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Ending years of fighting, the Senate gave final approval Tuesday to a compromise bill expanding Medicaid coverage to 16,000 of the poorest Utahns — while Democrats complained that it is "less than crumbs" compared to what the state should be giving.

It passed HB437 on a 19-8 vote, and is on its way to Gov. Gary Herbert for his expected signature.

"It targets those in extreme poverty," said House Majority Leader Jim Dunnigan, R-Taylorsville. The bill will extend health care to about 16,000 people, far fewer than the 125,000 or more that would have been served under more generous proposals killed in recent years.

Dunnigan said it targets the chronically homeless, the mentally ill and those recently released from prison — and will guarantee them Medicaid coverage for at least 12 months as they work to obtain jobs and get on their feet.

It will help 12,500 childless adults who currently are not eligible for Medicaid, plus an additional 3,800 adults with children, he said.

Adults with children currently are covered only if they have incomes up to about 40 percent of the poverty level. "This will increase it to close to 55 percent," Dunnigan said.

His plan would cost $30 million in state dollars and utilize $70 million in federal funds. Utah hospitals, which now bear the cost of providing emergency room coverage for the uninsured and would benefit from having those patients covered, agreed to pay $13.5 million of the state's share.

The bill would still require waivers from the federal government to take effect, and calls for state officials to seek them.

Democrats said it was a pittance compared to what should have been provided.

"This is less than crumbs. This is a cruel trick," said Sen. Jim Dabakis, D-Salt Lake City, complaining that "we are turning down $420 million in federal contributions" available from President Barack Obama's Affordable Care Act.

Getting all that extra money would have cost the state $44 million a year — but Republicans feared it as a part of "Obamacare," Dabakis said, or worried it could lead to runaway costs eventually.

"This is fiscal insanity," said Senate Democratic leader Gene Davis, D-Salt Lake City, who had pushed for full Medicaid expansion.

"The good working stiff who is making minimum wage isn't covered, and under full Medicaid expansion they would be covered," Dabakis said.

Sen. Luz Escamilla, D-Salt Lake City, said she had a call from a working-class victim of crime. "Her perpetrator will get coverage, but not her" under the bill.

Meanwhile at a Senate hearing earlier in the day, groups that serve the poor and homeless lined up to support the bill, as did business leaders.

Others praised the Legislature for at least taking a step to increase health care coverage in the state.

"There are chronically homeless people who are still struggling with their health," said Pamela Atkinson, an advocate for the poor. "This bill is really going to make a difference in people's lives."

"As the people turn to the most vulnerable among them, economies prosper," said Keith McMullin, an emeritus general authority of the LDS Church, CEO of its Deseret Management Corp., and incoming president of the Salt Lake Chamber. "Those who are not productive, can become productive and society can grow as a consequence."

He added, "While more must be done, this is a good step in the right direction."

Linda Wardell, general manager of the City Creek Center, speaking for the Downtown Alliance, called the bill "a common-sense Utah approach that respects the taxpayer while providing coverage for some of Utah's most vulnerable."

Spokesmen for Salt Lake City Mayor Jackie Biskupski and Salt Lake County Mayor Ben McAdams also praised the bill for the help it will provide the homeless and needy.

Meanwhile, Sen. Brian Shiozawa, R-Cottonwood Heights, a doctor who last year sponsored a more generous Medicaid expansion that was killed in the House, said Dunnigan's legislation "is a pretty good bill."

Also, Sen. Allen Christensen, R-North Ogden, who had opposed most Medicaid expansion proposals, said, "This plan is a great compromise. It doesn't do everything for everyone, but it does help the most needy."

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