It’s almost humorous to listen to doctors complain about student loans and the cost of doing business in Utah. Either they haven’t lived anywhere else, or they really are oblivious to the lower cost of living that Utah presents to all of its residents, including them.

I say ‘almost,’ because the rest of us are paying their bills, and they ain’t cheap.

If Medicaid expansion is too risky for doctors, maybe it's too risky for the rest of us
The “Gang of Six”: Senate President Wayne Niederhauser, Senator Brian Shiozawa, Governor Gary Herbert, Rep. Jim Dunnigan, Speaker Greg Hughes, and Lieutenant Governor Spencer Cox.

They, along with some people who actually sounded like they need legitimate help, gave lawmakers an earful at a hearing held by the Health Reform Task Force earlier this week. The Gang of Six has presented the latest in a long line of iterations Medicaid expansion (version 14.03 is officially known as “Access Utah.” It’s really just a mini-me to Big Brother’s Affordable Care Act, for better or for worse, and no one likes it).  And the plan would have forced healthcare providers (i.e. doctors, nurses, pharmacists, plastic surgeons, etc.) to help bear the cost of Medicaid expansion.

That’s not fair!

No, it’s not. Taxes rarely are. Given the Utah Legislature’s penchant for passing new taxes this year (in spite of the Republican super majority in the House), perhaps we shouldn’t be surprised at yet another tax, even on a bunch of rich folk. But do we really want to decrease the incentives that drive highly intelligent individuals to spend a decade in school so that they can deal with sick people every day?

Probably not. Still, maybe the Access Utah proposal wasn’t a total loss. Here’s why:

In responding to Access Utah, Utah’s healthcare providers conceded that the risk in Medicaid expansion is too high to willingly accept.

  • The Utah Legislature has been reticent to pass Medicaid expansion because of the unknown risks to the state budget.
  • Mirroring House concerns, Greg Bell, former lieutenant governor and current president of the Utah Hospital Association, said in the hearing that that hospitals are concerned that there is nothing to limit skyrocketing costs and would “strongly oppose an open-ended assessment” on hospitals.

Catch that? After years of pressing for Medicaid expansion, providers conceded that the actual risk is too high for them to accept it.

If Medicaid expansion is too risky for doctors, maybe it's too risky for the rest of us
Dan Liljenquist

Here’s Dan Liljenquist, who consults Intermountain HealthCare, acknowledging the same point:

“If there is a silver lining to the storm of opposition toward the Utah Access proposal, it is that certain health care providers who have for years vociferously advocated for full and immediate expansion have now publicly acknowledged that there are significant costs and risks with Medicaid expansion that they are not personally willing to bear. In politics, as in life, it is always easier to offer up someone else’s money than it is to commit your own.” 

If the risk is too high for doctors (including physicians (average salary $177,135) , anesthesiologists (average salary $332,854), chiropractors (average salary $129,990), optometrists (average salary $110,607), pharmacists (average salary $117, 331) and plastic surgeons (average salary $351,099)) , then maybe the risk is too high for the rest of us, too.

Maybe we should focus more on a plan that would limit Medicaid expansion to the at-risk population rather than opening it to able bodied, working age adults. There are people in Utah who cannot get insurance and finding a way to help them get back on their feet is a cause we should all support.

Is Access Utah the way to do it? I’m dubious. It imposes a tax on healthcare providers merely because they are healthcare providers. My sense of fairness revolts at this, no matter how disingenuous to hear a BMW driving doctor complain about student loans.

Supporters of Medicaid expansion have been quick to tout the benefits of society sharing the costs of medical insurance, but reluctant to examine the costs–long and short-term–that come with the expansion of government largess. If this week’s hearing accomplished nothing more than forcing proponents of to acknowledge risks, then we have at least taken a step in the right direction towards prudent and compassionate public policy.


What does Access Utah look like?
  • The proposal would impose an average $67 per month cost to physicians’ practice. Each class under the proposal would have a different rate.
  • In Utah, about 124,500 individuals are eligible under Medicaid expansion (including people already eligible but who haven’t signed up but might because of increased advertising. These folks will bring Utah only a 70/30 reimbursment rate, rather than the much touted 90/10 rate). Of these,
    • 29,500 are children already eligible for CHIP coverage through traditional Medicaid (and yet, their parents haven’t signed them up? What gives, folks?);
    • 2,000 are “woodwork” adults that are already eligible for coverage through traditional Medicaid;
    • 32,000 are above 100% federal poverty level (and already eligible for coverage through the Affordable Care Act),
    • 63,000 to fall between 0%-100% of the federal poverty. Of this population half already have coverage (through employment, by living at home with parents, etc).
    • That leaves about 31,500 people who need coverage and who are able bodied and working age adults.   
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