This cartoon in the Salt Lake Tribune tracks the message that went out yesterday about Healthy Utah: the House gunned it down in cold blood. Trouble is: it’s a cartoon, and just about as true to real life.
I know many of you are concerned–deeply concerned–about serious problems in our health care system, and want to see the legislature take constructive steps to address those problems and to ensure that we as a society take care of the poorest and neediest among us. Others encourage fiscal restraint and careful consideration of ideas like this one: does trapping people in a cycle of poverty and dependency actually help them? We’ve had ever-expanding social welfare programs since the 40s, and yet progress on income inequality, social mobility, and lifting people out of poverty has been poor (at best), despite all the money and resources invested.
With that in mind, please allow me to make the following observations:
First, the idea that the House “isn’t willing to debate” Healthy Utah is false. We have debated that issue like no other issue in recent memory, with input from physicians, health care providers, the Senate, the Governor’s Office, legislators on all sides of the issue, and hundreds of emails, letters, phone calls, town hall discussions with ordinary citizens like you over many months. After all that, the House decided, as a body, that we could not–would not–support full Medicaid expansion in what amounts to State buy in of ACA/Obamacare. There was almost no support for that option in the House, and debating it further wastes precious time that can be devoted to other options. Why no support? Because many in the House–including a number of experts in finance and health policy–have serious questions about whether this program is affordable, sustainable, and actually delivers on its promises.
Second, we can and will debate other options, ranging from doing nothing (for now) to doing something more finite and manageable. There is quite a bit of interest in the House in trying to help the most needy–people with disabilities, mental health, or substance abuse problems who need care the most and who place the greatest strain on the current system. If we can find a better and more effective way to deliver care to them, many of us are all ears.
Third, there is little incentive to act now beyond a false promise that we “save money” by signing up to a program with a price tag for the state in the hundreds of millions of dollars–if not billions (quite literally)–over time. Kind of like “going broke to save money.” Many of the early adopting States are trying to get out of it now, and we might well ask ourselves “Why?” There is little risk in waiting until the dust settles on many of those experiments to see what path forward makes the most sense for Utah.
Fourth, what gives anyone confidence that we should buy into this program, when every other federal program we are aware of has only grown bigger and more expensive over time?
Fifth, the notion that the federal government is taking $800 million from us and giving us nothing back is grossly exaggerated. While we do pay taxes–heavy taxes–associated with Obamacare, much of that already comes back to the State in the form of subsidies to participants on the Health exchanges as well as increases in traditional Medicaid, particularly for children and people with disabilities. Do we lose money? Sure, but far less than the numbers widely cited as a justification for this move.
Sixth, the notion that the House “doesn’t care about the poor and needy” is patently false. We do care, even as we raise both philosophical and practical questions about how best to meet those needs. Does creating a permanent entitlement for hundreds of thousands of Utahns, who will now look to the State to provide their medical care, make good policy? If so, at what price? Should we extend coverage to healthy adults below the poverty line if it means cutting Medicare to low income seniors? What if it means that people currently waiting on the disability list must wait longer? What if it means deep cuts to education over time? Transportation? Air quality? Those are just a sampling of the serious questions raised by this proposal, no matter how well-intentioned.
In town hall meetings, here’s what I’ve seen: people love the idea of providing coverage to everyone if it can be done cheaply, which is what Healthy Utah offers (at least on the surface). But the more they understand about the unknowns, the the potential problems, and the direct and indirect costs, the less supportive they become. For that reason, a solid majority of people who’ve responded to my survey have supported only a limited expansion or nothing, which happens to track almost perfectly where the House is on this issue.
Remember that old adage about “If it sounds to good to be true, it probably is?” That applies to Medicaid expansion, and that is why the House hesitates before plunging the entire state over a fiscal cliff because the federal government tells us that’s what we need to do to get our own money back..
I hope you know that in this issue, as in all issues, I am doing my level best to represent you–all of you–in a thoughtful and principled way. I know this matters deeply to a lot of you, which is why we’re working so hard to try and find a solution we can get behind. Know that I welcome your thoughts and opinions on this and any other issue.