An estimated 57,000 people in our state fall into this so called donut hole.
They make too much money to qualify for Medicaid, but not enough to purchase a plan through the Affordable Care Act.
Under the ACA all 50 states were supposed to expand the program to include these people, but the Supreme Court ruled that part of the law was unconstitutional and left the decision to individual states.
So far, 24 states have not expanded, Utah is one of them.
You could say Charlotte Lawrence, who is suffering from both cervical and ovarian cancer is the face of the debate in Utah.
“I’m just trying to stay optimistic and doing everything I can possibly do, hoping that things will just work out,” said Lawrence.
We first met the mother of five in February at the State Capitol, pleading with lawmakers to take action.
She was denied a health insurance plan under the ACA because she doesn’t make enough, but she makes too much to qualify for traditional Medicaid.
For now she goes uncovered as she battles a disease that could take her life.
“It gets so frustrating when a doctor will refer you to a test and you have to decide when you come home from work that there is a shut off notice on your door. Do you pay that shut off notice to keep utilities on or do this test to see how things are progressing,” asked Lawrence.
Democrats say that’s exactly why the state should have just accepted full Medicaid expansion to begin with.
“People are going uninsured and it’s just not good for our state, it’s not good for our pocketbooks either. This Medicaid expansion would put money back into the state’s economy, $2.2 billion,” said Peter Corroon, Chairman of the Utah Democratic Party.
Governor Gary Herbert says the one size fits all Washington solution isn’t right for our state.
He rolled out the Healthy Utah Plan in February, it’s an alternative to Medicaid expansion.
“They need help and we want to help them. As I’ve said many times before, doing nothing is not a good option and it’s not an option for me,” said Herbert.
The governor’s plan would utilize $258,000,000 in taxes he says are being paid by Utah taxpayers anyway for a three year block grant.
The pilot program would insure about 111,000 Utahns through the private market.
It would require participants to work if they can, pay co-pays and share in the cost of the premiums.
The governor calls it the Utah solution, for our unique needs.
“To me it’s common sense, it respects the tax payer dollars and gives the recipients a better choice,” said Herbert.
The governor needs the legislature to sign off on the plan and so far it’s a no go.
Both the Senate and House introduced their own plans during the session.
The sticking point for the top republican in the House is accepting federal funds.
House Speaker, Becky Lockhart wants the solution to be funded with state money.
“If we continue to ask for money from the federal government how do we expect them to ever control themselves? We are 17 plus trillion dollars in debt as a nation,” said Lockhart.
A legislative healthcare task force made up of members of the House and Senate is now investigating all the latest enrollment numbers for the ACA and Medicaid.
It is also looking into all possible options.
The task force will take those findings and make new recommendations to leaders in both chambers.
“This is a permanent decision. We need to be really, really careful about how we do it, when we do it and this is going to take some time,” said Lockhart.
Democrats say republican leadership has had plenty of time.
“Utah could have taken the money already, we’ve been dithering on this several months now,” said Corroon.
Lawrence doesn’t know how much time she can afford.
“Having friends pass away and die it’s really put a lot of pressure on my kids, going mom’s not doing what the doctor asked her to do, because she’s taking care of us and making sure our needs are met,” said Lawrence.
Governor Herbert was told by Health and Human Services there is nothing in his plan that should be a deal breaker.
He’s working with the Department of Health and hopes to have federal approval by the end of the summer.
Then the governor plans to focus his attention on convincing lawmakers here at home, which would likely include a special session.