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Utah Considers Medicaid Expansion Proposals

April 27, 2018

With Gov. Gary Herbert (R) having signed into law a bill to increase the number of people eligible for Medicaid in Utah, a coalition of political advocacy groups is working to expand the program even more.

With Gov. Gary Herbert (R) having signed into law a bill to increase the number of people eligible for Medicaid in Utah, a coalition of political advocacy groups is working to expand the program even more.

Utah Decides Health Care, a coalition of political advocacy organizations pressing for a Medicaid expansion initiative, submitted more than 165,000 signatures to Lieutenant Gov. Spencer Cox, the Deseret News reported on April 16.

Overlapping Expansions

Previously, individuals earning up to 60 percent of the federal poverty level (FPL) were covered by Medicaid. Enactment of House Bill 472 (H.B. 472) expanded Medicaid eligibility to include individuals earning up to 100 percent of the federal poverty level (FPL) and instituted work requirements for new and existing recipients.

H.B. 472 added about 65,000 individuals to the program and requires the Utah Department of Health to ask the federal Centers for Medicare and Medicaid Services for approval of the partial eligibility expansion. The Affordable Care Act requires states expanding Medicaid to enroll individuals earning up to 138 percent of the FPL.

If Cox declares enough signatures are valid, Utah voters will decide in November whether to expand eligibility for Medicaid to individuals earning up to 138 percent of the federal poverty level, 85,000 individuals would be added to the program, in addition to those made eligible by H.B. 472.

Better Off Uninsured?

Gerard Gianoli, M.D., a neurotologist at the Ear and Balance Institute in Covington, Louisiana and a policy advisor for The Heartland Institute, which publishes Health Care News, says Medicaid provides substandard health care.

“Numerous studies have shown better health care among those who are uninsured than those with Medicaid,” said. “Medicaid is not synonymous with quality health care. Utahns should not expect any improved quality of health care for their citizens as a result of this Medicaid expansion.”

‘Number-One Budget Buster’

Gianoli says the future cost of Medicaid expansion will not be worth whatever short-term benefits it may provide.

“Among states in fiscal crisis, the number-one budget buster is Medicaid,” Gianoli said. “This entitlement is easy to increase or expand, but very hard to contract later. I would anticipate this to become a very sore spot for Utahns down the road, as it burns a hole through the state budget and the taxpayers will be on the hook for it.”

Michael Melendez, director of policy at The Libertas Institute, says Medicaid expansion would ultimately make things worse for program recipients.

“In the long run, Medicaid expansion would hurt those in need by ripping away benefits that they have come to depend on,” Melendez said. “If you are a consumer of Medicaid, you will begin to experience a reduction in quality of care, as there will be less money and services to be divided among an ever-expanding number of people. Overall, the costs for health care will most likely rise as well.”

Part of the Problem

Gianoli says Medicaid expansion is a symptom of the problems with health care, not the cure.

‘The reason we have runaway prices in health care is due to the third party-payer system and, in particular, Medicare and Medicaid, which control more than a third of all health care expenditures,” Gianoli said.

Melendez says Medicaid expansion will make things worse, not better, for the people of Utah.

“The quality of life for Utahns would be diminished through higher taxes, lower-quality health care services, and higher costs for health care,” Melendez said. “Medicaid expansion may achieve its goal in the short term, but inevitably as the federal government cannot afford to pay for this Medicaid expansion in the long run, states would be forced to pay an ever-increasing amount for expansion. Eventually, the state would have to cut Medicaid benefits for a portion of recipients or cut the quality of care for all individuals on Medicaid, to avoid going into massive debt.”

Calls for Deregulation

Instead of more and bigger government, Gianoli says free-market policies provide better health care at lower cost.

“The free-market system has created the most innovative products at the best prices the world has ever seen,” Gianoli said. “It can do this with health care as well. Enactment of equal treatment for those paying cash for medical services and price transparency laws will result in competition, lower prices, improved access and better quality.”

Melendez says there are still other ways to improve the affordability and quality of health without increasing the size and power of government.

“We can start by reducing the barriers to entry for health care professionals, along with the burdens of licensure and limits on scope of practice,” Melendez said. “Lawmakers could reduce barriers on concierge and telemedicine, direct-pay models, out-of-state practitioners, medical cost-sharing, and charity care. We can explore options for consumers to opt for service agreements that incorporate certain tort reforms and damage caps. We could also deregulate insurance plans in Utah for those that are exempt from Obamacare.”

Author
Ashley Bateman writes from Alexandria, Virginia.
bateman.ae@googlemail.com