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Guest Commentary: A Vote for Proposition 3 – Medicaid Expansion – Will Bring Unexpected Costs to Utahns

by Senator Dan Hemmert (R – Orem)

Imagine you’ve decided to make a necessary major household purchase, like a new car. Let’s say you find a vehicle that suits your family, so you sit down with the car dealer to finalize terms. You ask the total price, how much the payment will be, and the term of the loan. You are told that the dealership cannot tell you an exact price or a precise monthly payment, but the term of the loan will be “from now on.” Would you buy that car on those terms?

Last session the Utah Legislature passed a Medicaid expansion measure that includes cost controls and limits enrollment. It establishes clear and reasonable eligibility rules and gives us options should the costs exceed our means.

For our friends on the left, many of whom do not reside in Utah, this was not enough. As a result, Utah voters will vote this November on whether to enact full Medicaid expansion as dictated by the “Affordable Care Act” (Obamacare), instead of Utah’s more tailored approach.

Obamacare Medicaid expansion includes no cost or enrollment circuit breakers, and once we are in, we will never get out. The “term of the loan” is indefinite. Our decision will determine our future ability to fund vital state needs like education, transportation and public safety.

I understand why Medicaid expansion might appear appealing to some. It is in Utah’s “DNA” to want to lend a hand to those in need, it has been since the days of the pioneers. None of us wants that to change. Most proponents of Medicaid expansion may have the best of intentions; what they don’t have is the best grasp on fiscal reality.

Our “Utah style” limited Medicaid expansion is designed to help those truly in need, while protecting taxpayers from excessive, budget-breaking costs. Under Proposition 3, all of that flexibility vanishes in favor of a “top-down, one size fits all”, Washington, DC-style plan.

Since 32 states have chosen to expand Medicaid under federal mandates, we can examine their track record. Here’s what we know:

• In every expansion state, both enrollment and cost estimates have been woefully inaccurate; reality has sometimes doubled projections, which this means costs far outstrip the state funds budgeted.
• 82% of new enrollees have turned out to be childless, able-bodied adults, mostly unemployed. 55% do not work at all.
• The promised benefits– fewer uninsured, far less uncompensated care, reduced emergency room utilization, vastly improved health outcomes –materialize marginally or not at all.
• Because of federal reimbursement formulas, the very people most of us really want to help – the chronically ill, seniors in need of long-term care, and individuals with physical or developmental disabilities – actually end up at the back of the line behind thousands of childless, unemployed adults! Nationally more that 600,000 such people are currently denied the care they need in favor of millions of new, able-bodied adult enrollees.

Medicaid is a broken system; doubling down on a broken system is foolish. Utah’s share of expenditures will only grow. In 2000, Utah spent $774 million on Medicaid; $127 million of that was Utah’s share, or 11.8% of Utah’s budget.

In 2016, the most recent year for which we have complete data, Utah’s total Medicaid expenditure was $2.5 billion, a whopping 229% percent increase in Medicaid alone. Utah’s share increased to $893 million, a 603% increase since 2000. And that was without Medicaid expansion under Obamacare as proposed in Prop 3.

Medicaid currently absorbs 18.7% of Utah’s General Fund budget. How much more can we afford without more tax hikes or major cuts in services? If it goes to 30%? 40%? That is happening in other states. So what are we willing to cut, or which taxes are we willing to raise, to pay for it?

This legislature has sometimes been criticized for its reluctance to grow state government, for demanding that we “pay as we go”. But as a result, Utah is among the most fiscally sound states. It’s been said, “It is easy to identify the Blue states – just look for all the red ink.” Utah has avoided that pitfall by adhering to principles of fiscal prudence.

We have options – full Obamacare Medicaid expansion is not the only game in town.

Proposition 3 is an empty promise with terrible consequences. Utah will be “buying a car” with no defined price, infinite payments, and no warranty against breakdown. We must not allow well-funded, out-of-state forces to impose such a devastating bargain on our state.



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