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When both a warm heart and a cold calculation lead to the same conclusion, a desire to do something different can require a great deal of rationalizing.

Such thinking was on display in large measure Thursday when Gov. Gary Herbert hosted a his annual day-long Health Summit in Salt Lake City. Much of the program was devoted to trotting out alternatives to the best next step in health care reform, the one that would help low-income people and save the state millions of dollars. That step would be the full expansion of Medicaid under the provisions of the Affordable Care Act.

Such a move, already embraced in states including Arizona, Nevada and New Mexico, would at once extend health coverage to an estimated 123,000 Utahns who now lack it — a number so large that no civilized nation would tolerate it — while putting the state's balance sheet $131 million ahead over the next 10 years.

Yet, Herbert has hesitated. He isn't convinced that the federal promise of paying 100 percent of the expanded Medicaid costs over the first three years, and 90 percent of those costs every year thereafter, is a pledge that can or even should be kept by a federal government running such large deficits.

A little trepidation is understandable on the part of any state leader, when being offered a large income stream that could dry up and leave the state holding the bag for either higher costs or slashed services. But other states have put their pencils to the same variables and decided that the chance to both help sick people get the care they need while adding millions to their economies is more than worth the risk of having to make some new decisions in a few years.

If Utah continues to dither on this matter past the 2014 implementation target — toying, as the summit did Thursday, with half-hearted alternatives such as limited Medicaid expansion or charity care — it faces a loss of $4.8 million per month. This is money that would not only help deserving people receive needed health care, it is money that would ripple through the Utah economy, creating jobs and expanding business opportunities.

Most days, creating jobs and expanding business opportunities are on top of Herbert's to-do list. He proudly says they are what he measures every decision and option against.

But if Herbert won't fully expand Medicaid, Utahns are left to wonder. Does the governor mean what he says about expanding the economy? Or would he rather pass up a key opportunity to create jobs, and help ease human suffering at the same time, rather than acknowledge that a Democrat from Washington actually had a good idea?