State lawmakers consider expanding Medicaid coverage

It’s called Medicaid Buy-In. It would expand health coverage and make it more affordable to New Mexicans. Bills in the House and Senate request the Legislative Health and Human Services Committee to look into exploring that option through a study.

“Health care option that is affordable, provides good quality care for all our families, would mean that our families could actually focus on getting better, healing, and not having to navigate multiple systems or to be without health care altogether,” said Adriann Barboa with Strong Families NM.

Barboa said 900 thousand families in New Mexico already rely on Medicaid, which means the coverage works for many New Mexican families. So what if that were available to more?

“We’re one of the first states to be looking at something like this, and so this session we are running a memorial in the state Legislature that would direct the Legislative Health and Human Services Committee to start studying how this might work,” said Colin Baillio with Health Action New Mexico.

That means talking to all parties involved — hospitals, insurance companies and average New Mexicans — about Medicaid.

“It covers all the benefits that folks could need, which includes dental and vision care which is out of reach for a lot of people right now,” said Baillio.

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Oregonians to vote on Medicaid taxes as costs soar

PORTLAND, Ore. (AP) — Oregon aggressively expanded its Medicaid rolls under the Affordable Care Act, adding enough people to leave only 5 percent of its population uninsured – one of America’s lowest rates.

Now, with the reduction of a federal match that covered those enrollees, the state is calling on voters to decide how to pay for its ballooning Medicaid costs.

A special election on Tuesday asks Oregonians whether they approve of a tax on hospitals, health insurers and managed care companies that would leave Medicaid, as it is now, untouched. More than 1 in 4 residents here rely on it.

Maine voters were in the national spotlight when they recently approved Medicaid expansion. But experts say Oregon’s election is the only instance of voters – not lawmakers – getting the final say on the complicated question of how to fund rising Medicaid costs.

The outcome could have significant consequences for the state’s health care spending.

“If it’s not supported, you have a huge hole, and where do you go from there?” said Stacey Mazer, senior staff associate with the National Association of State Budget Officers. “I followed these issues starting in the fall, and this was the biggie.”

Measure 101 would impose a 0.7 percent tax on some hospitals and a 1.5 percent tax on the gross health insurance premiums collected by insurers and on managed care organizations, raising anywhere from $210 million to $320 million over the next two years.

Proponents call the tax an “assessment” and say money raised could cover the more than 350,000 low-income Oregonians who were added to the plan since 2014 while state lawmakers work out a long-term solution.

The loss of that revenue could jeopardize an additional $630 million to $960 million in federal Medicaid matching funds that flow to the poorest in the state, according to the nonpartisan voter pamphlet. That possibility prompted the very hospitals and health insurers who would be taxed to come out as the measure’s biggest backers. They say the cost of the taxes would be less than that of uninsured emergency-room visits.

The ballot measure arose from a grassroots campaign to put parts of a bipartisan legislative funding solution passed last year before voters. Republican Rep. Julie Parrish and several colleagues were angered by portions of the bill that exempt large, self-insured corporations like Nike from Medicaid taxes but not Oregonians who buy insurance on health care exchanges.

They also believe hospitals and insurers will pass the cost to consumers, despite language that limits premium rate increases to 1.5 percent.

Parrish, who represents a Portland suburb, spearheaded the drive to collect more than 84,000 signatures to get the measure on the ballot. Her cellphone number appears in the official voter’s guide with a note urging voters to call her with questions.

“This is not a ‘We hate Medicaid’ referendum,” Parrish said. “This is about the fact that our colleagues put forward some pieces of the funding package that we believed to be unfair, unequitable and unsustainable.”

Those in favor of the measure say Parrish’s opposition to the taxes is what’s unsustainable. More than 175 organizations have backed the pro-Measure 101 campaign, including former Gov. John Kitzhaber, an emergency room doctor.

People who support Measure 101 have raised $2.8 million. Parrish and her allies have raised $353,000.

Portland resident Kelly Burke has volunteered at a pro-Measure 101 phone bank. She briefly lost her insurance years ago when she was pregnant with her second child. She now has a serious auto-immune disease and is thankful she has insurance through her partner’s employer.

“What people don’t understand is that people are working, but they still can’t afford health care,” she said.

Medicaid is a federal-state collaboration originally meant for poor families and severely disabled people. Over the years, it’s grown to become the largest government health insurance program, now covering 1 in 5 Americans.

In 2014, Oregon was one of 32 states and the District of Columbia to allow people making 138 percent of the federal poverty line to qualify for Medicaid under the Affordable Care Act. That’s $34,600 for a family of four. Before, they had to make less to qualify.

The changes brought Oregon’s slew of new enrollees. For the first two years, the federal government covered the full cost for them – and for those in other states.

