification on the status of the Healthy Utah deal.

The waiver would allow the federal Secretary of Health and Human Services to approve experimental programs such as the Healthy Utah plan so long as they promote the overall objectives of Medicaid.

Patton responded that the Health and Human Services Secretary, Sylvia Burwell, had personally reviewed the Utah plan with the President and that all of the points which have been negotiated would be included in the waiver.

While posing his questions, Spendlove described the effort as “making lemonade out of lemons,” a feeling shared by many Utah lawmakers. Patton testified that the necessity of the plan’s development was due to the additional taxes that have been imposed by the federal law which Utah wants to reclaim. Utahns in the so-called “coverage gap” would apply for the plan through the Department of Workforce Services, allowing a much promoted and controversial “work effort” requirement to be incorporated into the overall Utah plan. Patton stated that while Utah cannot withhold benefits from participants under federal guidelines, it is possible for the state to withhold state benefits such as Temporary Assistance for Needy Families (TANF) funds, general assistance, or even driver’s licenses for a “work effort” compliance failure.

Lieutenant Governor Spencer Cox told the task force that the wait on the federal waiver for the Healthy Utah plan option was due to the deference being paid by Utah’s executive branch to the state’s legislature, stating that, “We believe that this is the very best deal we could get from the federal government.” Cox also explained that the Governor still believes that “the ACA is still very flawed and is working with the state’s federal delegation to repeal and replace that law.” Before leaving the meeting, Cox said of the Healthy Utah plan, “…the Governor believes that there is room for ample discussion on this topic.”

The task force co-chair, Representative Jim Dunnigan (Republican – Taylorsville), presented several options which described various levels of participation by the state and the resulting numbers of covered Utahns.

An insurance broker by profession, Dunnigan is a known opponent of the Affordable Care Act and has expressed his desire that the expansion of Medicaid be available only to those Utahns who are “medically frail,” thus being unable to work for their benefit. The difference is that the governor’s team obtained the agreement to cover those who constitute 138% of the federal poverty level in household income or approximately 95,000 people in Utah. “We still have a lot of indigestion over these numbers,” said Dunnigan. “[The numbers] have not been vetted… the assumptions are many and the landscape has changed considerably.”

As many as 67,000 Utahns who do not presently qualify would be covered under the new provisions of the Healthy Utah plan as delivered today. One of the options presented today was to include only 9,000 of those in the state. While it would be a key to determining what the state will eventually do for those less fortunate, the task force deferred defining “vulnerable populations,” during this meeting.

Senator Gene Davis (Democrat – Salt Lake) defended the expansion as “taking care of the needs of the citizens of the state of Utah,” while Representative Francis Gibson (Republican-Mapleton) wanted to steer the discussion toward the cost of the expansion commitment.

Gibson is not alone among Utah legislators who are concerned about the costs, especially after three years when the federal government’s participation in the expansion ceases. “Our largest budget items are for education and healthcare,” said Gibson, “Where will the monies come from?” Fearing a required tax increase to eventually sustain the program, Gibson described the effort to extend the plan past the pilot program as one that the Governor’s office won’t have to face.

After the hearing, the Democratic leadership called for their Republican colleagues to step-up their efforts to get a solution completed and in place. “This is no longer about saving face, it’s about saving lives,” said Representative Rebecca Chavez-Houck (Democrat – Salt Lake) in a statement issued following the meeting.

“Every month that is proposed for more research or more information puts Utahn’s lives at risk,” the statement read. “The Governor has negotiated in good faith with the federal government to bring back taxes to the state… It’s time for the legislature to prove how different we are from Washington and to move on this issue – protecting Utah’s working families.”

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