38 reasons Utah won’t see Medicaid expansion this year

It might be 2016, or even 2017, before Utah sees legislative action on Medicaid expansion.

A self-imposed July 31 deadline blew past without any compromise between House Leadership and the Governor, despite a loose framework for the compromise. At this rate, it’s becoming increasingly difficult to see Medicaid expansion this year.

38 reasons Utah won't see Medicaid expansion this year
House Majority Leader Jim Dunnigan

The 2016 campaign season has effectively begun and as the election approaches, campaign calculus means that the chances of a special session diminish. Forcing legislators into Medicaid during election year is suicide.

While the Governor pushes to get a Medicaid expansion deal done, something Hughes has called a “generational” decision, Republicans in the House are wary of adding an unpredictably expensive program to Utah’s budget. Just as he wouldn’t put a bill in front of the House that wouldn’t pass with a Republican majority, it’s unlikely that Utah House Speaker Greg Hughes will put a compromise in front of the House unless it can pass with support of the Majority Caucus.

Sure, there are probably 12 or 13 Republicans that will support whatever compromise is proposed, and there are the Ds…but that’s still not a majority. Right now, there just aren’t 38 Republicans to vote for any form of Medicaid expansion.

38 reasons Utah won't see Medicaid expansion this year
Utah House Speaker Greg Hughes

Plus, there are a sizable number of House Republicans that are still new (less than four years in the House). Hughes isn’t going to force his members to vote on Medicaid expansion that they can’t support as the go into  election year.

Without 38 Republicans in the House to support Medicaid expansion, it’s unlikely we’ll see a special session any time this year.

This raises another question: why hasn’t the Gang of Six put their legislation out, yet?  What is the deal?

As yet, other than GOP legislative leadership, legislators haven’t yet seen anything. A framework for the deal presented in July described a “market driven” solution, the first nationally, to Medicaid expansion. Ironically, it may be this market driven solution that proves to be the poison pill.

During the session, lobbyists and activists for healthcare providers were vocal with a narrative that argued that every dollar that Utah put into Medicaid expansion would return nine back. Of course, the major beneficiaries of the nine dollars would be health care providers: the hospitals, doctors, pharmacists, drug companies, medical device manufacturers, psychiatrists, labs, ambulatory and surgical services, substance abuse treatment centers and groups, therapist, home health providers and more.

There was a lot of money at stake once the expansion passed. With so much money to be earned, providers worked together with activists to create a narrative that this was all about providing care for those most in need and preventing deaths.  The math is simple, they said.

Meanwhile, a lot of Republican legislators, charged with annually balancing the budget, remained skeptical. Projections in 2014 by Milliman (an actuarial firm) suggested that only 48% of eligible people would actually enroll and the cost would be around $78M, twice what the state had projected just one year earlier. Under Healthy Utah, providers saw it as a boon to their bottom line.

Under the new framework, though, healthcare providers face the possibility of helping to bear those costs. Now, the buzz around the Capitol is that health care provider are balking.

Healthy Utah was a good idea when the state was bearing the cost and health providers were reaping the benefit, but relying on the market has made providers take a second look, questioning whether the Medicaid expansion projections were correct and making arguments that sound suspiciously like those made against Healthy Utah last year.

In other words, the math isn’t so simple.

It’s going to be hard for Hughes to get 38 Republicans behind any Medicaid expansion proposal, but it’s going to be harder if healthcare providers are working behind the scenes to stop it.

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