UPDATE, February 4, 4:01 p.m.: Republicans in Utah’s state senate voted on Monday to repeal voter-approved Medicaid expansion, replacing it with a plan that costs more to cover fewer people.
Medicaid expansion was approved by Utah voters in November, opening up coverage to an estimated 150,000 low-income, uninsured people.
Utah voters in traditionally red and blue districts alike embraced the measure, frustrated by years of Republican stonewalling on Medicaid expansion in the GOP-led state legislature. The ballot measure, known as Prop 3, captured 53 percent of the vote, amid the highest midterm election turnout in a generation.
Undaunted, Utah Republicans are quickly advancing legislation to strip Prop 3 of key provisions before it takes effect in April. The bill cleared a key state senate panel on Tuesday, and needs only a vote by the full senate to go to the GOP-majority house. The legislation, SB 96, caps Medicaid expansion enrollment, adds onerous and confusing work requirements, and shrinks the pool of qualified adults, among other provisions.
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Most worrisome to Medicaid expansion supporters, the GOP bill requires a special type of federal waiver the government has never issued. Backers of Medicaid expansion consider Republicans’ latest maneuver to be a poorly veiled attempt to thwart the will of the people. Protests erupted at the kick-off of the legislative session on Monday, as the Salt Lake Tribune reported.
“Some politicians seem to have forgotten who they work for,” said Jonathan Schleifer, executive director of The Fairness Project, which has pushed for Medicaid expansion in Utah and other states. The bill to undo key parts of Medicaid expansion, SB 96, is “a slap in the face to the Utahns who voted for full Medicaid expansion in their state,” he told Rewire.News.
The bill’s sponsor, state Sen. Allen Christensen (R-North Ogden), told Rewire.News he’s “philosophically opposed to putting more and more people on the government handout lines.”
“Most groups of people are already Medicaid-eligible, leaving only basically healthy, adult males,” he said. “Some lack many options, but there are usually alternatives available if they look around.”
Before Prop 3, Utah was among 17 GOP-dominated states that rejected Medicaid expansion under the Affordable Care Act. Frustrated by state politicians, voters in these states took matters into their own hands via the ballot box. Maine was the first state where voters passed a proposition for Medicaid expansion. Voters in Utah, Idaho, and Nebraska followed suit. In these three states alone, more than 330,000 people are expected to gain health coverage via Medicaid expansion.
Republicans, who’ve tried to paint Medicaid expansion as a partisan issue, increasingly appear tone-deaf to constituents who view health-care coverage as a human right.
“Voters knew what they were doing, they were informed,” said Stacy Stanford, a health policy analyst with Utah Health Policy Project.
Prop 3 extends Medicaid coverage to those making below 138 percent of the federal poverty line, which is less than $16,642 for an individual. It hikes state sales taxes slightly to finance Medicaid expansion, with the federal government expected to pick up 90 percent of the costs.
In contrast, the Republican bill asks the federal government to carry only 70 percent of expansion costs—a change that requires a federal waiver from the Trump administration. The legislation cuts the pool of eligible adults to only those making up to 100 percent of the federal poverty line. It caps eligibility, and adds work requirements and new restrictions. People who violate program provisions could be locked out of coverage for a year.
Before now, the Trump administration hasn’t allowed per-capita caps, and has already rejected proposals with eligibility limits of 100 percent by Utah and other states, as Modern Healthcare reported.
Voters don’t want these changes, Stanford told lawmakers at Tuesday’s hearing. “Utahns voted to expand Medicaid, not cut it,” she said. “We didn’t vote for caps, or delays, or red tape. We voted for a 90-10 match, not 70-30. We voted for full expansion on April 1, no strings attached. The voters got it right.”
The bill’s sponsor, Christensen, insisted the caps and new restrictions are fiscally prudent. A recent analysis of voter turnout suggests his opposition to Medicaid expansion puts him out of step with his constituents, as some 54 percent of voters in his district favored Medicaid expansion.
Right-leaning allies in the state have stoked fears about spiraling costs if more people sign up for Medicaid than expected. A spokeswoman from the Koch-affiliated Americans for Prosperity Utah called Medicaid expansion a “catastrophe” in states like Kentucky, where the pool of low-income, uninsured adults who became eligible surpassed state projections.
As passions flared at the bill hearing, citizens chided lawmakers for ignoring the will of the 53 percent of statewide voters who favored Medicaid expansion.
“I represent 53 percent of Utah voters,” said Paul Gibbs, to cheers from the audience. He said Medicaid saved his life when he needed a kidney transplant. Expanding Medicaid could save the lives of thousands of uninsured Utahns, he believes.
“I’m here because I had an aunt who died of cancer,” he told lawmakers. “She wasn’t able to receive treatment soon enough because she wasn’t eligible for Medicaid.”
The bill stands a good chance of clearing the state senate in a vote expected Friday.
Subverting the will of voters isn’t isolated to Utah Republicans. In December, Republican lawmakers in Wisconsin enacted a package of bills to sabotage early voting and blunt the authority of the newly elected Democratic governor and attorney general. Meanwhile, GOP legislators in Michigan passed paid sick leave and a minimum wage increase so they could keep the measures off the ballot in November 2018 and water down the laws in 2019.