Census numbers show neighboring states outpacing Utah on health care access

SALT LAKE CITY — As Governor Gary Herbert signed a Medicaid expansion bill into law in a formal ceremony on March 27, the US Census Bureau posted numbers showing how many Utahns were uninsured under current law.

Thirty-two states chose to expand Medicaid under Obamacare, under which the federal government paid 90 percent of costs so long as states agreed to provide health insurance for all legal residents making less than 138 percent of the poverty threshold.

Utah chose not to expand Medicaid initially, and then failed to pass a program called Healthy Utah, which was negotiated between Herbert and the Obama administration.

The US Census Bureau released Small Area Health Insurance Estimates (SAHIE) for 2016, showing how many people have health insurance in every state and county in the United States.

2016 is significant, because it shows insured rates after a full second year of Obamacare implementation, and the numbers in Utah and nationwide are dramatic.

Utah had a 16.6% uninsured rate in 2008.

In 2016, 9.7% of Utahns were uninsured.

That 6.6% improvement is smaller than improvements shown by all of Utah’s neighboring states that chose to expand Medicaid:

  • Arizona went from 20.5% uninsured to 11.9%, improving 8.6%.
  • Colorado went from 18.1% uninsured to 8.6%, improving 9.5%.
  • Nevada went from 23.2% uninsured to 13.1%, improving 10.1%.
  • New Mexico went from 23.9% uninsured to 11.2 percent, improving 12.7%.

The fact that Utah’s insured rate decreased without expanding Medicaid also suggests that, from that original pool of 16.6% lacking insurance, it’s the poorest who did not get help. A fact Herbert acknowledged as he spoke about the new Medicaid expansion.

“It’s always been troublesome for us all that there’s this gap of people who have not been able to access affordable, quality health care,” Herbert said.

The new expansion was more palatable for conservatives in the Utah House of Representatives because it requires recipients to work or seek work, and it allows the state to provide coverage to Utahns making less than 95% of the federal poverty rate, rather than Obamacare’s expected 138%.

Correction: a previous version of this story said the program would kick in on January 1, 2019.

The Utah Department of Health says there is no certain implementation date for new Medicaid coverage under HB 472. The bill requires UDOH to submit a waiver request to the federal government by January 1, 2019, and the fiscal note to the bill anticipates the program beginning on July 1, 2019.

It’s possible the expansion will not happen.

Governor Herbert said at the bill signing ceremony that he talked with Vice President Mike Pence on “a number of occasions.”

“[Pence] said we are willing to give waivers under the law,” Herbert said.

That assurance is not the final word, however, because a similar program in Arkansas was shot down by the federal government on March 5, according to the Utah Health Policy Project.

Stacy Stanford with the UHPP argues that getting such a waiver approved is unlikely because covering only those below the poverty threshhold rather than the required 133% of poverty means the federal government would foot a much bigger bill by paying subsidies on the ACA exchange.