Two of Utah’s most high-profile Democrats announced their support today for an extremely limited version of Medicaid expansion. While Salt Lake County Mayor Ben McAdams and Salt Lake City Mayor Jackie Biskupski would prefer a more comprehensive expansion of Medicaid, they indicated they would take what they can get.

House Bill 437, sponsored by House Majority Leader Jim Dunnigan, R-Taylorsville, would cover only 16,000 of the Utahns who fall into the coverage gap and are unable to get insurance. This covers “the poorest of the poor,” Dunnigan says, meaning it will primarily cover the chronically homeless, those recently released from prison, and some who are mentally ill.

“Health care is important to everyone,” McAdams says, “but it is a lifeline for the people that Rep. Dunnigan’s bill will reach.”

McAdams went on to say, “We have got to break the cycle for those who cycle in and out of our jails, and in and out of our homeless services system."

David Litvack, who serves as deputy chief of staff under Mayor Biskupsi, is himself a former lawmaker and past House minority leader who represented Salt Lake City. He spoke on the bill in Biskupski’s stead after announcing the mayor has a cold. “We want to thank Rep. Dunnigan for his hard work on behalf of Salt Lake City’s most vulnerable population,” Litvack says. “Mayor Biskupski is pleased to offer our support for this legislation.”



Over the past few years, the Legislature has considered several other comprehensive Medicaid expansion proposals. Most notably, there was Gov. Herbert’s Healthy Utah plan put forward in 2015—which would have covered 125,000 Utahns currently unable to purchase or afford health insurance. It was passed by the Utah Senate but was then blocked by the House. Another proposal, Utah Access Plus, which was a collaboration by leaders of the House, Senate, and the Governor’s office, was also killed after House Republicans voted against it in a closed caucus.

House Speaker Greg Hughes, R-Draper, has repeatedly said in the past that while lawmakers feel empathy and compassion for those who are suffering without access to health care, the House’s biggest concern is the budget, and House members are unwilling to fully expand Medicaid because of the price tag.

McAdams’ and Biskupski’s support of Dunnigan’s bill came as a surprise to many, given how vocal both had been in support of comprehensive Medicaid expansion to cover all Utahns inside the coverage gap.

“I must acknowledge that there is another bill this session that proposes full Medicaid expansion,” Litvack says, referencing Senate Bill 77 from Senate Minority Leader Gene Davis, D-Salt Lake City, which would fully expand Medicaid and has successfully passed through a Senate committee. “We know there are many in the community who feel that this would be the optimal solution, but there is simply not the political support to move in that direction, and we cannot let that be in the way of taking a critical and important step forward.”

McAdams says he’s not worried that his support of Dunnigan’s bill will take away the political pressure for the House to pass a more comprehensive plan.

“With all due respect to Sen. Davis,” McAdams says, “I think we’ve seen over the last couple of years what the appetite is in the House for either full Medicaid expansion or other plans like Healthy Utah. So we are looking on adding our support for the neediest Utahns."

McAdams added, "I certainly hope that more will be done in the future, but we’ll have to talk about next steps down the road.”

Dunnigan refused to say whether or not he personally would prefer to expand Medicaid to cover all 125,000 Utahns who need coverage, but said that “[my] bill provides services to those who are most deserving … my focus is on those 16,000. I think that there are many in the House who are very concerned that we shouldn’t have just an open-ended checkbook to cover [those people] when we cannot say what the total cost would be.”

Other Democratic lawmakers are outspoken critics of Dunnigan's proposal. Sen. Jim Dabakis, D-Salt Lake City, posted a graphic on Facebook comparing Dunnigan's plan to Davis' plan (pictured), saying "Can someone rational please explain to me why the Utah Legislature is taking the Dunnigan Plan and not the Davis Plan? It's mystifying to me."

Josh Kanter, board chair for Alliance for a Better Utah—a progressive advocacy group that is fiercely opposed to Dunnigan's bill—says he understands why McAdams and Biskupski support the bill. However, if Dunnigan's bill becomes law, he strongly doubts that lawmakers will again consider further expanding health insurance to the tens of thousands who still don't have it.

"We don't think this is the right way to approach this," Kanter says. "Everyone deserves health care, and by doing this, we're essentially writing off everyone who makes between $1,200 a year and 138 percent of the federal poverty limit. Certainly, morally, that's not the right approach."

Former Utah Lieutenant Governor Greg Bell, who now works for the Utah Hospital Association, which supports Dunnigan's bill, says that he's cognizant of ABU's concerns, but says HB 437 is still a good bill. "I honestly can't say whether or not anything additional will ever get done. But while I wish that we could get something bigger or better done, it's just not going to happen," Bell says.

At his weekly meeting with reporters on Tuesday, Gov. Herbert echoed those statements, saying that while he wished something like his Healthy Utah proposal could get passed, he doubts it will happen. The governor did not say whether or not he would continue advocating for a more expansive approach in the future.

Dunnigan’s bill is currently awaiting consideration by the full House of Representatives. If it passes, it is expected that it will also pass successfully through the Senate.

In addition to covering state politics for City Weekly, Eric Ethington is communications director for Political Research Associates.