In their campaign to secede from federal health-care reform, arch-conservatives in the Legislature are pushing a scheme to wrest control of health-care regulation from Washington and vest it in a compact of states. In any atmosphere other than the tea party politics of today, this would be considered a joke.
SB208 would ask Congress "to return the authority to regulate health care to the member states." This would give the states in the compact the power to opt out of the federal Affordable Care Act, pejoratively known as Obamacare. Each state could adopt its own regulations, keeping or rejecting existing federal laws and rules as it chose. It would receive federal funds each year in a block grant equivalent to the amount the federal government spent on Medicare, Medicaid and other federal health-care entitlements, excluding those of the Defense Department, Veterans Affairs and American Indians, in that state in 2010. A formula would adjust that figure annually based on population and inflation.
This bill is political grandstanding of the first order. To understand it, you have to remember that one of the ways that the ACA would expand health-care coverage to uninsured people in the United States is through a broadening of Medicaid to make more people eligible. If SB208 were to succeed, Utah could reject that expansion, as well as the individual insurance mandate and the associated penalties that are the most controversial provisions of the Affordable Care Act.
But why would Congress agree to let Utah run its own health-care programs with $4.1 billion of federal money and no regulatory oversight? Utah might as well ask Congress to let the state operate its own air force at Hill Air Force Base with a block grant from the Pentagon budget.
What's more, the way SB208 is structured, the block grants wouldn't keep pace with health-care inflation or plunges in the business cycle. That would mean major cuts in federal health-care funds for Utahns.
Utah also would have to create a new bureaucracy to regulate health care, which would add another level of regulation to a complex business that already is drowning in red tape.
There's no question that Medicaid, the federal/state partnership that provides health insurance to the poor, has placed increasing pressure on state budgets. But Utah already has adopted a plan to pay providers to keep clients well and improve health-care outcomes. Utah doesn't need to secede from the federal government to achieve reform.
SB208 is a bad idea born of circus politics. The Legislature should kill it.