Health

On December 6, 2018, Governor Herbert released his budget recommendations for the next fiscal year (2020). The budget is based on a consensus forecast developed by the Governor’s Office of Management and Budget, the Office of the Legislative Fiscal Analyst and the Utah State Tax Commission.

In summary, the budget recommendations reflect an estimated $1 billion in surplus revenue due to Utah’s booming economy; a $200 million tax cut and a call to modernize Utah’s tax system. The budget’s theme is Growth and Quality of Life and presents budget recommendations covering the following key areas: Quality of Life, Qualified Workforce, and Tax Modernization.

Voices for Utah Children works to make Utah a place where all children thrive. While reviewing the Governor’s recommendations we asked one simple, important question: "Is it good for kids?" If it’s good for kids that means Utah’s families can fully participate in the economy and support their children. That means parents are able to ensure their children reach their full potential and grow up ready to contribute to Utah’s thriving communities.

Continuing the Governor’s theme of Growth and Quality of Life, Voices staff have reviewed the budget and make the following observations:

1. Quality of Life

Funding for Medicaid Expansion Implementation

In November, Utahns expressed their clear support for Medicaid expansion and chose to extend health insurance to 150,000 new individuals. Utah voters elected to expand Medicaid to individuals and parents, without work requirements or caps. Voters even chose a small sales tax increase to support affordable health coverage. The Governor recognizes this historic step forward for Utahns in his budget recommendations and allocates funds for expansion implementation by April 1, 2019. The policy brief accompanying the budget also explores different scenarios and “what ifs” about the provider and consumer safeguards included in the ballot initiative; however, none of these questions preclude expansion from rolling out April 1st. It is paramount that individuals and parents in the coverage gap be able to enroll in coverage as soon as possible, without any added delays or restrictions, and we thank the Governor for supporting expansion funds in the budget.

Proposition 3 did not include any additional work requirements or barriers to care, as the Governor’s budget and policy brief also notes. Our new state law does not stipulate that Medicaid enrollees meet a work requirement as a condition to health coverage. We support exploring future programs that help connect Medicaid beneficiaries with job resources, training, or helps facilitate community engagement. However, we should not rush into changes and any work support program should not preclude someone from receiving coverage. As we have seen in other states, the complexities and confusion around reporting a work requirement often result in individuals unnecessarily losing coverage- even though they are working (See Arkansas’ recent experience). We support programs that help individuals be healthy and work; but people cannot work if they are not healthy.

Funding for Children’s Health Coverage

The Governor’s budget includes important funding recommendations to ensure that Utah children are covered, as demonstrated through Medicaid consensus figures. The Governor’s recommendations are particularly timely as recent data show an alarming increase in the number of uninsured children in Utah. In fact, Utah was one of only nine states to experience an increase in our child uninsured rate. We thank the Governor for extending a welcome mat to ensure that more children can receive health insurance. Going forward, there are additional steps we hope the Governor will support, so that more children do not lose health coverage: it is critical to ensure children can avoid unnecessary insurance loss or disruptions, by implementing a policy of 12-month continuous eligibility in Medicaid; in addition, Utah must counter the ‘chilling effect’ in health coverage due to federal policies targeting immigrant communities. We thank the Governor for his previous efforts encouraging qualifying parents to sign their children up for Children’s Health Insurance Program (CHIP). It is especially critical now that the Governor continue to create a welcoming, safe environment for Utah families to obtain affordable health coverage.  

E-Cigarette Taxes

The Governor recommends a sales-tax increase on e-cigarettes. As the Governor notes, e-cigarette use is on the rise and can have a significant, harmful impact on the health of our youth. We are encouraged that the Governor recommends taxing e-cigarette and related paraphernalia like traditional tobacco products. This is an important step to keeping our kids healthy. National research shows e-cigarette use can be highest among some of our most marginalized youth, including LGBTQI, gender non-conforming and transgender youth. We hope that, in addition, state agencies will also ensure that 1) we are collecting state-level data to better understand impacted kids here in Utah and 2) we are providing the right kinds of care and services, so all kids feel affirmed, loved and supported.

