Utah Republicans are modifying the Medicaid expansion plan approved by taxpayers to cover fewer people by…spending more money:
Utah voters decided to expand Medicaid under the Affordable Care Act in November. But the Republican legislature is scaling back the voter-approved plan.
The Republican legislature has passed legislation that would, in effect, replace the voter-approved Medicaid expansion with a more limited version that would actually cover fewer people while spending more money in the first few years. The bill passed both chambers with a two-thirds majority. It now heads to Republican Gov. Gary Herbert, who is expected to sign it.
GOP lawmakers are making a big bet: that they will be the first state to receive approval from the Trump administration for a partial Medicaid expansion. Originally, the Senate-passed legislation stipulated the entire expansion would have been repealed if the feds rejected Utah’s plan, reversing the will of the voters completely. But the state House, facing intense pressure, changed the bill at the last minute so if the Trump administration does reject partial expansion, the full Medicaid expansion as originally approved by voters would take effect instead.
Taking benefits from the poor to give to rent-seekers: Republican fiscal policy in one sentence. The fact that unified Republican governments will only expand Medicaid if compelled to by the state’s voters and in those cases will generally try to undermine the implementation is almost enough to make me conclude that Republicans don’t really love Medicaid at all!
It’s worth adding that the widespread use of waivers in Medicaid policy is another illustration of why the “this most recent of the countless revisions of Medicaid is unconstitutionally coercive” holding in Sebelius is so bad even John Roberts didn’t really believe it. For better or (more likely, as in this case) worse Medicaid has always offered states more flexibility than many uses of the federal spending power that haven’t faced a serious constitutional challenge. To make the Medicaid expansion the one and only unconstitutional use of the spending power ever always made less than no sense.