by Bill Tibbitts, Associate Director
There are many concerns and criticisms of the Medicaid waiver application that Utah's Department of Health is currently accepting public comment on. This waiver application asks the federal government to fully implement SB 96, which the Utah Legislature passed earlier this year in order to scale back the Medicaid expansion proposition that was approved by Utah voters in November of last year.
One big problem with SB 96 and this waiver implementing it, is that it asks the Trump administration to approve changes to Medicaid that have been explicitly rejected by Congress. Separation of powers is fundamental principle of the United States Constitution. Congress is supposed to write the laws and the Executive Branch of government is supposed implement the laws as written. Congress can delegate finalizing the details of legislation at the administrative level but the Executive Branch cannot use its ability to write administrative rules that overrule decisions made by the Legislative Branch.
SB 96 includes several ideas that have been rejected by Congress. The biggest of these ideas is imposing a "per capita cap" on federal Medicaid spending that would sever the connection between federal Medicaid spending and healthcare costs-- which have consistently been growing faster than inflation. The idea of capping increases to federal Medicaid spending at a lower rate has been championed by Ronald Reagan, George W. Bush, Newt Gengrich and Paul Ryan but Congress has consistently rejected their proposals-- in a large part because the majority of Governors have opposed the idea.
Given how clearly and consistently Congress has voted against this idea, the Trump administration cannot claim the decision about how Medicaid funding is structured is something Congress intended to delegate to the Executive Branch. This makes it likely that a decision to approve Utah's waiver application will be successfully overturned in court.
Our biggest concern with the per capita cap proposal is that if it is implemented it will make our state government solely responsible for determining how to react to the escalating costs of healthcare. If future governors and state legislators fail to find a way to slow the growth of costs then they will have to choose whether they wish to cut services, reduce eligibility, cut provider rates, raise taxes or increase premiums and copayments for Utahns in poverty. The fact that the Legislature passed SB 96 tin a year in which they seriously discussed cutting taxes by over $200 million suggests which of these options are most likely to be adopted if current legislators are still in office five years from now..
Aside from these long term concerns, there are more immediate reasons why states show not be applying to experiment with per capita caps. If the per capita cap is approved by the feds, and not overturned by the courts, then we have entered into an era in which Congress is irrelevant to questions of healthcare policy. That means that if a new President is elected next year we have the risk that this year's approval will be withdrawn in an abrupt and arbitrary way. It is unwise for our state to volunteer to be on the leading edge of something that unpredictable.
Medicaid saves and changes lives. It makes it possible for people to receive the surgery they need to return to the workforce. It gives people with chronic health conditions like diabetes a way to obtain the healthcare and medication they need to manage those conditions. Our state's economy is booming and so we are able to invest in the health and well being of the people of our state without experimenting with untested and unwise funding mechanisms.
There are many concerns and criticisms of the Medicaid waiver application that Utah's Department of Health is currently accepting public comment on. This waiver application asks the federal government to fully implement SB 96, which the Utah Legislature passed earlier this year in order to scale back the Medicaid expansion proposition that was approved by Utah voters in November of last year.
One big problem with SB 96 and this waiver implementing it, is that it asks the Trump administration to approve changes to Medicaid that have been explicitly rejected by Congress. Separation of powers is fundamental principle of the United States Constitution. Congress is supposed to write the laws and the Executive Branch of government is supposed implement the laws as written. Congress can delegate finalizing the details of legislation at the administrative level but the Executive Branch cannot use its ability to write administrative rules that overrule decisions made by the Legislative Branch.
SB 96 includes several ideas that have been rejected by Congress. The biggest of these ideas is imposing a "per capita cap" on federal Medicaid spending that would sever the connection between federal Medicaid spending and healthcare costs-- which have consistently been growing faster than inflation. The idea of capping increases to federal Medicaid spending at a lower rate has been championed by Ronald Reagan, George W. Bush, Newt Gengrich and Paul Ryan but Congress has consistently rejected their proposals-- in a large part because the majority of Governors have opposed the idea.
Given how clearly and consistently Congress has voted against this idea, the Trump administration cannot claim the decision about how Medicaid funding is structured is something Congress intended to delegate to the Executive Branch. This makes it likely that a decision to approve Utah's waiver application will be successfully overturned in court.
Our biggest concern with the per capita cap proposal is that if it is implemented it will make our state government solely responsible for determining how to react to the escalating costs of healthcare. If future governors and state legislators fail to find a way to slow the growth of costs then they will have to choose whether they wish to cut services, reduce eligibility, cut provider rates, raise taxes or increase premiums and copayments for Utahns in poverty. The fact that the Legislature passed SB 96 tin a year in which they seriously discussed cutting taxes by over $200 million suggests which of these options are most likely to be adopted if current legislators are still in office five years from now..
Aside from these long term concerns, there are more immediate reasons why states show not be applying to experiment with per capita caps. If the per capita cap is approved by the feds, and not overturned by the courts, then we have entered into an era in which Congress is irrelevant to questions of healthcare policy. That means that if a new President is elected next year we have the risk that this year's approval will be withdrawn in an abrupt and arbitrary way. It is unwise for our state to volunteer to be on the leading edge of something that unpredictable.
Medicaid saves and changes lives. It makes it possible for people to receive the surgery they need to return to the workforce. It gives people with chronic health conditions like diabetes a way to obtain the healthcare and medication they need to manage those conditions. Our state's economy is booming and so we are able to invest in the health and well being of the people of our state without experimenting with untested and unwise funding mechanisms.
