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Any decision on how Utah will provide health coverage to tens of thousands of its poorest residents seems to be months off and rests largely in the hands of Gov. Gary Herbert after the House and Senate reached an apparent impasse on the issue.
The Senate on Monday passed SB251s1, which would draw on federal Medicaid funds to provide health-insurance subsidies to about 54,000 Utahns who make less than $11,600 a year. At the same time, the bill gives Herbert the green light to go to Washington to try to strike a better deal with the Obama administration, if he can.
"[SB251s1] merely gives the governor the ability to go back without his hands tied to negotiate in good faith for the state of Utah for a block grant for these patients," said Sen. Brian Shiozawa, R-Cottonwood Heights, the sponsor of the legislation. "We retain legislative oversight."
But House Speaker Becky Lockhart, R-Provo, said the House will not consider Shiozawa's bill or the Medicaid expansion proposal Herbert recently offered but that doesn't prevent the governor from trying to negotiate with the White House.
"The executive branch has full authority to negotiate with the Obama administration whenever they like, and it appears they have been doing so," she said.
Senate President Wayne Niederhauser, R-Sandy, said Utah needs to take its time making the Medicaid decision, even if that means the governor takes a few months to work out a deal and calls a special session, or even comes back to the Legislature next session.
"The human aspect of this is very compelling and that is a great concern for us and we'd like to see this move ahead as quickly as possible," Niederhauser said. "But we're making a decision that is going to be a long-term decision. … I don't think we have to be in an absolute hurry. Let's just make the right decision for Utah."
Herbert wants to seek a $250 million block grant of federal Medicaid funds that would allow Utah to subsidize insurance coverage for those making up to $15,500 a year about 57,000 more than would be covered under Shiozawa's proposal.
Utah Democrats sought a more direct route Monday, pushing to replace Shiozawa's bill with a proposal to enroll all 111,000 low-income Utahns in Medicaid, as envisioned under the Affordable Care Act.
Sen. Gene Davis, D-Salt Lake City, said the U.S. Department of Health has rejected waiver requests similar to the one Herbert seeks, and suggested it would make more sense to take the full Medicaid expansion.
"The bottom line is you either cover everyone or don't get [the waiver], and this takes care of that with no game playing," said Davis.
Sen. Jim Dabakis, D-Salt Lake City, said other Republican-led states have accepted Medicaid funds. "It would be a shame to turn down this money over ideology."
The Democrats' effort failed on a voice vote. Shiozawa's bill the passed the Senate 19-6, despite causing heartburn for some GOP senators.
Sen. Daniel Thatcher, R-West Valley City, labeled it the least favorite bill he's voted for this session.
"We have no options that I consider good," Thatcher said. "This is the best of the bad options before us."
Meanwhile, the House passed a bill Monday calling for the Health Reform Task Force to study possible Medicaid solutions if the House and Senate can not come to an agreement before the Legislature adjourns Thursday a prospect that is appearing more and more likely.
"It does not preclude any other solutions," said Rep. Jim Dunnigan, R-Taylorsville, sponsor of the bill. "It does give the Legislature a mechanism to continue to work on this if we do not reach a conclusion before we adjourn … this week."
House Republican leaders had put forward a coverage plan that would reject most Medicaid funds, instead using $35 million of state money and $80 million of federal money to provide some level of health care to an unknown number of Utahns.