SALT LAKE CITY — With congressional Republican plans to repeal and replace the Affordable Care Act seemingly dead for now, one Democratic state senator is making an impassioned plea for Utah to finally join over 30 other states to fully expand Medicaid.
Sen. Jim Dabakis of Salt Lake City, joined by Health Policy Analyst Micah Vorwaller and Education/Communications Director Jason Stevenson, both of the nonprofit Utah Health Policy Project, held a sparsely attended town hall at the Utah State Capitol Tuesday night. Dabakis urged Utahns to sign an on-line pledge refusing to vote for candidates of any party who do not support accepting the state’s share of federal Medicaid funding that could extend health care access to tens of thousands uninsured Utahns.
“Every year Utah sends over $650 million back to Washington. They give it to Washington and then refuse to take back our share,” Dabakis said of tax dollars Utahns pay into the system. “Our Legislature is excited to take all the transportation money and all the put-out-the-fire money … but when it comes to the poorest of the poor for health care, (the money’s) contaminated and we’re not taking it.”
Dabakis spoke of the string of failed attempts on Utah’s Capitol Hill to pass any kind of Medicaid expansion since 2014, with the exception of the narrowly tailored House Bill 437 lawmakers approved in 2016. That legislation expanded Medicaid eligibility to an estimated 9,000 to 16,000 adults that met certain requirements.
Citing a 2016 Dan Jones & Associates survey and a 2014 Brigham Young University poll, Dabakis said he’s now looking to the majority of Utahns who support Medicaid expansion to sign his online petition and help make a difference in the future of Utah’s health care.
“We can do this, we’ve gone through this roller coaster of loopy Republican ideas … and now we’ve got issues,” Dabakis said. “Some day the people of Utah have to take control of our government.”
What’s at stake for Utah?
“We really dodged a bullet when the Graham-Cassidy bill died today,” Stevenson said during Tuesday’s Town Hall, noting the measure would have caused roughly 32 million Americans and hundreds of thousands of Utahns to lose their health care coverage. “That’s why I’m excited to talk about Medicaid expansion. We’re going to discuss the possibility of covering our coverage gap of 80,000 to 100,000 of low-income, most vulnerable Utahns.”
That gap consists of people whose wages fall below the federal poverty level — in 2017 that means $12,060 for individuals or $24,600 for a family of four — but who make too much to qualify for Utah’s existing Medicaid programs that vary based on income, age, pregnancies, disabilities and numbers of children.
Under the ACA, a range of federal health care subsidies are provided to people making 100 to 400 percent of the federal poverty level. And full Medicaid expansion could cover people up to 138 percent of the FPL. But a 2012 U.S. Supreme Court decision upholding the constitutionality of the law’s individual mandate also left Medicaid expansion to the discretion of the states.
The Utah Health Policy Project’s annual reports for the past three years indicated that 225,216 Utahns enrolled in ACA coverage in 2014; 175,637 in 2015 and 197,187 in 2016.
But that growth could be hindered this year due to recent changes handed down by Trump administration officials. An Aug. 31 memo from U.S. Health & Human Services announced plans to trim funding for “navigators” who educate new and returning ACA enrollees about their options. According to the directive, since its launch in 2013, the Navigator program has reached more than 9 million people.
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The 12-week ACA enrollment period has also been cut in half this year, running for six weeks from Nov. 1 to Dec. 15 rather than the regular 12 weeks. Aspiring enrollees could be further hampered by limited hours of access to the federal Exchange website, healthcare.gov, on Sundays, as reported by the PBS Newshour and Kaiser Health News.
Randal Serr, who has directed Take Care Utah since its start five years ago, said that with full funding, they were able to employ eight full-time and eight part-time licensed navigators who were able to take on the most complicated cases. But the recent 61 percent funding cut means losing much of that training and expertise.
“We’re not losing Take Care Utah,” Serr said Thursday. “We still have several people around the state who can provide the free assistance, but we’re losing those who could speak other languages and help the people who needed it most.”
Serr also took issue with this year’s shortened enrollment period.
“These are political decisions that don’t pass the smell test of actually trying to help people,” Serr said. “Best-case scenario, it’s incompetence; worst case, it’s a political move and sabotage.”
He also noted that funding cuts don’t match the language of the Aug. 31 memo which said money would be distributed to states according to the percentage of their enrollment goals reached the prior year. Take Care Utah hit 75 percent of its goal, Serr said, but will only get 39 percent of its funding in 2018.
Under the failed Graham-Cassidy bill, Medicaid expansion and insurance subsidies would have been replaced by new block grant programs for 2020 thru 2026. States would be given latitude in how they used those dollars. But by 2027, those block grants would disappear altogether.
The Congressional Budget Office offered a quick analysis of the rushed bill, projecting it would decrease the deficit by $133 billion from 2017 to 2026, but would also leave many millions of Americans uninsured for a variety of reasons: Medicaid enrollment would fall due to reduced federal funding for the program, enrollment in individual insurance coverage would also drop off due to subsidy reductions, and without the ACA’s individual mandate and associated penalties, enrollment in all types of health insurance would decrease.
On Sept. 13, Sen. Bernie Sanders, an independent from Vermont and former Democratic presidential candidate, introduced single-payer legislation that would essentially extend Medicare coverage to everyone.
Sariah Crowton-Suarez works as a part-time assistor with Alliance Community Services at 3159 Grant Ave. in Ogden, where she not only helps enroll people in ACA coverage, but also helps them navigate the oft confusing world of health insurance.
In the midst of political uncertainty over health care coverage, Crowton-Suarez said she still intends to sign people up under the current ACA options.
“We see a little bit of everything. I see a lot of people that don’t qualify for Medicaid or the Marketplace, so they end up in the gap,” Crowton-Suarez said. “That’s hard because we want to help them.”
In such cases, she refers them to a clinic where they can receive care — in Northern Utah, that would be one of eight Midtown Community Health Center locations.
Midtown operates clinics in Clearfield, Logan, Ogden, South Salt Lake and Washington Terrace. According to its website, Midtown has provided affordable, needs-based healthcare to underserved residents in Northern Utah since 1994. Now its eight clinics provide medical, dental, behavioral health and pharmaceutical services to over 26,000 patients each year.
But it appears these sites also face potential loss of funding.
Alicia Martinez, executive director for Midtown Community Health Center, said her staff is gearing up for the ACA’s shorter open enrollment period, but patients have many questions about continued access to health care.
“All we can do is move forward as usual since no bill has made it very far. However, Midtown and all community health centers across the nation are facing the health center funding cliff,” Martinez said by email. “With both issues front and center, our future as a health care provider in our communities is uncertain. If there is not action on health center funding (due to expire Friday, Sept. 29), the health center program is facing a 70% loss in funding. That is the fight we are fighting now.”
Serr said that in spite of federal cuts, Take Care Utah will continue its work of connecting people to affordable health care while the ACA is still in force.