Integrating Physical and Behavioral Health

We applaud the Governor for addressing Utah’s bifurcated healthcare system where different entities are responsible for physical and behavioral health services. The policy brief accompanying the budget discusses efforts to better integrate these systems. We hope that these efforts will also incorporate the behavioral health care needs of specific populations including children and new mothers. The behavioral health care needs of these populations are often overlooked and under-resourced. For example, women suffering from perinatal mood disorders - commonly called “maternal depression”- often have trouble finding treatment and care. Going forward, new efforts to better integrate services should make sure kids and parents can get the unique behavioral health care they need early on, before a condition escalates.

Jessie Mandle, Senior Health Policy Analyst

School Safety

When it comes to spending on “school safety,” the Governor’s budget has given us cause for concern. Governor Herbert appears to support the recommendations of the “School Safety Advisory Committee,” a group which has drawn criticism for its lack of representation and for conducting its business outside the public view.

In November of this year, this Committee presented a $194 million bill titled “School and Student Safety Amendments,” which designated $164 million for schools to upgrade their physical facilities with student safety in mind. In his budget, Governor Herbert includes $66 million in “flexible” funding for this same purpose. We have no problem with funding for schools to modernize and improve their infrastructure, as many schools are in need of basic maintenance anyway. Why not build in new safety features while modernizing facilities?

We appreciate that the Governor has set aside $31.7 million in his budget for a “school counseling program,” which appears to reflect a similar $30 million ask from the School Safety Advisory Committee during November interim. We applaud Governor Herbert for explicitly saying that this funding should be used for counselors. Mental health professionals, social workers, counselors and other professionals are critical for building a safe and positive school climate. Investing in prevention when it comes to bullying, violence and suicide makes more sense than trying to deal with the aftermath of these ongoing challenges.

Our concern about school safety funding arises from what is not said in the Governor’s budget, but which exists in the proposed legislation from the School Safety Advisory Committee: a mandate for each school in the state to form “Threat Assessment and Student Support Teams” that are authorized to respond to “significantly disruptive behavior” from students – whatever that may mean.

This approach, which is loosely based on a specific protocol that has yielded good results in other states, could jeopardize the recent juvenile justice reforms that received a great deal of well-deserved attention and praise in the Governor’s budget document. Utah’s impressive juvenile justice reforms have included a focus on using restorative, rather than punitive, practices in schools. This approach decreases the number of youth who are referred to court for very low-level offenses (such as truancy and smoking), incurring high costs to taxpayers and negative outcomes for the youth themselves. We are very concerned that the legislation recommended by the School Safety Advisory Committee does not align with these important reforms. We all want our kids to be safe at school, but not every proposed solution creates actual safety, and some approaches actually make some groups of students less safe. Voices for Utah Children will have much more to say on this subject as we move closer to the 2019 Legislative Session.

Anna Thomas, Senior Policy Analyst

2. Quality Workforce

Education

We at Voices, are particularly happy about the recommendations for sustained and improved funding of public education. Education is the key to future career success for so many Utah kids – and our teachers are key to education. That’s why we are so pleased with the Governor’s support for boosting teacher pay. When teachers do well, students do well.

We scoured the Governor’s budget for any mention of investment in early education with no luck. We’re not panicking yet. The Governor’s Education Road Map, released a year ago this month, included an entire section of recommendations related to early learning. We expect to see more investment in this area as current state-funded early education programs become better aligned and coordinated.

Child Care

We couldn’t help but notice the absence of any mention of state investment in – or even attention to – the pressing child care needs of Utah’s workers and students. We agree with Governor Herbert that “Utah must invest in its people to achieve long-term success,” and that “a dynamic economy requires a skilled and education population.”

Having the right skills and the willingness to work isn’t enough to make our workforce successful, though. More Utah workers than ever before are now also parents. They can’t be expected to engage productively in our thriving economy unless they have access to affordable, accessible child care. The state currently does a good job of managing federal dollars that help to subsidize child care costs for working parents but invests very few state tax dollars for this purpose. The Governor’s proposed budget would do little to change this.

