Earlier this week, the Utah legislature passed a measure that would restrict the state’s ability to accept Medicaid expansion money from the federal government under the Affordable Care Act — a move that essentially undid a ballot initiative — Proposition 3 — approved by voters last November.
Which is a very weird thing for politicians, who depend on channeling the public will, to do. In search of some explanation for this bizarre behavior, I reached out the the Salt Lake Tribune’s Benjamin Wood, who has been all over this Medicaid expansion fight.
Our conversation, conducted via email and lightly edited for flow, is below.
Cillizza: Start from the start: Who rejected the Medicaid expansion under Obamacare and why?
Wood: The state’s Republican lawmakers have been critical of the Affordable Care Act since Day 1 and made it clear early on they weren’t going to bite on the federal incentives to fully expand Medicaid. After the SCOTUS ruling making expansion optional, the legislature passed a law prohibiting the governor from adopting expansion without their approval, and subsequently rejected the governor’s own expansion plan, colloquially known as “Healthy Utah.”
A second attempt at Healthy Utah made it through the state Senate at the time, but hit a brick wall in the House. After that there were a series of incremental expansions, which kept the topic alive at the legislature every year, but the debate really flared up again when the ballot initiative started gaining momentum.
Cillizza: How did we get from that initial decision to a ballot measure all the way in 2018 that allowed Utah voters to have their own say on Medicaid expansion?
Wood: Despite the legislature’s opposition, Medicaid expansion remained fairly popular among the broader electorate. And groups in the health care and advocacy communities kept banging the drum about hundreds of millions of dollars in federal tax dollars that could be helping sick Utahns but for legislative roadblocks.
Lawmakers responded by taking some small steps over the years — one mini-expansion came to be known as “Frail Utah” because it covered only the most vulnerable residents — and last year passed a partial-expansion plan up to 100% of poverty, largely in reaction to the initiative.
That plan was on the books at the time of the November vote, but never got the federal waiver it needed to take effect.
Cillizza: Voters approved expansion with 53% of the vote. And yet, lawmakers took up — and passed — a measure that restricts that expansion. What was the stated reason for this?
Wood: Cost. And to be clear, cost has been the stated objection all along. The initiative included a tax increase to fund the state’s Medicaid expenses, but the governor’s budget office dropped new estimates after the election that suggested the initiative would run a deficit after a couple years.
The debate over the replacement bill has included other objections — partisanship, Obamacare skepticism, big government opposition, etc. — but the talking point has always been that other states have been harmed by expansion and Utah just can’t afford to follow suit.
Cillizza: How much political danger are Gov. Herbert and Republicans in the legislature courting with this move? Seems like a very dumb move, politically speaking?
Wood: In short: they’re safe. Utah is solidly Republican and this issue alone won’t change that. The “blue wave” in 2018 may have helped flip a congressional seat, but inside Utah it left the GOP with a slightly smaller supermajority than they had before. Gov. Gary Herbert has stated he won’t seek re-election in 2020, but his successor is all but guaranteed to be a Republican, and control of the legislature will remain in Republican hands.
But where this could cause some heartache is for individual GOP representatives in the Salt Lake City suburbs, which have been trending more and more purple. We saw four Republicans break rank and vote against the replacement bill, and among the “yes” votes are a representative who won election by less than 1 percentage point, and another who won re-election with a plurality of votes against a Democrat and a third-party challenger. So while there’s little danger for the party at large, this issue could play into some swing district results.
Cillizza: Finish this sentence: “In two years, the fallout from this move by Republicans will be ____________.” Now, explain.
Utah is dealing with shifts in its politics that add to this Medicaid debate in odd and esoteric ways. There’s an ongoing battle over how candidates qualify for party primaries that has exposed factions within the Utah Republican Party, and fueled a larger conversation about whether or not the state’s residents are adequately represented.
Utah isn’t going to stop being a Republican state any time in the foreseeable future, but the voter angst and division around Medicaid — and other subjects — could play a role in the type of Republicans who win elected office in the future.