The Realities of Medicaid Expansion

Government programs are complex, and government programs that involve healthcare are no exception. The debate over Medicaid expansion has already begun, and with it, so has the gossip. Let’s separate the rumors from the facts.

 Here are the facts:

On Tuesday Representative Jim Dunnigan and Representative Dean Sanpei presented HB 141 (substituted) to the House Business and Labor Committee. This bill contains an innovative alternative to full Medicaid expansion.

The bill creates a state-based program called, “Access.” Access will begin in January 2015 and continue to January of 2017. Right now, the state of Utah has two different waivers, given to them by the Bush Administration. These waivers are for Utah’s Premium Partnership Program and the Primary Care Network. Utahns covered under Access, will be part of those two existing state programs.

 Access is for Utahns who are below 100% of the federal poverty level and not eligible for traditional Medicaid. This includes the medically frail, and parents of children. Utahns over the 100% of the federal poverty level will receive premium tax credits.

If Utahns eligible for Access have a job, they’ll get health benefits through employer coverage. If they don’t have a job, the Access program will help pay the premium for other health coverage, services, or products. It also allows the state to better understand the below 100% population and who needs what type of health care.

 Now to the rumors:

Rumor: “GOP members voted to deny affordable healthcare to 123,000 Utahns.”

Fact: The reality is, we voted to provide coverage to tens of thousands of Utahns who do not currently have any form of health coverage.

Rumor: “GOP members want to tax you an additional $35 million.”

Fact: This is just plain wrong. Money for the Access program comes out of the general fund; there are absolutely no increases in taxes to pay for this smart, and innovative solution.

Rumor: “Taking full Medicaid expansion is ‘common sense.’”

Fact: Is it common sense to ask your children’s children to pay for your Medicaid? If the state of Utah accepts federal money, 40% of what we accept is already debt. This means you’re taking out loans in your posterity’s name.

Is it common sense to continue to fund a program that is so inefficient and fraught with fraud that it has an Inspector General whose only job is to recoup money the state of Utah, and the federal government, erroneously spent? Let’s spend our money on a program that covers Utah’s most needy effectively, and that isn’t subject to the whims of the federal government.

Is it common sense to continuously tell the federal government to manage its spending and pay down the debt all while increasing their spending and debt burden? If we want the federal government to be fiscally responsible, we as a state need to be prepared to be pioneering in our own approach to policy-making.

Rumor: “Accepting federal money is less expensive.”

Fact: 40% of federal money may be debt, but 100% of federal money is taxpayer money. Both programs cost the taxpayer, because that’s what government programs do. Full Medicaid expansion will cost the state of Utah at least 30 million dollars, because in order for Utah to be eligible for $300 million federal dollars, it has to put up 10%. So 30 million in Utah taxpayer dollars + 300 million in federal taxpayer dollars = $330 million taxpayer dollars for full Medicaid expansion. The Access program will cost the state between $30-35 million dollars.

The fact is, Access is an innovative, efficient, state-based solution that provides health care based on individual need and not the definition of a faceless bureaucracy.

You can read HB 141 and listen to its committee debate, here.