This is an archived article that was published on in 2016, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Supporters of the Affordable Care Act's Medicaid expansion provision have recently stepped up public criticism of the Utah Legislature for its decision to forgo full expansion of Medicaid under Obamacare. Amazingly, they have made this criticism even as Utah's uninsured rate has dropped by one-third, because organic, economically driven improvement seems insufficient in their eyes.

On one level, the indignation of full-expansion supporters is understandable. Just like full-expansion opponents ­— which include the majority of Utah legislators — supporters are driven by a desire to improve the lives of their low-income neighbors. They see in the full expansion of Medicaid under the ACA the promise of doing so, and so they become agitated when their opinion fails to win the day.

The facts, however, show that the Utah Legislature's decision to opt for a more modest expansion of Utah's Medicaid program was the wise and compassionate path – for both low-income Utahns and for taxpayers.

According to a new report from the Mercatus Center at George Mason University, which analyzed data from the federal Department of Human Services and the Congressional Budget Office, Medicaid expansion enrollment in states that expanded Medicaid has been nearly 50 percent more than projected. This has left clinics, hospitals and state Medicaid program administrators unprepared to handle the rush of newly covered patients, to the detriment of the lowest-income and disabled individuals for which Medicaid was originally designed.

For instance, in states ranging from Oregon to Arkansas, the lowest-income and disabled patients have been forced to wait longer for treatment – in some cases months longer – while more lucrative Medicaid expansion enrollees have been given priority. Ironically, in some cases this has led to a spike in emergency room usage for basic health care, which Medicaid expansion is supposed to reduce.

Additionally, according to the Mercatus report, these enrollment problems are compounded by the fact that the per-person cost of the health care for Medicaid expansion enrollees is much higher than expected – 49 percent higher, in fact. So having to cover 50 percent more enrollees in Medicaid expansion – at a per-enrollee bill to taxpayers of 49 percent more than expected – has left states scrambling to meet funding shortfalls. And those states' options are not pretty for Medicaid expansion enrollees or for taxpayers: enact tax hikes that destroy jobs and economic growth, cut funding from programs like public education or transportation, or throw Medicaid expansion enrollees back into the health care wilderness.

In other words, expansion states have gotten themselves into an unsustainable, structurally unsound Medicaid expansion program, and the only "solutions" are to harm the lives of low-income families, taxpayers, or both. Is this really the path of compassion?

Imagine you received a temporary inflow of cash and wanted to use it to help out a homeless family. Would it be compassionate to finance the down payment and first several months' mortgage payments on a home for this family that they couldn't afford on their own? Would it be compassionate to hold out the promise of this new home to this family, knowing that in a short time they would be tossed back into homelessness again, likely more psychologically damaged and dispirited than they were before?

Or would the truly compassionate decision be to offer more modest financial help to this family, with the genuine hope that this would help sustain them over the long term? This is exactly what the Utah Legislature chose to do with its more modest expansion of Medicaid, outside the auspices of the ACA.

By passing a modest expansion of Medicaid for low-income Utahns, policymakers helped those most in need of health care assistance. By limiting that expansion to what Utah taxpayers could sustainably afford, they shielded the taxpayers from the unsavory options that expansion states are now facing. And by pursuing a modest expansion, they protected Utah's most vulnerable populations from the anguish of waiting for months to receive the health care services they need today.

Thankfully, we have policymakers in Utah who usually look to principles and values instead of election cycles when it comes to the longest-lasting, weightiest policy decisions. The more Utah's elected officials refuse to bend to short-sighted political pressure, the more they help Utah remain a state that is grounded in the principles and values that produce the economic prosperity, flourishing communities and strong families that we enjoy, and that our children and grandchildren will thank us for.

Derek Monson is director of public policy at Sutherland Institute, a conservative public policy think tank located in Salt Lake City.