Medicaid expansion: Princes in legislature ought to try being paupers

Mark Twain's The Prince and the Pauper

Mark Twain’s The Prince and the Pauper

In “The Prince and the Pauper,” Prince Edward has the misfortune of switching places with a pauper, Tom Canty. After leaving the royal courts of his father King Henry VIII, Edward struggles to survive on the streets surrounding Offal Court off Pudding Lane.

When it comes to the Utah Medicaid expansion debate, perhaps most Beehive State legislators need their own “Prince and the Pauper” experience.

Medicaid expansion would help 123,000-plus Utahns. But the state legislative did not pass a resolution, leaving them (let alone some 270,000 more) in the cold. (States colored in gray in the article’s main photo will not be expanding medicaid).

Why is this particularly heinous?

As part of an agreement of the Patient Protection and Affordable Care Act, the federal government is willing to pay 100 percent of the expansion cost in the first three years, and 90 percent thereafter. But the legislature is mostly comprised of hyper-conservative lawmakers. What’s worse, they are fearing right-wing backlash in an election year. So they said they are not willing to take the money.

“Irreversible decisions ought to be made with as much deliberation and as much information as you possibly can,” said House Majority Whip Greg Hughes.

That’s exactly why a legislative task force spent the better part of a year studying the issue, as part of the studies Gov. Gary Herbert commissioned. Studies already released are exactly why the governor seeks a “block grant” option.

That conservative plan has already impressed Republican governors, including those over Iowa (a key state in presidential elections) and Arkansas of the ruby-red South. It would cover 60,000 Utahns falling through the gap, with incomes below 138 percent of the federal poverty level. It would require $258 million in federal expansion dollars. The best provision: it could last only three years, so the state could opt out if things aren’t looking good after the federal government is no longer committed to pay the full cost.

Gov. Herbert was looking forward to seeing how the House would like his plan, sponsored in bill form by Sen. Brian Shiozawa. But Becky Lockhart refused to even look at it in that chamber. Instead, she and lawmakers want to reject more than $500 million that taxpayers have already sent to Washington, instead spending $30 to $35 million in state money that remains undetermined where it would come from.

Of course, Utah’s new drama queen has been looking for ways to oppose Herbert in preparation for a gubernatorial bid. (And of course, she was critical of Gov. Herbert’s efforts to accept Obamacare in any fashion whatsoever, even though she pushed for an education technology proposal that would cost upwards of $300 million.)

That may seem like a lot. But according to a report by the independent Public Consulting Group, even general Medicaid expansion would create 3,100 jobs and $2.2 billion in Utah’s economic activity. It would generate $130 million to $160 million in additional state and county tax revenue. Tax revenues from expansion-related spending will also likely pay back the cost. And Utah would actually save: budget relief from expanding Medicaid reduces state costs by $149 million. (See the Utah Health Policy Project’s study.)

Thankfully, Gov. Herbert is sending advisers to the nation’s capital to negotiate in the White House. Unfortunately, lawmakers would still need to approve any agreement, and the feds will take three months or more to decide.

Those pursuing their own political motivations or inviting red tape are making reasonable – and caring – options difficult. At the very least, the governor’s “block grant” plan should be embraced for Utah to maintain its reputation as the best-managed state. Then at the very least, we would know that some Price Edwards ought not to spend some time on Pudding Lane.

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