In back-to-back committee hearings to a packed room of more than 200 people that spilled over to a second hearing room, the Utah House Business and Labor committee advanced only their own version of expanded Medicaid.
The outcome was expected by many who understood the ideological aversion that the majority of House has against any public policy associated with the Affordable Care Act, otherwise known as Obamacare – an anxiety has completely colored the debate and outcome thus far in the session.
First up was Senator Brian Shiozawa (Republican – Cottonwood Heights) who presented a Senate approved version commonly called as “Healthy Utah,” a plan announced more than a year ago and fine-tuned to get through at least most of the legislative branch.
The room was dominated by supporters of Shiozawa’s legislation, so much so that when the chairman asked for public comment, the people desiring to offer positive testimony flooded out those in opposition.
“We can agree that the Affordable Care Act is not perfect,” said Shiozawa, “I didn’t vote for it and you didn’t either.” The senator, as an Emergency Room physician working for MountainStar Medical at Salt Lake City’s St. Marks Hospital, understood the provider side of the issue completely and proved that in weeks of work in getting the bill toward law up to this date since the bill was filed on February 5th and referred to the House twenty days later.
As much as Dr. Shiozawa understands the hospital side of the matter with personal expertise and with his Senate colleagues’ approval, Representative Jim Dunnigan (Republican – Salt Lake County) understands the insurer side as a broker in his professional life. It was up to Dunnigan as the House majority leader to come up with an alternative to the Healthy Utah plan after criticizing it so thoroughly before and during the legislative session.
The result was HB 446 was filed on the day before its presentation to the House committee. Dunnigan’s legislation has been come to be known as “Utah Cares” and is a scaled down Healthy Utah.
One of the real differences between the two Medicaid expansion plans is that Utah Cares relies upon Primary Care Networks (PCN’s) for economic efficiency. Dunnigan and his colleagues did not want the state of Utah to be reliant on reimbursement from the federal government that ceases in two years. That kind of efficiency prompts critics to emphasize that Utah Care’s PCNs would allow a patient to be diagnosed with a life-threatening illness but would not cover in-patient hospitalization for the same illness. That, they say, could lead to more medical bankruptcies and testimony to that end was heard on Wednesday.
Dunnigan characterized his bill as less than desirable in some ways, he used an automobile analogy, calling it a “Yugo,” He added that his bill was one that “still gets you where you need to go.”
By the same 9-4 vote on party lines, each bill received the votes that made one survive the House Business and Labor Committee for further House debate while the other now is finished with the legislative branch effort. Shiozawa’s Healthy Utah 2.0 was rejected in favor of Dunnigan’s Utah Cares bill which will advance to the floor of the House and then need Senate consideration as well.
Dr. David Patton, who oversaw the Healthy Utah plan along with Shiozawa and who spent a serious amount of time negotiating with the White House and Health and the Human Services Secretary (two of them), testified that there were sufficient commonalities between the two bills and that his Department of Health could still make the effort toward expanding Medicaid work. The PCN lack-of-hospitalization aspect was one that he didn’t readily know how to address at the close of the hearing. After the fateful committee action, the Governor’s press secretary, Marty Carpenter, released a statement saying only that, “The governor looks forward to working with the Legislature on a solution that best protects the interests of the Utah taxpayer and provides necessary coverage for Utahns in need.”