The Deadline is Here

Utahns have been waiting 1,000 days for a solution to the coverage gap. Now lawmakers have 16 days to deliver it. 

The Republican leadership team in the Utah House

In the aftermath of the U.S. Supreme Court ruling that protected the Affordable Care Act’s (ACA) premium subsidies for over 80,000 Utahns , prospects were looking up for finally closing Utah’s Medicaid coverage gap.

"This ruling lets us really kind of ramp it up,” House Speaker Greg Hughes, (R-Draper) told reporter Glen Mills at ABC-4 on the same day of the Court’s decision. “It's not going to be in the next week or so, but now I think we're a lot closer than we were prior to knowing what the landscape would look like.”

By “us,” Speaker Hughes is referring to the “Gang of Six,” a special group of policymakers created on the last day of the 2015 legislative session to negotiate a solution to Utah’s coverage gap by a July 31 deadline. The gang, made up of Gov. Herbert, Lt. Gov. Cox, President Niederhauser, Speaker Hughes, Sen. Shiozawa, and Rep. Dunnigan has been meeting regularly ever since and even took a trip to Washington, DC to see federal officials.

Rep. Jim Dunnigan (R-Taylorsville)

But last week, more statements from a leading member of the Gang of Six put the brakes on meeting the deadline. During a July 7 press conference, Rep. Jim Dunnigan (R-Taylorsville) suggested the gang might only develop a “concept” plan by July 31^st, and that even achieving the goal was unlikely. Rumors began to circulate that the some members of the gang wanted to delay a decision for another seven months until 2016 legislative session, or 18 months until the outcome of the next presidential election. Suddenly, the prospect of an August 2015 special session to fix Utah's Medicaid coverage gap seemed less likely.

With just 16 days until the July 31^st deadline, and 53,000 low-income Utahns still living in the Medicaid coverage gap, Utahns want our lawmakers buckle down to fix it.

Utah’s coverage gap is a man-made, state-wide disaster that requires an effective policy solution that is not beyond the reach of our legislature. Fixing the coverage gap is entirely their job. Everyone in the "Gang of Six" has said that "doing nothing is not an option." There is no one else to blame for continued inaction. Not Congress. Not the federal government. And not the 88% of Utahns who support the Healthy Utah plan. In addition, many of our red state neighbors are ready for our conservative solution to the coverage gap, and Utah is the closest to delivering the template they have been looking for. Our state has an unprecedented opportunity to lead on the biggest health care dilemma facing over a dozen legislatures across the country.

With the King v. Burwell court decision behind us, the policy-based challenges the Gang needs to overcome are 1) budgeting the overall cost of the program, and 2) who bears the risk if the cost to the state goes over projections.

In recent interviews, both Sen. Brian Shiozawa and Speaker Greg Hughes have indicated a desire to have hospitals, providers, and the pharmaceutical industries help the state mitigate the risks of potential cost overruns. This is good news. We are one step closer to a solution when the debate shifts from which plan we should implement (Healthy Utah vs. capped or partial expansion) to how do we pay for the best plan.

Gov. Gary Herbert (R)

No matter the cause, we expect the Gang of Six to develop a funding system that engages the hospitals and providers and enables the state keep some “skin in the game.” So long as the plan follows these key principles and closes the coverage gap completely with a comprehensive health benefit and brings back the maximum amount of tax dollars back to the state—we are on board with finding payment options.

We think a great place to start is to review the significant cost budget savings other states achieved after they expanded Medicaid.