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House and Senate Republicans will meet next week in closed-door caucuses for briefings on a proposal to use Medicaid funds to help provide health insurance to tens of thousands low-income Utahns.
The plan they will hear is the product of hours of negotiations between leaders in the House and Senate and Gov. Gary Herbert, launched after Herbert's Healthy Utah plan failed to win support earlier this year in the Republican-dominated House.
Depending on the reception the plan receives particularly from skeptical House members the governor could call a special session in mid-October to vote on the plan.
"I'm optimistic," said Senate President Wayne Niederhauser, one of the so-called Gang of Six that hammered out the framework.
The plan calls for the providers who would receive the additional Medicaid funds hospitals, doctors, pharmaceutical manufacturers and insurance companies to pay more than $50 million toward the expanded coverage. Lawmakers have estimated that's about seven cents of every dollar they would get from the expanded coverage.
When lawmakers gather Tuesday, they will not have an actual bill to review. Attorneys are still working on writing the legislation and will not have it ready in time.
"We've pretty much agreed conceptually," Niederhauser said. "We're now just waiting for the details to come together."
Niederhauser, R-Sandy, said the Republican leaders will share the plan with the Democrats, but it's not clear when. After the caucus, he said, details will be made available to the public. The Health Reform Task Force will hold a public hearing on the plan sometime in the next month.
The federal government will pay 90 cents for every 10 cents the state puts toward the program, bringing in hundreds of millions of federal dollars to offer insurance subsidies to as many as 126,500 Utahns who have income up to 138 percent of the federal poverty level about $33,000 for a family of four.
If approved by the Legislature and the federal government, it would be the first private-sector oriented plan for Medicaid expansion a key provision of the Affordable Care Act, known as Obamacare in the United States.
Utah would pay about $25 million to cover, with a federal match, what Republican lawmakers are calling the "woodwork effect," those already eligible for Medicaid coverage who are expected to sign up after the plan kicks in.
The hardest sell will be to Republican House members, who were largely opposed to Herbert's Healthy Utah plan when it was proposed earlier this year.
Rep. Ken Ivory, R-West Jordan, who was one of the Healthy Utah opponents, said he remains concerned that Congress will cut Medicaid funding, forcing Utah to bear more of the burden.
"I don't think we do anyone any favors to put in a new program and a new dependence on a program that is not sustainable," he said. "You're passing on cost to average people and the premise is you're relying on a federal government that is $18 trillion in debt to afford an additional program that they'd have to borrow more money for."
"I'm skeptical, but we want to see the details of what they've come up with," he said.
Rep. Steve Eliason, R-Sandy, said spreading risk among the stakeholders "is the right direction," and helps keep the program sustainable. And some federal waivers that have been issued by HHS in the past year help provide more flexibility.
"I think those will be game-changers for some," he said. "I'm going to wait and see what the forthcoming details are. … I'll keep an open mind."
Even if the bill passes, there would be work left to do. Herbert's staff would have to negotiate with the U.S. Department of Health and Human Services to get the federal government's approval of portions of the proposal.
And the bill is likely to face opposition, in particular from the Utah Medical Association, which represents the state's doctors. The group opposes having providers pay for the expansion and fears costs could climb through the roof.