Q: Is there enough money for Utah to expand Medicaid? I keep hearing that the ballot initiative didn’t provide enough money to cover all the costs. Isn’t that why voters chose to increase the sales tax?
A: All fiscal estimates show that Utah has enough money to implement expansion for the first few years, if not longer. A lot of the fiscal impact statements beyond the first years include predictions, different interpretations, and what-if scenarios about the new law.
Bottom line: Utah has the money to implement expansion now; it’s already in the process of doing so and we shouldn’t slow down. The sales tax increase that Utah voters supported will ensure there is enough money in the state budget for Utahns to enroll in Medicaid. State agencies are working diligently to implement the law on April 1, as Utah voters approved it. Utah families cannot afford to derail those efforts with costly and burdensome proposals that do nothing more than take our eye off the ball and delay meeting the needs of those who have no other way to afford health care coverage.
Q: But, really? I hear that other states end up spending a lot more than they expected on Medicaid.
A: There have been numerous, peer-reviewed studies looking at the experiences of other states that have expanded Medicaid, including this Brookings Institute report: Do states regret expanding Medicaid? [The short answer is no]
Medicaid expansion is an economic win for states because of the federal dollars that will be returned. But also because of the many budget offsets that come with Medicaid expansion. States that have expanded Medicaid have consistently found that expansion is a net saver. However, Utah’s current fiscal estimates for Proposition 3 do not appear to include all of the anticipated cost savings and offsets we’ve seen in other states.
Bottom line: The national evidence and data show that the cost to expand for states is minimal, while the overall economic and public health gains are high. Any effort to change Utah’s plan is just a delay tactic that will cost more money and more time and prevent people from getting the health care they need and deserve. Utah must keep moving forward now.
Q: So, could the Legislature pass a different Medicaid expansion plan, through a waiver? What does this mean?
A: The proposals legislators are considering would require additional federal approval, through a federal waiver. (Proposition 3 does not require a waiver.) In theory, these plans could cover everyone in the coverage gap. The hitch is that the federal government has to approve such a plan, and there is no public indication or evidence that they would do so, or that any such plans would be fiscally prudent for Utah to implement. What’s more, the Legislature’s plan would require public comment periods, and will be subject to legal challenges, further delaying Utahn’s coverage, not to mention increasing its costs.
In addition, many of the Legislature’s proposed changes to Proposition 3 would include other provisions that put up additional barriers to health care enrollment and amount to radical restructuring of the Medicaid program here in Utah and nationally. These changes make it harder for Utahns to get care and are likely to be challenged in courts, piling on more unnecessary costs and delays.
Bottom line: If the Legislature passes a different Medicaid expansion plan, it will mean more barriers to coverage, increased administrative costs, and lengthy- if not indefinite- delays. Utah already has a smart, fiscally sound, plan to give families across the state access to the health coverage they need. The state agencies will continue to work to implement that plan as voters intended so enrollment can begin April 1. Let’s focus on getting people the health care they need and deserve instead of increasing bureaucracy, red tape and risks that help no one.
