If you left the 2015 Utah legislative session wondering, “What happened to Medicaid expansion?” you aren’t alone. Many Utahns were shocked when the session ended on March 12 with no solution.
At first it seemed like something would get done. By mid-February four different coverage bills were competing for attention and votes. It seemed that anyone could create a Medicaid bill by slapping an adjective next to “Utah,” blaming the federal government, and calling a press conference. By early March legislative leaders were begging reporters to stop peppering them with Medicaid Expansion questions and ask them instead about simple issues like the gas tax formula.
But in the end, Gov. Herbert’s Healthy Utah plan was defeated in a House committee, while competing plans were similarly neutralized. The 72,000 Utahns living in the coverage gap—and their equally numerous supporters—were left with nothing except hoarse lungs and elevated blood pressure. For a session that started with bold pledges to tackle big and transformative issues, the Medicaid expansion debate ended with a whimper and most post-mortems of the 2015 session labeled the whole process a failure in governance.
So is it even worthwhile to review what happened? We think yes, because the strongest arguments and the biggest misperceptions raised during the session still matter as the debate goes into overtime.
But since a normal legislative recap is boring, we've re-imagined the 2015 legislative session as a playoff-style showdown between Healthy Utah and the field of coverage plans that rose to challenge it. The only caveat to this approach is that Utah’s Medicaid politics isn’t a game when your family’s well-being depends on the outcome--and we know thousands of Utahns waiting for this "game" to end.
So with apologies in advance, let’s review this year’s legislative session like ESPN would.
Round 1: Healthy Utah vs. Frail Utah
In December 2014 the Health Reform Task Force attempted to disqualify the Healthy Utah Plan even before the competition got underway. During a December 18th meeting, a majority of the task force surprised many in the audience when they bypassed the governor’s plan to recommend a limited Medicaid expansion that would cover 100,000 fewer lives. Despite months of task force discussions on the benefits of closing the coverage gap and meeting the mental and behavioral health needs of the uninsured, the task force decided to pinch-run an untested coverage plan that was later dubbed “Frail Utah” in a clever op-ed written by Rep. Brian King (D-Salt Lake).
Dressed in the uniform of S.B. 153 and sponsored by Sen. Allen Christensen (R-Ogden), Frail Utah would have extended Medicaid coverage to Utahns earning under 100% of the federal poverty level (FPL) who are also medically frail, uninsured, and vulnerable to becoming disabled. And because Frail Utah did not come close to fixing the overage gap, the federal government would only cover 70% of the total cost, leaving the state responsible for 30% of the cost. In contrast, Healthy Utah triggers the “enhanced” ongoing match rate of 90% federal funds and 10% state funds—a significant difference when calculating the total state cost of closing the gap. On February 17 the Senate Health and Human Services (HHS) Committee advanced the Frail Utah bill, but nine days later the full Senate defeated Frail Utah in 17-9 vote, and sent it back to the locker room.
Around the same time S.B. 164, the ball-carrier for the governor’s Healthy Utah plan, also had its debut in the Senate HHS Committee. Like its frail counterpart, the Healthy Utah bill also advanced to the full Senate. But before it could be voted on, sponsor Sen. Brian Shiozawa (R-Cottonwood Heights) changed Healthy Utah from a three-year pilot program to a two-year pilot with an automatic sunset. These changes were designed to make Healthy Utah more attractive to conservative lawmakers concerned about the long-term cost of the plan. After an afternoon of serious debate, the full Senate passed the revised Healthy Utah plan with a 17-11 vote. You can find UHPP’s one-page scouting report about Frail Utah and Healthy Utah here.
Result: Healthy Utah soundly beat Frail Utah in a Senate showdown, but how well would it play as a visiting team in the House?
Round 2: Healthy Utah vs. House Leadership
Healthy Utah’s initial reception at the Utah House is not unlike a football fan wearing Ute red to a BYU game, or BYU Blue to Rice Eccles Stadium. Immediate hostility puts it mildly.
After straw polls were taken in closed House Republican caucus meetings, Speaker Greg Hughes R-Draper) announced that the Healthy Utah bill would not be heard by the House.
“Healthy Utah, as it passed out of the Senate, does not have legs in the House. At all,” he told FOX13 News in late February. Claiming that public hearings on the bill would only be “political pageantry,” Hughes benched the Healthy Utah bill at the House Rules committee.
But two weeks of pressure from the local media (including strongly-worded editorials from Utah’s four major newspapers SLT, DN, DH, SE), the public, advocates, and other lawmakers, Speaker Hughes announced that Healthy Utah and a newly created plan called Utah Cares would face-off in the House Business and Labor Committee.
Result: Healthy Utah beat the House leadership in a two-week staring contest after Speaker Hughes blinked and the House suited up a last-minute player called “Utah Cares.”
Round 3: Healthy Utah vs. Utah Cares
H.B. 446, dubbed Utah Cares, was drafted and sponsored by Majority Leader Rep. Jim Dunnigan (R-Taylorsville) as a slightly upgraded version of 2014’s “Access Utah” plan. Utah Cares would extend Medicaid to cover about 21,000 childless adults and parents with dependent children, and use Utah’s Primary Care Network (PCN) to cover 20,000 others earning under 100% FPL. Because Utah Cares did not meet criteria set forth by the ACA, the federal government would only cover 70% of the cost—assuming the plan could even get approved by the federal referees. As a result, Utah Cares would cost the state $64 million (2015-2017) and return only $82 million in taxpayer dollars.
