About 100 people strolled into the lobby of Utah Gov. Gary Herbert's office Friday and piled up colorful paper-link chains meant to represent the state's uninsured that would be covered by Medicaid expansion.
"Say yes to Medicaid expansion," the group chanted, standing in a circle around the pile.
The action was the culmination of a rally that began on the steps of the Capitol. The event was organized by the faith-based community and was the latest example of the increasing pressure Herbert is facing to accept the federal government's offer to expand Medicaid.
Under the health care overhaul law, the federal government has offered to pick up the full cost of Medicaid expansion in the first three years, and 90 percent over the long haul.
Just as Democratic leaders did earlier in the week at a news conference, the participants in Friday's event called Medicaid expansion the "right thing to do." Providing health insurance to more of the state's uninsured is not only the moral decision, but it will also save the state money by getting people out of the emergency room and into doctor's offices, they said.
To date, 23 states have announced plans to expand Medicaid. That lists includes eight states led by Republican governors, including Arizona and Nevada. Thirteen states, including Texas and Wyoming, had announced they won't expand. The rest, like Utah, have yet to decide.
Herbert, a Republican, remains steadfast in his commitment to taking as much time as he needs to ensure his state carefully analyzes the cost-benefit analysis of the expansion. He's set no timeline for a decision.
"There are no federal deadlines to make a decision so we will take the time to do this right," said Robert Spendlove, the state's deputy chief of staff for state and federal relations.
The state has paid an outside consulting group to do an analysis on what Medicaid expansion would mean for the state. There's no timeline for its completion, Spendlove said, adding that it's more important that it's done well than quickly.
There are an estimated 300,000 uninsured in Utah, about 10 percent of the state's population. It's estimated that about 130,000 of them would initially be covered in Medicaid expansion.
Currently, there estimated 225,000 to 250,000 people on Medicaid in Utah.
About 20 million uninsured people across the nation would gain health coverage if all the states agree to expand Medicaid, according to the nonpartisan Urban Institute for attribution. Most of them would be adults.
Some of the indecision in Utah and other states is due to concerns that deficit-burdened Washington may renege on the 90 percent deal. The regular Medicaid match rate is closer to 50 percent, which would mean a significant burden of the costs would shift to the states.
Supporters of Medicaid expansion are sensitive to those concerns, but say the state could set up the expansion so that it could discontinue it if the federal government pulls back the promised funding. It's an approach they refer to as a "circuit breaker."
"Every day that they do it, there are people that are being helped," said Vinnetta Golphin, a pastor at Granger Community Christian Church in a Salt Lake City suburb. "Three years down the line, maybe things shift. But that's three years of health care that some people don't have."
Most of the uninsured who would benefit are working poor, and many are Latinos, supporters say. They say the expansion would also be a boost to the state's economy by creating more jobs in the health care fields.
Proponents of expansion question why Utah would turn down the federal funds.
"Is Utah going to stand out like a sore thumb and not take this money for its neediest citizens?" said Sen. Jim Dabakis, R-Salt Lake City.
Medicaid expansion would not cost the state anything in the first three years thanks to the federal reimbursement, but by 2021, it would cost the state an estimated $60 million, shows projections from the Utah office of the legislative fiscal analyst.
Rally-goers Jose and Lisa Velarde were on Medicaid for a few months when they moved to Utah from Mexico, where Jose Velarde immigrated from. When their 2-year-old daughter had a heart murmur and had to go to the emergency room, Medicaid helped them stay afloat. Now, they have health insurance, but want to stand up for others who don't.
"People deserve to have health insurance," Jose Velarde said. "The government should at least give it a chance for the first three years."