This is an archived article that was published on in 2016, and information in the article may be outdated.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.

Whether you like it or not, the Affordable Care Act is here to stay. It has been sustained twice by the Supreme Court, first in 2012 and then again in the King v. Burwell decision. And with the continuation of the ACA, so has the optional expansion of Medicaid.

To date, 31 states have subsequently passed the Medicaid expansion, including most recently Montana and Louisiana. Despite well-founded concerns about costs, enrollment and sustainability, no adopting state has rescinded the program. A number of conservative GOP governors including John Kasich of Ohio and Mike Pence of Indiana have expanded Medicaid in their states.

So what do they know that we do not?

I am in favor of a market-based strategy that will hold down costs, increase affordable enrollment of uninsured Utah citizens and improve healthcare outcomes. I favor decreased use of the ER for non-urgent cases and favor better treatment for such cases in the less costly, more comprehensive primary care setting. I favor rehabilitation of prisoners, substance abusers and the mentally ill over the incarceration and homelessness alternatives we now have.

Utah, like the rest of the country, faces a crisis in healthcare. We currently have over 13 percent uninsured in Utah. This population often has no primary care physician, has poor or absent preventative care and comes to the ER as a last resort. Often too late to diagnose a medically disastrous condition. For those with insurance, our health care premiums and co-pays are skyrocketing.

A Medicaid expansion would help in a number of ways.

First, fiscally it makes sense. Since we are already paying $600 million to $800 million in ACA taxes each year to the federal government under the ACA, we have already paid for the Medicaid expansion. By not expanding Medicaid, Utah has lost $1.2 billion in federal funding as of 2016.

These monies would have funded over 3,000 new high quality jobs here in Utah and reduced the uncompensated care burden in clinics and hospitals. Arkansas legislators noted an improved economy and health care costs that finally stabilized under their Medicaid expansion, and they have renewed this with a 75 percent vote in their legislature.

A Utah Medicaid Expansion would provide vital funding for the rehabilitation programs of the recently passed Justice Reinvestment Initiative. This rehabilitation would potentially break the cycle of drug abuse, incarceration and recidivism. It would give these men and women a chance to rebuild their lives, get jobs and education and keep them out of jail and off the streets.

You want a remedy for homelessness? Here is a big start.

The New England Journal demonstrates significantly improved health outcomes and decreased mortality in those States that have expanded Medicaid compared to those which have not. Like Utah. We now have the distinction of having a higher uninsured rate than the rest of the country. Not a great record for the "Best Managed State."

We have the opportunity to markedly improve the health and well being of 70,000 poor and uninsured Utah citizens. By expanding Medicaid we can increase primary and preventative care, which will keep many patients out of much more expensive ERs and prevent debilitating or deadly illness. Care will be better and health costs will go down in this group. We literally could have saved hundreds of lives lost during the past three years while we have debated this issue.

Lastly, in response to well-meaning legislators who are concerned about the distress patients will feel if Medicaid insurance is someday taken away: Every uninsured patient that I see in the ER is desperate for health insurance, no matter how temporary. It literally is a life and death decision for them. They are all willing to take the risk.

As you know, I sponsored and successfully passed Healthy Utah, which fully expanded Medicaid, in the Utah Senate in 2014 and 2015, only to see it killed in House committee. A majority of Utah citizens support this, then and now. Many well respected groups including Utah Medical Association, Utah Hospital Association and Utah Nurses Association, and many business and professional organizations like the Utah Mining Association, Salt Lake Chamber of Commerce and others recognize the vital role of an expansion.

This last session I supported a much more limited Medicaid expansion bill as it was the only bill that would pass the House. I supported this in the hope of building on this base incrementally as data shows improved health outcomes, stabilized costs, and improved lives of thousands of uninsured Utah citizens. To date this bill has still not gotten approval from the federal government, so we still have nothing to show for the bill. Meanwhile thousands of poor and uninsured patients, fellow Utah citizens are waiting. Still.

Expanding Medicaid is a fiscally sensible, healthy solution to the growing problem of the uninsured in Utah.

Sen. Brian Shiozawa, M.D., represents parts of southeastern Salt Lake County in the Utah State Senate.