ST. GEORGE — A Republican and a Democratic lawmaker are bringing separate bills to the Utah Legislature this session — each with the goal of expanding Medicaid to more Utahns.
Until now, Utah and 17 other mostly-conservative states have resisted the option to expand their eligibility requirements. But that resistance is changing with the Trump administration indicating in January it would approve any state plans for Medicaid that include work requirements for some of those covered.
Medicaid is a federal-state program that provides health care coverage to low-income families with children and others who meet specified criteria such as age, disability and the like. States run the program and states determine eligibility.
Rep. Robert Spendlove, R-Sandy, and Senate Minority Leader Gene Davis, D-South Salt Lake, have both run expansion proposals past the Legislature in years past to no avail, but they are at it again with new or revised bills.
Currently, and if these bills are not passed, Utahns have to be disabled, older than 65, or make less than a $15,800 annual income to be eligible for Medicaid.
Encouraged by the Trump administration, Spendlove is currently drafting a bill that would expand Medicaid to up to 100 percent of the federal poverty level and enact a work requirement for some of the people covered by the program.
Up to 60,000 Utahns are estimated to gain health care through his bill if passed, Spendlove said.
“The Affordable Care Act, while well-intentioned, was fundamentally flawed,” Spendlove said. “The Obama administration wouldn’t have approved things like work requirements. The new administration has let us know they are in favor of our bill and would approve it if it’s passed.”
Spendlove puts a priority on the outcome of health care services and creates cost-control mechanisms to make sure growth in Medicaid coverage doesn’t get out of control. He said:
Most of the current health care system is fee-per-service, so you pay for each individual service you get. This one would be trying to emphasize greater care and having better outcomes as the goal.
Republicans didn’t want to hand out Medicaid money to people who weren’t focused on bettering their lives, Spendlove said. That’s why the Utah Legislature, which is largely controlled by Republicans, did not want to expand Medicaid under Obamacare.
Davis has had a bill for Medicaid expansion bouncing around the Legislature for the past three years, he said, but hopes this is the year one will finally pass.
Amendments proposed in his bill, designated SB 47, would help Utah use Obamacare to expand its Medicaid eligibility to 135 percent of the poverty level, he said.
“That would include single men and women, people who are out of work and people who are working menial jobs with a very limited income,” Davis said. “They would then be able to get the services they need for health care, as well as substance abuse and mental health programs.”
His proposed amendments would also allow the governor to go to the federal government rather than the state Legislature to negotiate Medicaid expansions.
Although he wasn’t aware of the bill Spendlove is working on because it has yet to be introduced, Davis would consider adding work requirements to his own bill if it means it will be passed. He said:
If the Trump administration puts a rule in place that says everyone has to work to get Medicaid, then we’ll do that.
Why expand Medicaid
Because Trump is so willing to approve work requirements for Medicaid coverage, Gov. Gary Herbert’s administration is looking to take the opportunity to get more Utahns who are in poverty covered through Medicaid.
“Is it a big deal?” Herbert spokesman Paul Edwards said. “Yeah, I think it’s a big deal.”
The governor’s support of work requirements for Medicaid has everything to do with helping people help themselves, Edwards said, and getting them lifted out of poverty.
“If they are needing these kinds of services because they are in financial straits and if they are in a position, physically and mentally, to take on the added responsibility of work, it would really be a blessing and an opportunity for them to become self-supportive,” he said.
Davis said expansion of Medicaid would also benefit the state by allowing millions of dollars to go toward hospitals and medical service providers. It could also lead to new jobs, he said, and could boost tax revenues for the state from for-profit health providers.
Spendlove said that while it’s the goal for people to find work, there will be exceptions to the work requirement; those exceptions might include, for example, Medicaid recipients who are going to school, disabled, actively looking for work or taking care of dependents.
“We’re trying to help people,” Spendlove said, “help them improve their lives and get out of poverty.”
Spendlove said he’s confident his bill will be debated and passed in this year’s legislative session. Medicaid expansion is one of the most important topics in this year’s legislative session, Davis said.
“If the Legislature does nothing, then I see there being a referendum,” he said. “One way or another, it will happen.”
Family planning amendments
While Medicaid expansion legislation is still up in the air, the Utah House passed another bill Tuesday relating to Medicaid, designated HB 12, seeking amendments to laws relating to family planning services. That bill is sponsored by Rep. Raymond Ward, R-Bountiful, and would use Medicaid to allow low-income families to have more access to long-lasting birth control.
“(This bill) could help as many as 11,000 low-income families in Utah to have more control over when they choose to have children,” said Rep. Rebecca Chavez-Houck, D-Salt Lake City. “Birth control is so expensive, and many low-income Utah women simply cannot afford it.”
This bill was taken to the Utah Senate Wednesday for consideration.
The Associated Press contributed to this report.
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