This letter is posted for reference in work I have performed or been involved in.
January 29, 2019 – Following the successful 2018 vote for Prop 3 to expand Medicaid in the state of Utah, the Senate introduced bills to repeal the Medicaid rollout for Utahns. An interesting article on this subject was published in 2024: It keeps people with schizophrenia in school and on the job. Why won’t insurance pay? (NPR)
To: Stuart Adams; David G. Buxton; Jani Iwamoto; Luz Escamilla; Allen Christensen; Scott Sandall; Ron Winterton
Cc: Lincoln Fillmore
Subject: Please vote no on SB96 and SB97
Hello Committee Members –
I’m writing to ask that you vote “no” on the two current bills that attempt to repeal Medicaid expansion.
I am the father of an adult son who has been diagnosed with paranoid schizophrenia. I have been working since November 2018 to help him sign up for Medicaid, and are in limbo waiting for an approval that would allow him to begin treatment at Valley Mental Health – a medicaid only facility.
I have been thankful for my company-provided insurance but know that he is losing coverage as he ages out of that system. We are struggling to find coverage with adequate mental health counseling with prescriptive support that he needs.
My reality is that without treatment he will lose the support he currently has. The ability to receive support through a Utah-based medicaid program will literally be life-changing for him.
Respectfully,
Gregory Green
Gregory,
Thanks for your email. Thank you for sharing your son’s story. My wife’s late brother had the same disease until he passed away in 2015. I understand your difficulties, though not as well as my wife and her parents do. To help people like your son, I’m running a separate bill (SB39) to provide new funding and a new way for you to get treatment for your son, especially as he ages out of eligibility on your insurance plan.
Regarding Prop 3, I am confident that expansion will move forward in a way that provides more options for your families, but it will necessarily look different than what was on the ballot in November. Unfortunately, that program is projected to run a deficit of more than $150 million over five years. That deficit has to be closed, because our constitution does not allow for an unbalanced budget. In order to close the gap, I see four options:
- Repeal the initiative
- Raise taxes beyond what voters approved in the initiative.
- Cut funding to other programs (like education, transportation, public safety, or air quality) that voters did not approve in the initiative.
- Restructure the initiative so that it can be implemented in a more efficient way and reduce costs to fit the taxes approved by voters.
Each of those would change what was approved by voters. Which do you prefer? Or, do you see another option that I’ve missed?
Thanks,
Senator Lincoln Fillmore
Hello Lincoln –
Thank you for the link to https://le.utah.gov/~2019/bills/static/SB0039.html. I am reading through that now.
I’m not sure why Prop 3 has to be necessarily different than what was on the ballot. I don’t have any conflicts with Prop 3, and generally support its increase of the state’s sales tax by 0.15 percentage points (from 4.7 percent to 4.85 percent) to fund Medicaid expansion costs. According to https://gardner.utah.edu/wp-content/uploads/Medicaid-Brief-Final-Aug-2018.pdf the cost to Utah would only be $77m. Please tell me what analysis projects costs of $150m? Regardless, the federal funds made available through this are significant, and are currently unavailable. An attempt to repeal Prop 3 goes directly against the will of voters and would obviously be challenged in courts by us. Your third option doesn’t have to happen if the tax increase is implemented, and the fourth option would obviously be entertained where improvements that improve the efficiency of the Medicaid rollout can be made.
Thank you,
Gregory Green
Greg,
In Prop 3, the voters approved Medicaid expansion for a set amount of money. Unfortunately, the money, after the first year, won’t cover costs. Anything we do to close that gap changes the initiative. We could raise more taxes. (SB96 does that.) We could take money from other programs (SB96 does that, too) to cover some of the gap. We could also restructure service availability so that people that are eligible for access under non-Medicaid programs get that coverage first. (SB96 does that, too.)
The federal funds available for Medicaid expansion are more than $1 Billion per year in 2024. And the sales tax increase approved by voters brings in another $105 million. And savings from the expansion are another $40 million per year. Yet, with all that, there is still a $65 million deficit in year five, which makes the cumulative deficit over that five year period over $150 million.
The tax approved by voters is simply not enough to fund the program the way it’s structured. Even the initiative’s sponsors acknowledge this. They’d just prefer that we take money from other programs to pay for the expansion, which is their top priority. It may also be yours. However, I think that SB96 strikes the right balance of providing access to health care for all Utahns within the funding authorized by voters.
Thanks,
Senator Lincoln Fillmore
Note: I contest the numbers that Lincoln provides in his response, which is contrary to research on fiscal impact published by third parties at that time.