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Gary Herbert has found himself in a tough spot. Not as tough as the spot that thousands of Utah residents without health insurance find themselves in every day, but tough enough.

Every decent bone in the governor's body has to know how utterly heartless it would be for the state to just walk away from the expansion of Medicaid health care coverage as offered by President Obama's Affordable Care Act. Not only would the expanded coverage prevent suffering, save lives and otherwise do invaluable good for many of the state's low-income and working poor households, it would also provide a shot in the arm to the state's economy by making workers more productive, students more attentive and health care providers more economically healthy.

But the political side of the governor's brain also knows that the core of Utah politics, which holds sway over the Legislature, doesn't always do compassion or logic. It often does anti-Washington, particularly anti-Obama, posturing. Any tiny thought Herbert might have had to simply accept an expanded Medicaid program, clearly the best course of action from both a humanitarian and fiscal point of view, seemed to him a sure non-starter.

Thus, Healthy Utah. That's Herbert's plan to accept into the state economy the $258 million the federal government would have used to expand Medicaid coverage in Utah. It would go to provide poor folks with subsidies to buy coverage, laundering the money through the private sector health insurance companies whose sometimes inhumane practices made Obamacare necessary in the first place.

Smelly, but workable.

Herbert also sought to make his alternative more appealing to Utah's ruling right wing by marinating it in a bit of dripping contempt for the poor. Specifically, adding a work requirement for able-bodied adults who dared to seek coverage for their families.

When the reviewers at the U.S. Department of Health and Human Services balked at the work requirement, Herbert decided he'd call it a "work effort" instead. A system that would provide information and encouragement for unemployed Healthy Utah customers to seek, find or be trained for work. Something the state does a lot of anyway.

As one health care advocate correctly noted, less stick, more carrot. And, with luck, enough to get both the feds and the Legislature to agree to a compromise that will finally extend to perhaps 110,000 Utahns the kind of access to health care that residents of the Earth's other civilized nations have long taken for granted.