The Need for a Full Medicaid Expansion

8266216454_d24ba2b0fd_b Brad Bennion

Medicaid expansion has been a controversial issue in Utah for years. While Republican lawmakers here are wary of “blank checks” and federal involvement, thousands of the poor and homeless remain uncovered under Utah’s social safety net. A bill passed in March aims to be the solution. But while the plan does provide some needed relief to those in need of medical care, it does not do nearly enough to resolve the larger issue.

It’s striking how so much support for Medicaid expansion amounted to so little. Expanding Medicaid was seen as a necessary step by people on both sides of the isle, with Governor Gary Herbert signaling it as a major aim of his administration. A variety of solutions were debated in the legislature, with many pushed to the side before a final compromise could be reached. As a result of all these passionate appeals, there seems to be a disconnect between the final bill and the importance given to the issue by legislators. The compromise is quite simply disappointing.

The financial side of things shows that the new bill is far from what was needed. The final agreement would cover about 16,000 additional people, a far cry from the 125,000 covered by earlier failed agreements. It is not a good sign when a bill provides for less than 1/5th of the people that need service. This gap is likely to be devastating for many of the poor and homeless in need of medical care. In turn, this is likely to lead to a strain on hospitals and prisons, perhaps costing more than full funding would have.

Wider Medicaid expansion was already a feasible option for Utah. Under the Affordable Care Act, the government offered 90% federal matching funds for expanded Medicaid — more than the 70% normally offered. When the Utah legislature refused this federal help, they were left scrambling for a lesser-funded alternative. Despite widespread knowledge of the need for this expansion and concern for monetary efficiency, Utah lawmakers still turned their backs on this opportunity to help Utah’s poor.

In a way, Utah’s compromise showed how politics often aims to respond to issues without genuinely caring they get resolved. Although this measure will technically expand Medicaid, it will not do nearly enough to address the extent of the problem. The danger is that Utah lawmakers may see this as a complete answer to the problem instead of the partial solution that it is. Although we should celebrate that this is a step in the right direction, we shouldn’t let this stop us from seeking a full expansion of Medicaid in the future.

I appreciate the practicality that went into this Medicaid compromise, as Utah legislators recognized the need to provide help to the disadvantaged. I understand the issue with expanding a social program in a red state, especially when doing so might make one seem too close to the controversial Affordable Care Act. Ultimately, however, this is an issue that we must try to resolve the best we can. The next step is to acknowledge that reform must be done correctly, with care for how it will be budgeted and without artificially restricting it.

Utah lawmakers showed their ability to solve problems when they voted to expand Medicaid and ease the burden on Utah’s poor. It would be equally practical to do so again, taking care to ensure that the program covers all those who need it. The fact that the Affordable Care Act’s fate is uncertain should not stop Utah lawmakers from doing what they can for their state. In the future we can only guess what kind of strains the issue of homelessness will put on our state’s economy; what we don’t need to guess about is that further Medicaid expansion is a widely popular way to address it. 

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