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Utah doctors support expanding Medicaid but with a few caveats.
After hours of contentious debate Saturday over a provision in federal health reform that would expand the health safety net to cover more of the nation's poor, the Utah Medical Association's (UMA) House of Delegates approved this carefully parsed statement:
"When health care reform measures are under consideration by the governor and Legislature, the UMA will support such measures as will improve our patients' access to care, including the expansion of Medicaid coverage if that is the best way to provide coverage to all Utahns."
It seems a tepid endorsement for a policy that would insure a third of the state's uninsured, about 105,000 people.
But advocates for the expansion, such as Ray Ward, a family physician in Bountiful, say it's the best they could hope for given the circumstances.
"Some were against making any statement at all," said Ward. "The group said increased coverage is important and they said the Medicaid expansion is a valid way of doing it. I'm happy they at least said that."
To expand Medicaid or not is one of the most politically fraught decisions facing states in the wake of the U.S. Supreme Court's ruling on the Affordable Care Act. The high court upheld the law, but said the U.S. government can't withhold existing Medicaid funding from states that decline to broaden their rules for who is eligible.
Utah Gov. Gary Herbert and Republican legislative leaders have said they are waiting until after the November election to act, and physicians were loathe to tie policymakers' hands, said Brian Hales, an anesthesiologist at Davis Hospital & Medical Center in Layton and president-elect of UMA's Board of Trustees.
This year's convention was one of the biggest, with Medicaid topping the agenda. "It was a big deal. There was a lot of testimony on both sides of the issue," Hales said.
Doctors heard from uninsured patients, state health officials and legislators on Friday and were about evenly split, he said. "Sen. Allen Christensen [R-North Ogden] was there and indicated that [the chance of] passage of the expansion at the Legislature was nil. We took that to heart.
"So on Saturday when we were wordsmithing the language, I made an appeal for more flexibility," Hales said.
Other than the American Academy of Pediatrics, which supports expanding Medicaid, few doctor groups have voiced an opinion. UMA's support is critical for its size 3,500 doctors strong and influence, said Judi Hilman, executive director of the Utah Health Policy Project.
Utah currently has one of the leanest Medicaid programs in the country. It's hard to qualify unless you're disabled, pregnant, a child or an extremely impoverished parent. Adults without kids, no matter how poor, do not qualify.
The federal health law aims to change that by expanding Medicaid to cover everyone who earns up to 138 percent of poverty-level income, such as a single adult earning less than $15,415 a year.
Ward said resistance by some doctors to the expansion stems from fear of government meddling. "They're so angry at the government and anything that expands it, they're against," he said.
But he isn't convinced there's a workable alternative.
One option being floated is to give working poor adults tax credits to purchase their own health plan. Whether the feds will give states that freedom isn't clear.
"I'm not sure it would work," said Ward. "Many of the low-end health plans have deductibles as high as $7,000, which is useless to someone earning less than $20,000."
Medicaid pays doctors less than Medicare and private insurance.
"No doctor right now could earn a living just seeing Medicaid patients," admits Ward. But he argues, "Getting paid crappy is better than getting paid nothing."
Also, if Utah says no to the expansion, it means turning away billions of dollars, since the federal government picks up most of the tab.
"We're paying those taxes anyway," said Ward. "If we don't accept the Medicaid expansion here, our money will go to pay for it in California and New York."