In 2017, the match dropped to 95 percent, adding $136 million in costs in Oregon. It will drop to 90 percent in 2020.

At the same time, the federal government asked Oregon to pay more for its other Medicaid recipients because of its strong economy. And state lawmakers voted to provide Medicaid coverage for children living in the country illegally starting Jan. 1, adding another $27 million in costs.

Parrish says she has a backup funding plan if Measure 101 fails, though her opponents say it’s not workable.

Lawmakers reconvene for a short, six-week session next month.

Follow Gillian Flaccus on Twitter at http://www.twitter.com/gflaccus


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Oregon voters weigh tax to fund rising Medicaid cost


PORTLAND, Ore. — Oregon aggressively expanded its Medicaid rolls under the Affordable Care Act, adding enough people to leave only 5 percent of its population uninsured — one of America’s lowest rates.

Now, with the reduction of a federal match that covered those enrollees, the state is calling on voters to decide how to pay for its ballooning Medicaid costs.

A special election on Tuesday asks Oregonians whether they approve of a tax on hospitals, health insurers and managed care companies that would leave Medicaid, as it is now, untouched. More than 1 in 4 residents here rely on it.

Maine voters were in the national spotlight when they recently approved Medicaid expansion. But experts say Oregon’s election is the only instance of voters — not lawmakers — getting the final say on the complicated question of how to fund rising Medicaid costs.

The outcome could have significant consequences for the state’s health care spending.

“If it’s not supported, you have a huge hole, and where do you go from there?” said Stacey Mazer, senior staff associate with the National Association of State Budget Officers. “I followed these issues starting in the fall, and this was the biggie.”

Measure 101 would impose a 0.7 percent tax on some hospitals and a 1.5 percent tax on the gross health insurance premiums collected by insurers and on managed care organizations, raising anywhere from $210 million to $320 million over the next two years.

Proponents call the tax an “assessment” and say money raised could cover the more than 350,000 low-income Oregonians who were added to the plan since 2014 while state lawmakers work out a long-term solution.

The loss of that revenue could jeopardize an additional $630 million to $960 million in federal Medicaid matching funds that flow to the poorest in the state, according to the nonpartisan voter pamphlet. That possibility prompted the very hospitals and health insurers who would be taxed to come out as the measure’s biggest backers. They say the cost of the taxes would be less than that of uninsured emergency-room visits.

The ballot measure arose from a grassroots campaign to put parts of a bipartisan legislative funding solution passed last year before voters.

More than 175 organizations have backed the pro-Measure 101 campaign, including former Gov. John Kitzhaber, an emergency room doctor.

People who support Measure 101 have raised $2.8 million. Opponents have raised $353,000.

Portland resident Kelly Burke has volunteered at a pro-Measure 101 phone bank. She briefly lost her insurance years ago when she was pregnant with her second child. She now has an auto-immune disease and is thankful she has insurance through her partner’s employer.

“What people don’t understand is that people are working, but they still can’t afford health care,” she said.

Medicaid is a federal-state collaboration originally meant for poor families and severely disabled people. Over the years, it’s grown to become the largest government health insurance program, now covering 1 in 5 Americans.


Gillian Flaccus is an Associated Press writer.


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Minnesotans fight to change federal law allowing government to recover estates for Medicaid costs

“It needs to be removed at the federal level because it can come back to haunt us at any time, really,” said Julie Gelle of Sandstone.

At issue is the so-called “55 clawback.” Congress in 1993 passed a law requiring states to recover the cost of long-term care for Medicaid recipients 55 and older via estate recovery after their death. States also were given additional authority to recover from the estates for other health expenses.

Minnesota took that option, said state Sen. Tony Lourey, DFL-Kerrick, but for a long time it affected almost no one. Recipients of Medicaid — known as Medical Assistance in Minnesota — were subject to an asset test, meaning that those who qualified for Medicaid had no estates from which to recover.

That changed when Minnesota opted for Medicaid expansion in 2014 under the Affordable Care Act, Lourey said. The income level for Medical Assistance eligibility was raised, and the asset test was discarded. Many Minnesotans became eligible for the program who hadn’t been eligible before. That included small farmers who were property rich but money poor.

Some Pine County residents said they were steered to Medical Assistance without realizing the help they received would count against their estates. Scott and Ellen Killerud, who live on a farm near Willow River, discovered in late 2015 that they’d accumulated $11,000 in potential estate claims. Scott Killerud told nearby farmer Rick Rayburn; he and his wife, Rose, found their claims reached $30,000. Rayburn issued a call to arms, of sorts, posting a letter in a Sandstone laundromat, where Julie Gelle saw it. When she checked, she found that she and her husband, Robert, had reached $15,000 in estate claims.

