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Utah legislative leaders and the governor were optimistic they will be able to reach a compromise on Medicaid expansion after their first joint meeting Wednesday with U.S. Health and Human Services Secretary Sylvia Burwell.
"I thought there was a great response from the secretary and her staff," said Senate President Wayne Niederhauser. "They understand this is a hard decision for states, and they understand it's a risk to our budget."
House Speaker Greg Hughes agreed. "We had real conversation," he said in a news conference by phone from Washington, D.C., on Wednesday afternoon.
But neither the legislative leader nor Gov. Gary Herbert said they heard what they wanted to hear: that the Obama administration will let Utah cap the number of people the state covers if it expands Medicaid to everyone earning poverty-level income and less.
Under Healthy Utah, the plan Herbert negotiated in 2014 with HHS, the feds would pay 100 percent of the costs next year and 90 percent of the costs in future years, leaving Utah to cover the remaining 10 percent.
That deal is predicated on Utah also extending Medicaid coverage to those making from 101 to 138 percent of poverty income people who already qualify for subsidized health care under the Affordable Care Act.
"The fundamental question is: 10 percent of what number?" Hughes said. "We have to reduce the risk as much as possible."
Niederhauser noted that if double the projected number of people sign up for Medicaid, the state's costs in 2021 could be $160 million rather than $80 million.
That would mean taking money from education, transportation or other human-service programs, Herbert noted.
The House and Senate leaders, Herbert and the sponsors of rival House and Senate health care bills Rep. Jim Dunnigan and Sen. Brian Shiozawa went to Washington together as their first substantive meeting since the last day of the 2015 legislative session.
The Senate, which passed a bill based on Healthy Utah, and the House, which supported Dunnigan's more modest Utah Cares plan, could not agree on a compromise in the frenzied last hours of the session, so the five promised, along with Lt. Gov. Spencer Cox, to forge a compromise by July 31.
Herbert said Wednesday he still thinks that's possible, and that he'll be able to call a special legislative session this summer to vote on the compromise. The governor described the negotiations with legislative leaders and HHS as a new start, but said it's not at "square one."
"We're going to try to find a solution," he said. "Whether it's Healthy Utah or Utah Cares or some hybrid of both or some new invention … I don't know.
"I have no pride of authorship," Herbert said. "We just want to find the right policy that solves the problem for the people of Utah and respects the taxpayer."
The governor would not say whether he remains committed to covering those up to 138 percent of the poverty level.
But all three said the highest priority is to cover those in the coverage gap, earning less than poverty income but too little to get subsidized health insurance.
Advocate Jason Stevenson, education and communications director of the Utah Health Policy Project, said he did not expect any concrete plans to emerge from the Utah leaders' first meeting with Burwell.
He's confident the six leaders will coalesce around Healthy Utah or a plan like it in the end, because it makes the most sense.
It gets the most money back from the feds at the least cost to the state, gives people a choice of plans, and is a private-market solution because it helps people buy private health insurance or supplement their employers' insurance, he said.
"What we've learned from the previous debate is that's what Utahns want, what the health care industry wants and the business community wants," Stevenson said.
Hughes and Niederhauser said Burwell and her staff were interested in data about the experiences of other states that have expanded Medicaid. Utah will provide some of that, and they'll do their own research, Niederhauser said.
The meeting, which lasted about 90 minutes, was fruitful, Hughes said. "It was important to her and brought greater context to see what specifically the issues are for our state, and that helps them … figure out how they can help us navigate this."