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Gov. Gary Herbert offered a vigorous defense of his Healthy Utah alternative to expanding Medicaid, arguing that it is the only plan to cover the poorest Utahns that makes budgetary sense.
Herbert said Thursday that based on numbers that legislative analysts and the governor's staff agree on the Healthy Utah plan would recover five times as much federal money and help to insure about nine times as many people as a plan being put together by House members.
"You do the math. Which one seems to be the most sensible to you?" Herbert said.
Lawmakers, especially those in the House, remain largely unswayed by Herbert's salesmanship, however. They are looking at a proposal that would only cover the neediest of the needy, those deemed "medically frail."
Under the best projections, that plan would cover nearly 16,000 people and cost the state roughly $203 million over six years. The federal government would cover $611 million. Fully implemented, it would cost $12,371 for each individual covered.
The governor's Healthy Utah plan would cost the state slightly more $236 million over five years but would recoup $3.2 billion in federal tax dollars paid by Utahns, he said, and would help 146,000 low-income Utahns buy private health insurance. In 2021, it would cost just under $5,000 per person covered.
"I think the contrasts are stark," Herbert told reporters Thursday.
Herbert said it is too soon to have discussions about whether he would veto a plan that covers only the medically frail, or any other proposal under consideration.
"I'm cautiously optimistic that we can eventually come together on something that makes sense to the taxpayers of Utah," Herbert said.
House and Senate Republicans are planning to hold a closed-door caucus next week so they can thoroughly discuss their views on the Medicaid-expansion proposals.
"This will be a roll-your-sleeves-up, speak bluntly [meeting]. We can't do this in a fish tank," said House Speaker Greg Hughes, R-Draper. "You don't see this happen. I've never participated in [a joint caucus] like that. I think that points to how unique the situation is."
House Majority Leader Jim Dunnigan, R-Taylorsville, a leader in the body on health-care issues, said he has been in regular discussions with the governor's staff and federal officials. He said his House colleagues are interested in trying to cover people in the "coverage gap" those below 100 percent of the federal poverty level, but they are still working on details of how to do that.
He said that, since those above 100 percent of poverty are already eligible for federal subsidies, it doesn't make sense to take them off their current insurance and move them to Healthy Utah, which the governor's plan would do.
"This is a complicated project," Dunnigan said. "We're actively engaged and working with the federal government, seeing what parameters we can use in … legislative solutions and hopefully that will fit with what the governor wants, as well."
Sen. Allen Christensen, R-Ogden, released a bill Wednesday that seeks to cover just that medically frail population.
"My plan is to give [coverage] to those who are medically frail who really, truly need it," Christensen said Wednesday. "And if I give it to all the other people who could get by without it I'm taking it right out of the pockets of some other people who are truly needy."
Herbert's Healthy Utah plan would provide subsidies to purchase insurance for those making up to 138 percent of the federal poverty level or $32,913 for a family of four.
Senate President Wayne Niederhauser has said he believes senators want to cover at least those making up to 100 percent of the federal poverty level, with those above the poverty line eligible for federal subsidies.
However, Niederhauser acknowledges, covering up to the poverty line makes little sense, since it would cost the state considerably more and recoup fewer federal dollars. Based on the projections, Utah would end up paying $655 million, would see a return of $1.8 billion in federal dollars, and would cover 93,000 people.