Medicaid and insurance mandates rule Utah Legislature's health policy front

There is no deadline for deciding, no legal obligation to say "no" to the Medicaid expansion under President Barack Obama's Affordable Care Act.

But that's exactly what House Republicans did.

Fearing a unilateral decision by Utah Gov. Gary Herbert, the House passed a last-minute bill barring him from expanding Medicaid to cover 131,000 of the state's poor and uninsured.

But the Senate struck the ban and passed a substitute version of HB391 directing Herbert to study the matter and consult the Legislature — leaving policymakers where they started.

"I don't think the [House] bill represented the opinion of the majority of the House," said Lincoln Nehring, a health analyst at Voices for Utah Children. "They were concerned about the governor having carte-blanche authority to move forward, and about Obama­care generally, but they weren't ready to make a decision."

HB391 does, however, cause one "big wrinkle," said Judi Hilman, executive director of the Utah Health Policy Project. In addition to considering a twice-delayed cost study, Herbert also now must study charity care as an alternative to growing Medicaid.

Hilman said she would rather spend time exploring the pros and cons of policy innovations surfacing in other states. "But if charity care is a false promise that keeps us from embracing more comprehensive solutions for people, maybe it's good that we get to the bottom of it."

Two other Medicaid bills surfaced this session: one to safeguard the state's Medicaid Inspector General and another that some say undermines his ability to crack down on fraud, waste and abuse. Both HB106 and HB315 passed with amendments.

Health and social service agencies received most of their funding wish lists, including extra money to pay for a second year of credit monitoring for victims of a large health data breach.

But it was health coverage — debate over who gets it and who pays for it — that took center stage.

As divisive as the Medicaid expansion was a bill to mandate that insurers cover autism treatment. So far, 31 states have done so.

The Utah Autism Registry estimates that about one in 63 Utah children registers along the spectrum.

But the Senate voted to strip out SB55's insurance mandate and instead expand a current pilot program to treat 500 children up to age 7, rather than 250 up to age 6. Doing so would cost $1.5 million.

Sponsoring Sen. Brian Shio­zawa, R-Cottonwood Heights, failed to dislodge the pared-down bill from House rules on Thursday.

He vowed to continue the fight after the 45-day lawmaking session. "This is not over. I'm willing to do whatever it takes to get the kids to therapy," said Shiozawa.