Advocates who have spent years unsuccessfully pushing Utah’s Republican Legislature to expand Medicaid under the Affordable Care Act are now planning to take the issue directly to voters with a ballot initiative.

The initiative to be filed Monday is backed by a number of state and local nonprofits, including Utah Health Policy Project, a group that advocates affordable health care, Jason Stevenson, the nonprofit’s education and communications director, said Friday.

If the initiative makes it on the ballot and is approved by voters in 2018, it would cover residents earning up to 138 percent of the poverty line, which is about $34,000 a year for a family of four, Stevenson said. There are about 127,000 people in Utah who would be eligible for the program.

Utah lawmakers chose not to expand Medicaid under President Barack Obama’s signature health care law, citing concerns about the state’s ability to pay for the program and questions about whether the federal government could afford to pay its share of the cost.

Under the Affordable Care Act, the U.S. government pays at least 90 percent of the cost of expanding Medicaid while states picked up the rest. So far, 31 other states have expanded their program.

Stevenson said Utah’s Medicaid-expansion initiative is estimated to cost about $70 million to $80 million, with the federal government kicking in about $700 million.

The initiative calls for Utah’s share to be paid by raising the state sales tax rate to 4.8 percent or 4.86 percent, up from its current rate of 4.7 percent.

Instead of expanding Utah’s program, Utah lawmakers passed a pared-down proposal that insures a sliver of the state’s poorest: homeless people making less than about $600 a year or those who need mental health or substance abuse treatment, particularly those in the criminal justice system.

The state has also proposed capping the number of people covered by the program at 25,000 and stopping their coverage after five years.

The Trump administration has not yet approved that program.

GOP House Speaker Greg Hughes said Friday evening that the Medicaid expansion proposal can’t guarantee that money generated from a tax increase will cover the costs of the program. Hughes, writing in an email as he traveled back to Utah from Washington, D.C., pointed to the many states that expanded Medicaid and saw costs rise faster than expected, straining their budgets as far more people signed up than anticipated.

Hughes questioned where Utah will get additional money to pay for added costs.

“Utahns are fiscally conservative,” he said. “We don’t want our tax dollars obligated toward things we can’t control or can’t afford.”

The initiative’s backers will have to gather about 113,000 signatures by mid-April for their proposal to make it on the ballot. Backers must also have the measure vetted by state officials to ensure it is constitutional and to estimate the proposal’s cost. Backers must hold at least seven public hearings throughout the state.

Stevenson said other nonprofits supporting the initiative include: Voices for Utah Children; AARP; Families USA, a main proponent of Obama’s 2010 law; and The Fairness Project, a national group that has worked on ballot initiatives for minimum wage in other states.

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Utah Medicaid expansion ballot initiative to be filed Monday