Critics say Utah’s Medicaid expansion leaves thousands without coverage and is in danger of a lawsuit

Posted at 3:05 PM, Apr 01, 2019
and last updated 2019-04-01 22:31:28-04

SALT LAKE CITY -- Leonard Bagalwa said he and his family would have been covered under Proposition 3, the voter-approved Medicaid expansion ballot initiative.

But under the Utah State Legislature's replacement of it, he makes a little too much money so he can't get Medicaid.

"Very frustrating," he said in an interview Monday with FOX 13. "To me, healthcare means peace of mind. So when I don’t have peace of mind, I cannot think of how to improve my income. It will be hard for me to think and work when oh, my child is sick or my wife is sick."

Ironically, Bagalwa has a job where he signs people up for healthcare coverage.

"I see the same situation other people are facing like mine," he said.

Bagalwa joined critics of Senate Bill 96, the Prop. 3 replacement bill, on Monday at a news conference where they decried the legislation as leaving tens of thousands without effective healthcare coverage.

"The legislature reminds me of my native home country where democracy is not respected," said the immigrant from the Democratic Republic of the Congo.

Voices for Utah Children, the Utah Health Policy Project and the Disability Law Center criticized SB96 as providing coverage for only half the intended recipients under Prop. 3. Standing in front of a bridge at Liberty Park, the argued the legislature's "bridge plan" had too many gaps in it.

"Why are we paying more to cover fewer people?" asked Jessie Mandle with Voices for Utah Children.

Under SB96, roughly 70,000 to 80,000 will be covered until the money runs out next year. The Trump administration has approved a waiver with a work requirement and a 70/30 split with Utah on costs. Those who qualify have to make about 100 percent of the federal poverty level, or about $1,000 a month.

Those who make above that continue to get federally subsidized plans, said Rep. Jim Dunnigan, R-Taylorsville, who co-sponsored SB96.

"I think the intent is to get low income Utahns coverage," he said Friday in an interview with FOX 13.

Lawmakers and Governor Gary Herbert have argued that what voters approved in Prop. 3 (and the sales tax hike that went with it) is a budget buster. Ballooning healthcare costs had the potentially to make Medicaid expansion very expensive, draining other essential government services taxpayers use.

"This is an important first step in covering vulnerable Utahns in a financially sustainable way," Gov. Herbert said in a statement.

But critics of SB96 argue that what the state is requiring of Medicaid recipients -- including enrollment caps, work efforts and even a partial expansion plan -- could get the state sued. Similar efforts in other states have been struck down by the courts.

"Those are really fundamental changes to the kind of structure of medicaid and funding. It just strikes me as though there would be national implications. It’s hard for me to see how there wouldn’t be some challenge to this," said Nate Crippes, a staff attorney for the Disability Law Center.

His group refused to say if they were drafting litigation, but Crippes told FOX 13: "We’re looking at all the options we have."

The Utah Attorney General's Office said Monday it would defend the law in court, if litigation were filed.

Meanwhile, Prop. 3's original sponsors announced plans to raise money to help election opponents of Rep. Dunnigan and Sen. Allen Christensen, R-Ogden, who drafted SB96. Utah Decides Healthcare announced on Monday its efforts to unseat the lawmakers.

"There is no point in having a democracy if the votes of its citizens are ignored. Too many people have fought and died defending our right to vote to let politicians ignore the results of an election and get away with it," said Utah Decides Healthcare spokeswoman Dawn Le.