How Medicaid Expansion Affects Salt Lake County

In 2011 the Supreme Court upheld the Constitutionality of the Affordable Care Act (commonly known as Obamacare) with one exception: Medicaid expansion. States could now choose whether or not to expand Medicaid coverage. 

Utah has already been taxed heavily (to the tune of $680 million) and sent those dollars to Washington, DC. If Utah chooses not to expand Medicaid or accept those dollars in a different form, Salt Lake County will have two choices: cut county behavioral health and substance abuse programs, or raise taxes to continue funding them. Here are the current options being explored by the Governor's office, Utah Senate, and Utah House:

Instead of expanding Medicaid, Governor Herbert came up with a plan to still keep some of the funds coming to Utah. (Remember, these are taxes that you and I have already paid. If Utah doesn’t take them, then other states will get to have the funds.) The Governor’s Healthy Utah Plan is designed to cover those 111,000 (about 50,000 in Salt Lake County) people under private insurance, without expanding the Medicaid roles. Only those determined to be medically frail would move to Medicaid coverage. 

Every month Utah waits, $4 million of our tax dollars go to other states. What makes Utah’s plan unique is the Governor asking for the money from the federal government to come in the form of a $258 million block grant. The state would use that to provide care and manage those who fall in the “donut hole”* of coverage, which are some of the neediest in Utah who don’t qualify for Medicaid, but can’t afford traditional coverage. Typically these are people who are at or below 133 percent of the poverty line or make less than $15,500 per year. Our coverage of those incarcerated in our jail also goes from 20 percent of inmates covered to 80 percent of inmates covered. Healthy Utah provides assistance to pay for health insurance on private markets. The exact amount depends on four factors:
- Ability to work
- Household income
- Access to employer or family health insurance
 - Individual health care needs

No matter what happens, Salt Lake County will be affected. If we take funds through the Governor’s Healthy Utah Plan or by expanding Medicaid we will be able to provide health coverage for the poorest of the poor and continue the county’s substance abuse program. Our substance abuse program helps to keep people out of jail, which then saves taxpayers money.

If we don’t accept these funds, Salt Lake County will be forced to significantly raise taxes to continue funding the substance abuse program, or risk cutting the program. This could still mean increased costs through additional incarceration of substance abusers who can’t get the help they need.

*Salt Lake County’s uninsured estimates