Utah’s Medicaid Expansion Could Go Past July

Utah Medicaid Coverage Gap
Utah Medicaid Coverage Gap

Utah’s policy leaders were in Washington DC today, meeting with Health and Human Services Cabinet Secretary Sylvia Burwell for an hour and a half.   They expressed their concerns over the waiver they seek to expand Medicaid and address Utah’s so called “coverage gap.”

Led by Governor Gary Herbert, the Beehive State leadership included Senate President Wayne Niederhauser (Republican – Sandy), House Speaker Greg Hughes (Republican – Draper), Medical Doctor and Senator Brian Shiozawa, (Republican – Cottonwood Heights) and House Majority Leader, Representative Jim Dunnigan, (Republican – Taylorsville).

Left to Right: Utah House Speaker Greg Hughes; Governor Gary Herbert; Rep. Jim Dunnigan; Secretary Sylvia Burwell; Senate President Wayne Niederhauser; Senator Brian Shiozawa, MD

“We’ve all agreed that doing nothing (on Medicaid expansion) is not an option,” emphasized Governor Herbert, who led off the remarks to Utah by stating that “Number one on our agenda was to see if we could work with Secretary Burwell and get some answers to some questions and clarification of issues and see if collectively the executive branch in concert with the Senate and the House could come up with an alternative to Medicaid expansion…that’s our quest.”

To many, he was restating a quest that has been evident for more than a year, and when asked if this meant that leadership was effectively “starting over,” with the negotiation process, the Governor said that this most current effort was to “see if we can start a solution on common ground, adding clarity and understanding.”

President Niederhauser indicated that the meetings revealed some “unanswerable questions” on the topic, and when pressed to describe them, he said that there was a lot of information that they were getting from “other states, like Arkansas and Washington state, that are making predictions on their ‘take rate’ that are, in some cases, double. That was something that the Secretary and her staff hadn’t seen,” he said.

Niederhauser is concerned that states will have to pay some additional. unplanned funds if they choose to accept some version of health care expansion. “So we agreed to provide [HHS] with more data so that they can ‘mine down’ on our information,” he explained.

Doing so, Niederhauser said, would keep Utah from scheduling an $80 million coverage commitment that might eventually be double that amount. The risk to the state budget by committing to expansion that has several unknown fiscal factors, was paramount on their minds.

Speaker Hughes said that Secretary Burwell told them that it was important for the federal Department of Health and Human Services to know where Utah’s specific challenges are. Risk assessment was the operative word in the discussions, according to Niederhauser and Hughes.

It was pointed out that the Speaker of the House has a majority leader who is an expert on risk management, and also has actuarial resources which would allow him to assess the risk very accurately. Hughes’ response was that it was important to Utah leadership to accurately assess the information that’s available and that more was being acquired “daily.”

Governor Herbert again acknowledged that “generational risk” was the premier challenge on the matter. This implies that the budgetary risk is tied to populations that have yet to arrive as a responsibility to the state. These numbers and the relevant data is readily covered by actuarial tables and projections.

When asked why Utahns would have to wait, given in-house talent for number crunching, Hughes brought up additional data from Illinois and other states “in real time” that would drive the decision on Utah’s Medicaid expansion.

But then Hughes admitted that the US Supreme Court case, King v. Burwell, would also inform the states’ decision. The case involves the Affordable Care Act and a court ruling is expected to be handed down before August. The implications from the judicial branch are vast and the stakes are high.

“There is an incredible amount of attention being paid to what the consequences of that decision either way are going to be to the ACA” Hughes said, adding that it would effect “the role that the states have regarding Medicaid expansion. It’s going to be hard to get too far along before we know what that Supreme Court decision is.”

That statement telegraphs a need for additional time for the legislative process to work well past July, when lawmakers originally agreed to finalize health care expansion, a commitment made during the final hours of this year’s legislative session.

Hughes did state that he “[agrees] with the Governor that the desired special session can occur as planned.”

“I think that the three of us now have additional information and facts that will allow us to bring this all together,” Herbert would add, also indicating that the July 30 deadline, was still a reasonable target for completion.

President Niederhauser said he felt that additional public meetings would not be productive, prompting media representatives to call for agenda and minutes to be issued for some degree of transparency.

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