Utah Senate Republicans are racing to replace the state's voter-approved Medicaid expansion with a more limited expansion model that would require an unprecedented CMS waiver.
The bill, SB 96, approved on a party-line committee vote Tuesday, would cover low-income adults only up to 100% of the federal poverty level, rather than up to 138% as required by Proposition 3. The proposal passed by 53% of Utah voters in November and requires coverage to start April 1.
The bill, coming on the second day of the legislative session with limited debate, also includes a per-capita cap on federal Medicaid spending, a new hospital tax and a work requirement. The Trump administration previously rejected proposals by Utah and other states to expand only up to 100% of poverty, and hasn't previously permitted per-capita caps, which likely would face a legal challenge.
Republican Gov. Gary Herbert said last week that he expected Proposition 3 to be implemented as the will of the people, but that it might later need to be modified to address budget issues.
The move by Utah Republican lawmakers is the latest sign that voter-approved Medicaid expansion ballot initiatives face uncertain prospects in all three GOP-led states where they passed in November. Republican elected officials in Idaho and Nebraska also have signaled they want to attach conservative provisions such work requirements. Republicans in the three states generally had opposed the ballot initiatives.
Similarly, in Montana, where a ballot initiative to renew the state's Medicaid expansion program failed in November, Republican legislative leaders want to add a work requirement and an asset test for eligibility.
"It's an attempt to take what voters decided and really change it drastically to fit within what is seen as conservative approach to expansion," said Matt Slonaker, executive director of the pro-expansion Utah Health Policy Project. "We worked on the ballot initiative for year and a half, talking to thousands of Utahns. Here we have legislation that would undermine entire process and repeal the ballot initiative in second day of session."
But the bill's sponsor, Sen. Allen Christensen, argued before Tuesday's committee vote that his bill offers an improved version of Medicaid expansion. "We are doing as Prop 3 voters wanted in a fiscally, financially responsible way," he said.
The ballot initiative paid for the state's share of the expansion cost through a 0.15% sales tax increase.
To launch the partial expansion by April 1, SB 96 proposes that the federal government assume 70% of the cost, rather than the 90% cost share under a standard Affordable Care Act expansion. That would require rapid CMS waiver approval. To pay for the state's added cost under that model, the bill would impose a new tax on hospitals, capped at $15 million a year.
At the same time, Herbert and GOP lawmakers are pushing for a $200 million-plus tax cut in the face of the state's projected $1 billion budget surplus.
Herbert's office, the CMS and the Utah Hospital Association did not offer comment for this article.
Slonaker said his group and other expansion advocates will try to convince enough GOP lawmakers to oppose the bill to deny the sponsors the two-thirds majority they need to override a possible Herbert veto and block a new ballot initiative challenging the repeal of Proposition 3.
"I don't think Gov. Herbert wants to be known as governor who repealed the will of the people," Slonaker said.