The irony is, Utah doesn’t just need to fill “high-paying jobs” with “highly skilled” workers. We need many more individuals who are willing to work jobs that don’t pay well enough relative to their importance to our economic development. These critical jobs are in the early care and education sector. Currently, the Utahns who provide child care to working parents all over the state, barely make enough to keep their own families out of poverty.

One easy way the Governor could bolster state investment in child care, would be to provide sufficient funding for subsidized childcare while parents are attending college. The Governor’s budget rightly emphasizes the importance of higher education in creating opportunity to otherwise “at-risk” families. However, lack of affordable child care keeps many parents – moms, especially – from going back to school to enhance their earning potential. If Utah is serious about investing in the workforce, the Governor’s budget should prioritize investment in college-based child care centers such as the Wee Care Center at Utah Valley University and the Sorenson Legacy Foundation Child & Family Development Center at Southern Utah University.

Anna Thomas, Senior Policy Analyst

anna@utahchildren.org

3. Tax Modernization

Utah’s economic structure is moving from goods based to service based. Most purchased goods generate a sales tax. Some services are taxed, but many others enjoy a sales tax exemption or a reduced tax rate. The following table illustrates a few examples.

The increase in services as an engine for economic growth is not generating enough tax revenue to keep pace with the rising cost to build and maintain Utah’s infrastructure and provide services which support communities and keep the economy humming. As Utah moves to a service based economy, transactions generating sales tax have declined from about 70% (in the 1980s) to 40%. As a percent of income, 95% of Utah’s families pay more in sales and other local taxes than the top 5% of higher income families.

Source: https://itep.org/whopays/

This is not the first time the Governor has called for a tax overhaul. Removing a few exemptions is a commonsense way to broaden the tax base. It is time for special interests to do their part to boost revenues needed to pay for investments which support Utah’s Growth and Quality of Life.

Revenue Earmarks

Earmarks are revenue assigned to fund specific government projects, services or programs. For example, gas taxes are earmarked for transportation needs while a portion of tobacco taxes are designated to fund antismoking initiatives. The recent voter approved Prop 3 calls for a sales tax increase earmarked to expand Medicaid access.

The Governor wants to reform the state’s earmark policy. He notes that 48% of new sales tax revenue growth is earmarked in FY2020 and further argues that earmarks are not transparent and do not allow policy makers to prioritize the state’s most pressing needs. He proposes that some earmarks be replaced by user fees.

The online dictionary defines fee as “a payment made to a professional person or to a professional or public body in exchange for advice or services.” A tax is “a compulsory contribution to state revenue, levied by the government on workers' income and business profits or added to the cost of some goods, services, and transactions.” Whether it’s a tax or fee, broadening the tax base must be done fairly, equitably and shared by all.

Patrice Schell Scott, State Priorities Partnership Fellow

Voices for Utah Children is dedicated to increasing coverage and care for all Utah kids. With this comes the responsibility to rethink how our language can be more welcoming and inclusive. When referring to children who are eligible-but-unenrolled in public health insurance, but who may now enroll as a result of Medicaid expansion, the term “woodwork” or the “woodwork enrollment” is often used. This term suggests “to come or crawl out of the woodwork” according to the Oxford dictionary, and can have a derogatory connation. We believe a better phrase is the term the “welcome mat effect.” More children having access to health care is better for our state and allows children to be healthy and better able to reach their full potential. We are excited to welcome more children to these programs, especially as eligible but uninsured children obtain coverage thanks to Medicaid expansion for their parents.

Learn more here.

U.S. Progress in Reducing the Rate of Uninsured Kids Stalls in 2017; Utah’s progress in reducing its overall uninsured rate halts too

Medicaid expansion is (still) the most effective way to move forward

Between 2016 and 2017, the U.S. uninsured rate for children remained flat at 5.4%, according to new Census data released today, after years of historic declines in the U.S. child uninsured rate.

Utah’s total uninsured rate, for adults and children, remained stagnant as well. Utah saw a slight increase from 8.8% in 2016 to 9.2% in 2017 (although data are not statistically significant). In previous years, Utah has seen a steady decline in its overall uninsured rate.

