Like so many health care supporters in Utah, I was upset when the Utah Legislature chose to override the choice voters made to fully expand Medicaid.
Proposition 3, which was supported by 53% of Utah voters (with an astonishing nearly 75% voter turnout in a midterm election), was replaced by Senate Bill 96. SB96 was a complicated partial expansion which sought unprecedented waivers from the federal government to receive full ACA Medicaid expansion funding to cover only people up to 100% of federal poverty level (rather than the 138% threshold required by law, and covered under Prop 3), and added unwieldy work reporting requirements, enrollment caps and other changes health care advocates opposed.
Like most of my fellow advocates, I had serious doubts that the federal government would approve this waiver, despite the insistence of SB96 proponents that it had been all but promised. On Friday, a report in The Washington Post revealed that Utah’s partial expansion waiver would be denied.
There has been a wave of confusion among both supporters and opponents of Prop 3 and SB96 as we all sort out the aftermath of that rejection. But SB96 itself tells us what should happen, thanks to a provision wisely added by legislators in the final days before the vote: if the waiver was not approved, we would move to the backup plan of Rep. Raymond Ward’s HB 210, a bill advocates supported which would fully expand Medicaid as called for in Prop 3, but make some fiscal tweaks to assure that it was fiscally sustainable.
I applaud this move by legislators to anticipate the potential for denial of the waivers and appreciate the promise they made to Utah voters to assure that Medicaid expansion took place. I thank SB96 co-sponsor Rep. Jim Dunnigan, who voted against his own bill in committee to help force the inclusion of the backup plan.
The federal government has not honored supposed assurances they made to Utah’s legislative leaders. But legislators now have an opportunity to demonstrate a higher standard by holding themselves to the commitment they made in the law they passed. The fallback position in SB96 outlines a plan that guarantees to Utahns that if the waiver was rejected, their choice to fully expand Medicaid would be respected.
Now it is time for elected officials to show that they can be trusted to keep their word. Full expansion must be implemented without delay to extend coverage to tens of thousands of Utahns badly in need.
Utahns have waited more than long enough. A recently released study shows that nationwide, 15,600 deaths could have been prevented by fully expanding Medicaid in states that have not yet done so. We have felt the effects of this in Utah. My own aunt was one of these statistics, as she was forced to delay treatment for symptoms that turned out to be esophageal cancer. Before she passed away, her doctors and nurses told her that earlier treatment, which could have been possible if she’d had Medicaid coverage, likely would have made a major difference to the outcome.
In an era when trust and approval of government leaders is low, Utah's leaders have a chance to earn respect and demonstrate integrity by immediately implementing the backup plan in the law they passed. It's time for all of us to call on them to do this. It's time for them to demonstrate to all that the "Utah Way" we so often hear about in local politics involves honesty and accountability. That it means when you make a promise to millions of voters, you keep it.
Paul Gibbs is an independent filmmaker, former Medicaid patient and health care activist who has campaigned for Medicaid expansion in Utah since 2014. He lives in West Valley City with his wife and two sons.