On Wednesday March 4 a standing-room crowd witnessed a head-to-head match-up of Utah Cares vs. Healthy Utah at the House Business and Labor Committee.
First in the arena was Healthy Utah, which Sen. Shiozawa ably presented by highlighting the plan’s two-year timeframe, support for private insurance, and lower overall cost. During the public comment that followed, 20 individuals and organizations spoke in support of Healthy Utah—including the Utah Medical Association, the Salt Lake Chamber, and several Utahns in the coverage gap. But despite these efforts, the committee voted 9-4 to defeat Healthy Utah to end its winning streak and its 2015 legislature season. Two Republican members of the committee; Rep. Gage Froerer (R-Huntsville) and Rep. Curt Webb voted in favor of Healthy Utah that night.
Following the defeat of Healthy Utah, Rep. Jim Dunnigan presented the Utah Cares plan to the committee, claiming it was more conservative and sustainable than Healthy Utah, while providing “good” coverage. Three organizations spoke against Utah Cares during public comment: UHPP, Utah Academy of Family Physicians, and the Disability Law Center. In addition, Salt Lake County resident Kip Griffith explained how PCN limited the ability of his doctor to treat his wife’s persistent medical issue. After several questions to Rep. Dunnigan, the committee voted 9-4 to approve Utah Cares and send it to the next game at the House. You can find UHPP’s one-page comparison of Utah Cares and Healthy Utah here.
Result: The home field advantage of the House Business and Labor Committee proved too much for Healthy Utah, while Utah Cares easily sailed through.
Round 4: Healthy Utah vs. The House
The day after the defeat of Healthy Utah in committee, the dozen House Democrats attempted to resurrect Healthy Utah from the purgatory of the Rules committee. In an unusually dramatic showdown, four Republicans voted with all 12 House Democrats to raise the Healthy Utah bill, but the attempt failed on a recorded 16-56 vote. When the alternative Utah Cares bill appeared before the full House on March 6, Democrats tried a similar tactic when Rep. Rebecca Chavez-Houck (D-Salt Lake City) motioned to substitute Healthy Utah for Utah Cares, eliciting another angry response from House Republicans. But that attempt failed, and after extending minimal mental health access to PCN (ie. the amendment didn’t add mental health benefits, but merely expanded the list of providers could prescribe psychotropic drugs), the House voted 56-18 to approve Utah Cares and send it to the Senate, where it lingered and died with no action.
Result: While attempts to revive Healthy Utah in the House failed, they did force all House members to publicly vote on the plan, a transparent action that leadership wanted to avoid.
Round 5: Healthy Utah vs. Overtime
As final hours of the 2015 legislative session ticked away with no compromise plan to close Utah’s coverage gap, Gov. Herbert held a press conference to announce that this contest would go into overtime. Citing the need for “more time to work together and agree on one specific resolution,” both the House and Senate quickly passed HCR 12 to create a special leadership committee charged with finding a solution before July 31, 2015. The six members of this super healthcare committee are: Gov. Herbert, Lt. Gov. Cox, Speaker Hughes, Senate President Niederhauser, Rep. Dunnigan, and Sen. Shiozawa. Because this committee will meet behind closed doors, some Utah groups have criticized the lack of transparency involved in any deal that can be reached. Democratic lawmakers—who have consistently supported the Healthy Utah Plan—also objected to their exclusion from the committee.
Result: No sports matches (even cricket matches) last three years, but Utah’s Medicaid expansion contest is about to reach that milestone. Plus, the ongoing deliberations by the “Gang of Six” mean that the campaign to close Utah’s coverage gap is far from over. This game could even enter Double Overtime if the super committee fails to reach an agreement by the end of July. In that case, could the fans riot?
Post-Game Analysis
The silver lining is that each year the goal of closing Utah’s coverage gap advances one more step towards a successful conclusion. And 2015 is following that trend, with the governor and the Senate—along with over 70 Utah organizations and overwhelming public opinion—lining up behind the Healthy Utah plan. Only the Utah House stands in opposition, mainly, we think, due to their lingering misconceptions about the Medicaid coverage gap and funding details for the Healthy Utah Plan.
As advocates for Utah’s underserved and uninsured, our work remains the same: Close Utah’s coverage gap with comprehensive, affordable healthcare insurance that protects taxpayer investments. Except now we have a new audience—the Gang of Six—in addition to our previous focus on lawmakers and their constituents. To keep this issue in focus across the state, we need to continue to share real stories of Utahns living in the coverage gap, to tell our legislators that we support the Healthy Utah Plan, and to educate and activate more Utahns by writing powerful and persuasive letters to the editors and op-eds.
Here’s how you can get involved:
- Send a persuasive message to your legislators from the Cover the Gap website (link)
- Write a Letter to the Editor (Deseret News or Salt Lake Tribune)
- Share your coverage gap or healthcare story at mystory@healthpolicyproject.org
- Come to our bi-monthly round table meetings (email RyLee Curtis to be added to the mailing list)
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