The gap in uninsured rates between states that expanded Medicaid, and states that have not, has grown in four straight years. If the uninsured rate had fallen in non-Medicaid expansion states at the same rate as it did in expansion states, another 4.5 million uninsured Americans would have had coverage last year.

In addition, Census data show continued disparities in coverage. In 2017, U.S. children in poverty had an uninsured rate of 7.8%, compared to 4.9% of children not in poverty. Among different racial and ethnic groups, Hispanic/ Latino children have the highest rate of uninsurance at a national average of 7.2%, compared to 4.3% among White children. (We'll have additional Utah-specific child uninsurance data available soon!)

Over the last several years, the U.S. and Utah have made significant progress reducing the rate of uninsured children. It is discouraging to see progress stall. Health coverage gives kids and families a healthy foundation and future. We will continue to work for all Utah kids and families to get insured and stay insured!

Medicaid expansion is the most effective way to help more children, parents and individuals enroll in health insurance programs, so we can continue to make progress toward helping all Utahns receive affordable health care. #YesonProposition3

Last week we learned that Congress will likely delay on funding CHIP -- again. We also learned that the Utah CHIP program posted a notice to parents that Utah’s CHIP funding will run out by the end of January and coverage could end. Grim news all around.

But what’s most upsetting is that Congress has put states and families in this position at all. We simply should not be here.

The CHIP program is a bipartisan program. Both the House and Senate have agreed upon a 5-year funding extension for CHIP. There is no excuse for this delay.

As others have noted, the damage to CHIP is already being done. While Congress assures us that CHIP will get funded, states face chaos and confusion. While members of Congress tell us that they prioritize families, millions of parents are worried that their kids’ coverage could come to an end.

Here at Voices for Utah Children, we will continue to call upon our Congressional reps to act quickly on the agreed-to, bipartisan solution for CHIP. We will continue to support state agencies, community partners and families as they navigate the best ways to ensure kids have consistent care.

But we also need to tell Congress that we should not be here in the first place. While Congress votes to cut care and drive up costs for more working families, they have neglected the well-being of our kids.

There is no excuse for their inaction.

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. 

CHIP & Medicaid Make a Difference for our kids & families and community.

The Truth about Utah Medicaid & CHIP

In Utah there is often a negative and inaccurate stigma around the word Medicaid. Most people do not know that Medicaid & CHIP are critical to Utah’s entire health care system. Over 300,000 Utahns are covered by these programs and 70% of the recipients are children. 215,000 Utah kids rely on Medicaid or CHIP for their health care. Over 40,000 parents & pregnant women rely on Medicaid to give their families a healthy start. Medicaid is the cornerstone of children’s health care, providing a crucial lifeline for low-income families and kids with special heath care needs.

Celebrate the People & Stories of Medicaid & CHIP

It’s time to lift up the stories and people of Medicaid & CHIP, so we can protect and strengthen these vital programs. We are joining amazing campaigns around the country to celebrate the critical role Medicaid & CHIP play in our community. By sharing stories and images on social media, with lawmakers & decision-makers, the media and the public, we can transform misconceptions and perceptions, and make Medicaid & CHIP even stronger.

Get Involved! 

Break down the stigma and celebrate Medicaid & CHIP! Your story is powerful

• Share your story on the Healthier Utah Coalition facebook page or send us a message.
• Take this quick survey: https://www.surveymonkey.com/r/VJP7Y7G
• Or just send an email to
• Finally, don’t forget to email, call and tag your local legislator and Congressional reps. Tell them how Medicaid & CHIP makes a difference in your life and for your community. We need more voices to keep these programs safe. All kids & families need to access affordable, quality health care.

Jasmine

“Both programs have helped us to stay away from debt during our kids’ illnesses.”

W. Family

“Our son’s care is still challenging; he still has all of the same health conditions and risks as he did two years ago.  However, it all seems to be so much more manageable thanks to Medicaid and the waiver. “

Courtney B.

“Medicaid allowed our son to get the necessary care… Without Medicaid we would have been more of a burden to the government programs and likely would have claimed medical bankruptcy”

Sierra C.

