The Art of the Passable 

After years of inaction—despite high public pressure—Utah lawmakers finally acted on Medicaid expansion. But whether the action amounts to more than an empty gesture during an election year remains to be seen.

It's been over two years since the Utah Legislature first met to consider whether to expand Medicaid under the Affordable Care Act for those who fall into the coverage gap, an estimated 50,000 to 60,000 Utahns who do not have health insurance through their jobs and make too little to afford private health insurance.

While many "Utah solution" versions of Medicaid expansion have been proposed in the past few years, each covering a different percentage of those needing health care, none had successfully passed both the State House and Senate. It wasn't until this year when one lawmaker, Sen. Gene Davis, D-Salt Lake City, actually proposed accepting the full expansion under the Affordable Care Act, giving health care to every Utahn in the gap.

While Davis did manage to pass it through a Senate committee, the bill stalled in front of the full Senate as House Republicans made it clear they had no appetite for passing what House Speaker Greg Hughes, R-Draper, calls "an open-ended check."

Instead, House Republicans favored a bill introduced by House Majority Leader Jim Dunnigan, R-Taylorsville, which covers 16,000 of the poorest Utahns—specifically the chronically homeless, those recently released from prison and some who are mentally ill. Those 16,000 Utahns are not a part of the 50,000 to 60,000 who would have been covered by other proposed plans, but rather are excluded from Medicaid in Utah because they are adult and childless.

Dunnigan's bill fractured the coalition fighting in favor of health-care access for all. Salt Lake County Mayor Ben McAdams and Salt Lake City Mayor Jackie Biskupski, both Democrats, held a joint press conference with Dunnigan announcing their support of his bill. "We know there are many in the community who feel that [full expansion] would be the optimal solution, but there is simply not the political support to move in that direction," said David Litvack, Biskupski's deputy chief of staff, at the March 1 press conference.

"What about the others?" Utah Democratic Party Chairman Peter Corroon retorted two days later at his own press conference. "What about the thousands of hardworking Utahns, their children, their families, our friends and neighbors in desperate need of medical coverage?"

Meanwhile, House Minority Leader Brian King, D-Salt Lake City, says that Rep. Dunnigan's bill is only being referred to as "Medicaid expansion" in order to alleviate the political pressure House Republicans have been feeling in this election year to get something done. He says that using that term implies that it's bigger than it is.

"Well, it is connected to the ACA in some ways, but it's true that it's more of a traditional Medicaid bill," House Speaker Greg Hughes, R-Draper, tells City Weekly. "But that's why we can get the support [for the bill]. Look, politics is the art of the possible. The reason we're not going to cover the whole gap is because of things like the budget uncertainty. We have to understand how it's going to impact our budget moving forward."

Now that Dunnigan's bill has passed, what do lawmakers say to the 50,000-60,000 working Utahns who still won't have health-care coverage? "Look, you can flip the script on that really easily," Hughes says. "What would you say to the 16,000 who also need coverage if you oppose this bill just because you want something bigger passed? We can't let perfect be the enemy of good."

When Dunnigan's bill was debated by the full House on March 4, Rep. Sandra Hollins, D-Salt Lake City, spoke against it, telling the body that in her work as a social worker, she sees the impact of Utahns not having access to health care. "How can we sacrifice one population for another?" she asked.

House Majority Whip Francis Gibson, R-Mapleton, said this bill may not be what some lawmakers or even citizens want. "But one of the things that makes Utah pretty good is," he said, "is that we do a good job of balancing our budget and knowing what we have."

Orem Republican Rep. Norm Thurston added that, "We could have gotten these people covered a long time ago if we hadn't wasted our time trying to hit a home run."

After the House voted 55-17 to approve Dunnigan's bill on March 4, the bill was rushed through the Senate on March 8, receiving committee approval at 8 a.m., and then final floor approval at 4 p.m. The Senate approved the bill 19 to 8, despite objections by Sens. Davis and Jim Dabakis, D-Salt Lake City, who loudly objected to the state committing $30 million to a Medicaid proposal that only covers the chronically homeless, instead of $34 million for full expansion that would cover all 105,000 Utahns who need coverage.

In addition to covering state politics for City Weekly, Eric Ethington is communications director for Political Research Associates.