A major question facing Republican Gov. Gary Herbert as he deliberates his 2015 budget is whether to expand the low-income health safety net, Medicaid.
But whatever path he chooses, advocates for Utah's most vulnerable are arguing for full disclosure of the financial implications.
"Few decisions in our state's history will have as much impact," according to the Family Investment Coalition, which is urging Herbert to release two budgets, one with the Medicaid expansion and a second without.
"Utahns need to be informed of the lost opportunity if the state rejects [the] expansion this year," reads their Nov. 13 letter to the governor.
Dual spending plans probably serve more of a political than practical purpose. A report commissioned by the Utah Department of Health has already estimated the expansion would provide coverage to 123,000 residents while saving the state more than $11 million in 2015.
That's just factoring in the state's General Fund, and doesn't include benefits for counties or a reduction in hospital charity care.
But it's "a significant sum" that Utah could use for other priorities, said Lincoln Nehring, a health analyst for coalition member Voices for Utah Children. "There's $11 million out there and the question is, what do we do with that? Do we invest in education or put it back into health care, or put it in the Rainy Day fund?"
The savings come from an influx of federal funding and won't last forever. The feds pick up the full tab for three years and declining amounts thereafter, but never less than 90 percent.
And there's always the chance that the U.S. government won't live up to its end of the bargain a point made by Republican lawmakers who oppose the expansion.
But in addition to the state missing out financially, failure to fully expand Medicaid will leave nearly 58,000 Utahns without insurance, jeopardizing their economic security and placing their health at risk, the coalition argues, referring to individuals who earn too little to qualify for insurance subsidies on the health exchange.
A main provision of the Affordable Care Act, expanding Medicaid was declared optional by the U.S. Supreme Court. To date, roughly half the states have embraced the expansion while the rest have either rejected it or remain undecided.
Herbert has said he hasn't made up his mind. He is expected to announce his 2015 budget on the first week of December.
"The governor is currently working with legislators on a Utah solution for Medicaid expansion," said Chief of Staff Ally Isom in an emailed statement. "There is no need for multiple budget plans since there are no direct impacts during fiscal year 2015. The budget is built off consensus numbers, a process that gathers information on economic indicators and involves multiple stakeholders. Establishing a budget on revenue scenarios derived outside this consensus process is a tenuous budget practice."
The Family Investment Coalition is comprised of more than a dozen advocacy and religious groups, including: AARP, the American Association of University Women, Community Action Partnership, Communidades Unidas, Legislative Coalition for People with Disabilities, New Frontiers for Families, the Road Home homeless shelter, Salt Lake Catholic Diocese, Salt Lake Community Action Partnership, Utahns Against Hunger, Voices for Utah Children, the Utah Health Policy Partnership, Utah Housing Coalition and Utah Statewide Independent Living Council.