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A Back-And-Forth Between State Lawmaker And Medicaid Advocate Underscores A Difference In Priorities

Roger McDonough
Director of Education and Collaborations Courtney Bullard, who is with the Utah Health Policy Project

On the first day of the 2019 Utah Legislative Session, lawmakers introduced bills to repeal or significantly alter the full Medicaid expansion passed by voters in November. 

At the capitol on Monday, KCPW's Roger McDonough tracked down Courtney Bullard, education and collaborations director with the Utah Health Policy Project, which was one of the backers of the successful ballot initiative push for full Medicaid expansion. Roger sat down with Bullard on a third floor of the Utah State Capitol to ask about SB96 and SB97, the two bills filed to change or repeal the voter-passed Proposition 3.

ROGER: What do you think the reticence is on the part of lawmakers is -- when it comes to keeping Proposition 3?

"So there have been some narratives kind of going around about the cost of the initiative which the campaign and all the coalition members involved in Proposition 3 have been very eager to talk with legislators about the cost of the initiative and rework the numbers so that we're making sure we're as responsible as possible," Bullard said.

As it happened, the sponsor of one of the bills in question, Ogden Republican Sen. Allen Christensen, then walked by.  

Sen. Christensen said that he was actually scrapping SB96 and introducing an amended version. The new bill would cover people up to 100 percent of the poverty level through Medicaid, while everyone else who would have been covered by Proposition 3 could be covered by the insurance exchange available under the Affordable Care Act. Instead of the work requirements sought in previous expanded Medicaid plans, Christensen's bill would ask prospective Medicaid recipients to show a "work effort."

"That means you have to do something toward becoming employed," Christensen said. "You can take a class, you can submit your resume, you can submit your job application - you can actually go out and look for a job - if you're so aggressive." 

Christensen and other Republican lawmakers say that the cost of the voter-passed Prop 3 will be greater than anticipated, and estimates from the Governor's Office of Management and Budget show a $10.4 million shortfall by 2021 and a more than $64 million shortfall by 2024.

But Bullard says those figures aren't the final word - and that costs can be dealt with as expanded healthcare coverage for poor Utahns rolls out. 

That sales-tax increase is the increase approved by voters in Proposition 3. Sen. Christensen says the state has assurances from the Centers for Medicare & Medicaid Services that this time, for his bridge plan, they'll get the required federal waiver for an April 1 roll-out. In the meantime, the state will negotiate an additional waiver to get the 90-10 federal/state split that exists in other states under full Medicaid expansion. Utah has tried that route before and failed, something that is worrying for advocates like Courtney Bullard.