I am able to…be alert around my kids and we can live our lives by ourselves and make memories together.

Rebecca J.

“…She endured a number of life-saving medical procedures… Medicaid made [them] possible.”

Melanie B.

“The Medicaid Medically Complex Children’s Waiver (MCCW) literally was a lifesaver”

Maritza

“Thanks to this program [my children] have maintained good medical attention and even surgeries…  

Krista B.

“Without Medicaid, our son’s disease would be breaking our family. Instead, we can pull together and help him and each other, because Medicaid helps us.”

Jodi H.

“If we did not have Medicaid, my son would be dead.  That sounds a bit dramatic, but it is the case.”

D'Andre

“I wouldn’t have been able to afford the hospital stay or his [type 1] diabetic supplies without CHIP.”

Christy

“We couldn’t have afforded [my daughter’s surgery] otherwise.”

"The rainbow through all of these dark clouds was... Medicaid."

"[Medicaid]'s crucial for our patients."

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved? 

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years. 

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. 

Recently the Healthier Utah Coalition ‘Save Medicaid Campaign’ put together a survey to get public feedback on the Utah Department of Health’s proposed changes to its Medicaid program. The proposed amendments to the Medicaid and Primary Care Network (PCN) included controversial program changes such as lifetime caps on coverage, work requirements, and $25 copays for ‘inappropriate’ use of the ER.  The proposed amendments would also eliminate presumptive eligibility in Medicaid and reverse an earlier Department of Health decision to restore comprehensive benefits to 19 and 20-year-old youth.

The Utah Department of Health held two public meetings at its Salt Lake City office in the summer. The Coalition’s survey was an attempt to reach a wider audience across the state, and walk through each amendment for those less familiar with the proposed waiver. We modeled the survey after a similar one developed by fantastic advocates in Kentucky. Survey responses were also sent to the U.S. Department of Health and Human Services, during their federal waiver comment period (if the respondent granted permission).

So, what did we learn?

Over 350 people took the survey. Survey respondents came from across Utah and all walks of life:

• Over half of respondents (58%) reported being either on Medicaid or PCN, or have a family member on Medicaid or PCN.
• The majority of respondents were between the ages of 30- 69.
• Over half of respondents (54%) were working less than 31 hours/ week. They reported working part-time, as a caregiver, or reported being retired, disabled or a student.
• 50% of respondents came from Salt Lake County, followed by Utah (11%), Davis (10%), Weber (8%), Washington (6%), Cache (3%), Iron (2%), and Box Elder (2%). Only six counties did not have any survey respondents: Daggett, Garfield, Juab, Kane, Morgan, and San Juan.

How did respondents feel about the proposed changes?

Overall, the proposed Medicaid changes were very unpopular. The most unpopular changes were imposing lifetime limits on PCN or Medicaid coverage. Interestingly, the option to impose ER penalties had the most support, although the majority of respondents still opposed it.

• 91% were against time limits on coverage
• 75% were opposed to work requirements
• 53% were opposed to ER penalties
• 87% opposed to eliminating presumptive eligibility
• 90% opposed eliminating comprehensive benefits for 19 and 20-year-old’s

A few of the comments from respondents:

“As a care taker for my elderly mother, I have been in this position for nearly a decade and my part time income is always below FPL, yet I cannot get inclusion into PCN because I have no children….  No one seems to be addressing people in my situation at all.”

“I am concerned that my adult daughter with significant health care issues may lose the critical coverage that she needs to sustain quality of life and even life itself.”

 “Many of the families I work with cannot afford $25 dollars [for an ER copay]. Paying this much as a co-pay would mean they do not eat.”

“[Without Medicaid] I would have died from cancer by now. I'm 41. I have so many prescriptions for my illnesses, I would be bankrupt and homeless, relying on hand outs. Now I have a part time job, housing I can pay rent and utilities bc my medical is covered. I know hundreds of people in my community who are receiving mental health care like myself. It's the best around. I am grateful daily as I am healthy only bc I have adequate health services. I can't imagine if I didn't. I would suffer severely. Many Utahns are in the same situation.”

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor.