Utah & Idaho: GOP Lawmaker issue a big fat middle fingers to their own constituents

I'm rather late to the game on this issue, but it looks like the story is already making major headlines elsewhere so I don't feel too bad; via Robert Pear of the NY Times:

In Utah and Idaho, G.O.P. Looks to Curb Medicaid Expansions That Voters Approved

The voters of Utah and Idaho, two deeply Republican states, defied the will of their political leaders in November and voted to expand Medicaid under the Affordable Care Act. Now those leaders are striking back, moving to roll back the expansions — with encouragement, they say, from the Trump administration.

Utah’s ballot measure, approved with support from 53 percent of voters, would expand Medicaid to cover people with incomes up to 138 percent of the poverty level — up to about $16,750 a year for an individual — and pay the state’s share with a small increase of the sales tax. Under the ballot initiative, 150,000 people are expected to gain coverage, starting April 1.

In Idaho, more than 60 percent of voters supported a ballot measure to expand Medicaid.

But in both states, the Republican Legislatures are looking for ways to roll back those votes.

I wrote a few pieces about both Idaho and Utah's Medicaid expansion ballot initiatives last year. Idaho's was more straightforward. Utah went through a rather confusing process, because the state legislature attempted to head it off at the pass, so to speak, by passing a limited expansion bill ahead of the full expansion initiative:

Gov. Gary Herbert signed a measure Tuesday to give more than 70,000 needy Utahns access to government health coverage, ending years of failed attempts on Capitol Hill to expand Medicaid in the state.

But whether House Bill 472 ever takes effect still remains uncertain. Under President Obama’s signature Affordable Care Act (ACA), the Utah law needs approval by the federal Centers for Medicare and Medicaid Services (CMS), which has sent mixed signals on whether it will fully sign off.

...HB472 also requires enrollees to prove they are working or participating in volunteering, vocational training or similar activities.

...Yet it remains unclear if even Trump’s CMS will approve one key provision Utah is proposing. The HB472 plan calls for only a partial expansion of Medicaid coverage for adults making up to 100 percent of the poverty line, or $12,140 annually for a single person.

The full expansion initiative passed last fall, of course, is supposed to cover Utah residents earning up to 138% of the poverty line, or around 150,000 people...without any work requirements.

The bill barreling through the Utah Legislature was “an effort to override the will of the people,” said Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit group that supported the full expansion of Medicaid.

Utah lawmakers, worried that the sales tax increase might not fully cover the costs, are rushing through a bill that would limit the expansion of Medicaid to people with incomes less than or equal to the poverty level, about $12,140 for an individual.

State officials say that the bill, which is estimated to cover 90,000 people, could be on the desk of Gov. Gary R. Herbert, a Republican, in a week or two.

Well, I guess the silver lining here is that the new partial-expansion bill, which appears to be otherwise identical to the old partial-expansion bill, has magically added 20,000 more people to the number it'll cover?

According to this analysis by the Center on Budget & Policy Priorities, not only would this bill overturn the explicit will of the voters and cover up to 60,000 fewer people, it would actually cost more then if they just expanded Medicaid directly, as the ballot proposal demanded:

In its place, the bill directs the state Medicaid agency to seek approval for an unusual and uncertain federal Medicaid waiver that would provide Medicaid coverage to 48,000 fewer Utahans and would cost the state $50 million more over the next two years, according to a state fiscal analysis.

(OK, 48,000 fewer would bring the total covered under the overturn bill down to...102,000? Huh...)

There may be confusion about whether the crappier version would only cover 70,000, 90,000 or 102,000 people, but the reason for the reduction is simple: It would cut off the income cap at 100% FPL instead of 138% FPL, as well as tacking on work requirements to boot (which have already caused at least 17,000 Arkansas residents to lose coverage in the past few months).

As for how this BS bill would cost more than if they just passed "clean" Medicaid expansion...

The partial expansion under SB96, if approved, would cause 48,000 fewer newly eligible people to enroll in Medicaid than the full expansion plan voters approved, which would cover approximately 150,000 people. Under CMS guidance, states can only receive the ACA’s enhanced federal match rate of 90 percent if they cover the entire expansion eligibility group. Therefore, Utah expects to initially receive its normal 68 percent federal match rate for its partial expansion, meaning it will have to cover 32 percent of the cost, instead of 10 percent under full expansion. Because it would cost more to pay for 32 percent of the cost of covering about 100,000 people than 10 percent of the cost of covering about 150,000 people, Utah would pay $50 million more to cover 48,000 fewer people through Medicaid, a fiscal note prepared for the Utah legislature confirms.

In other words, the total cost per enrollee would be the same...it's just that Utah would have to pay a much higher portion of that cost. So much higher, in fact, that it would still cost them more even though they'd be paying for fewer people to be covered. Brilliant!

So in short, we have a trifecta: The bill would 1) undemocratically overturn the will of the people in order to 2) provide coverage to tens of thousands fewer people while 3) costing the state of Utah millions of dollars more...all for absolutely no good reason whatsoever.

Congratulations, Utah Republicans! You’ve won the Triple Crown of Douchebaggery®!

Meanwhile, in Idaho, the newly-passed ACA Medicaid expansion initiative is under attack on two fronts: Not only is the GOP-controlled legislature trying to pull the same crap they are in Utah...

Three months after Idaho voters approved a Medicaid expansion ballot initiative, House lawmakers are still discussing what conditions or restrictions should be placed on the move.

No bills have been introduced yet, but a group of about 15 Republicans met this week to coordinate their proposal. They’re looking at nearly a dozen waiver options, including work restrictions, co-pay requirements and lifetime limits.

...Given the number of conditions they’re proposing, though, this would conceivably delay implementation beyond the expected Jan. 1, 2020, starting date.

...The Department of Health and Welfare expects to submit an amended state plan to CMS within the next few weeks, seeking federal approval of the new income limit. Any additional restrictions or limitations would require a separate waiver request. The Legislature would first have to adopt the waiver, which would then be subject to federal approval.

...but there was also a lawsuit seeking to negate the ballot expansion altogether:

The whole discussion of waivers, though, could be rendered moot by the Idaho Supreme Court. The court heard arguments this week in an Idaho Freedom Foundation lawsuit that seeks to block implementation of the ballot initiative. Zollinger said he’d prefer to wait for a ruling in the case before introducing a waiver bill.

The good news is that literally as I was writing up this blog post, the Idaho Supreme Court chimed in...

The Idaho Supreme Court on Tuesday said that Medicaid expansion, passed by voters as ballot Proposition 2, is legal.

The court ruled against the Idaho Freedom Foundation in its lawsuit, which argued that Prop 2 was written in a way that gave too much power to the federal government and the Idaho Department of Health and Welfare.

That's great news, but it still leaves open the possibility of the state GOP screwing around with the expansion program.

Unlike Utah's program, which is supposed to kick into effect on April 1st, Idaho's wouldn't start until January 1, 2020, so there's more time for Idaho legislators to mess with it before it starts up. Stay tuned...