Feeling misled and mistreated, the Rayburns, the Gelles, the Killeruds and a few others got the word out to any who would listen, demanding that the clawback be removed. They found an ally in Lourey, who led a legislative effort to overturn estate claims for 55-and-older Medicaid recipients for all except long-term nursing care.

Lourey initially met resistance on both sides of the aisle, he said, but on the last day of the 2016 legislative session that year’s $182 million state supplemental bill was passed with a provision that estate claims could no longer be accrued for Medical Assistance. The legislation made that retroactive to Jan. 1, 2014, meaning the claims against the Rayburns and others were reset to zero. Gov. Mark Dayton signed the bill into law.

The estate claims fix still had to be approved by the federal Centers for Medicare and Medicaid Services, which did so on Dec. 20, 2016, only stipulating that it also must be retroactive before 2014.

Problem solved? Not to the satisfaction of Minnesotans who would have been affected by the estate claims, or their advocates.

“What one Legislature and governor did, another Legislature and governor down the road might decide to undo,” said Buddy Robinson, staff director for Minnesota Citizens Federation Northeast and co-coordinator of the Greater Minnesota Health Care Coalition.

Lourey flatly rejects the idea that any Minnesota governor or Legislature would do so, calling it “not in the realm of possibility.” Nonetheless, he joined with state Sen. Scott Jensen, R-Chaska, in writing a letter encouraging the Minnesota congressional delegation to spearhead a federal fix eliminating the estate claim option.

“It would just be really good to get the federal legislation passed that finally sets this to rest,” Lourey said.

That needs to happen in part because the clawback is a form of age discrimination, said Lisa Krahn, executive director of the Seven County Senior Federation, which includes Aitkin, Carlton and Pine counties.

“Our organization thinks people should be treated more equally,” Krahn said. “And this is the ultimate kind of discrimination.”

It also threatens the ability of small farmers to keep their farms in the family, said Paul Sobocinski, an organizer for the Land Stewardship Project, a Minnesota nonprofit.

“If farmers are eligible for Medicaid, and then there’s a lien stuck on them, that’s really a bad situation,” Sobocinski said. “That kills the viability of the future of that farm for the next generation.”

Rayburn met last month with members of U.S. Rep. Rick Nolan’s staff in Duluth as they considered crafting a bill, he said.

A spokeswoman for Nolan said a bill is being drafted, but it’s “very early” in the process.

The bill’s framers are looking at two options, according to Rayburn. One would simply remove the sentence from the original law that allowed the clawback. Under the other, states that have instituted the clawback would be able to keep it and other states could implement it, but they wouldn’t be allowed to do so retroactively.

Rayburn prefers the first option, which he said would “fix something that was definitely wrong.” But it might spark resistance from states that are expecting returns from estate recovery, he said.

Nolan’s representatives have told him the latter option is more likely to pass, Rayburn said.

Will a Congress that is having difficulty keeping the government funded pay attention to a legislative issue raised by Pine County farmers and landowners?

Lourey is cautiously optimistic. “Congressman Nolan is very, very interested in this,” he said. “I know that our senators are also interested. I think it might be something that gets in.”

But for now, the people who raised the cry in the first place are still wary, Krahn said.

“People won’t apply,” she said. “They won’t talk to the county because they’re worried about this issue.”

The Rayburns learned that they qualified, barely, for a tax credit this year. They wouldn’t need Medical Assistance or MinnesotaCare, a program for people with slightly higher incomes that requires only modest premium payments.

But the insurance broker they spoke with couldn’t guarantee they wouldn’t be siphoned into MinnesotaCare, Rayburn said, so they decided to go without health insurance.

“My wife has become gun shy,” he said. “She said if it’s a government plan, we’re not going to do it.”

Similarly, Julie Gelle is going without health insurance for now, she said; her husband is over 65 and covered by Medicare.

“I used to be a trusting person,” she said. “I am no longer trusting. I am very suspicious of our government.”

But there’s one government program she seems to be OK with, and it will affect her soon.

“May 1, I get Medicare,” Julie Gelle said. “Woo-hoo! I’ll have health insurance. I’m counting the days.”

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What You Need to Know About Medicaid Work Requirements

Under a new policy from the Centers for Medicare and Medicaid Services, a government agency headed by Trump appointee Seema Verma, states will be allowed to institute work requirements for people receiving Medicaid coverage. If you’re wonderingwhatthese requirements might mean for people on Medicaid, we’ve got some answers for you.

The first thing to know is that this initiative has long been a policy priority for Republicans, who believe in instituting work requirements not just for Medicaid, but also for other social benefits programs. In the case of Medicaid, the Trump administration arguesthat work requirements will “improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” Medicaid work requirements are also a pet cause of Verma’s.

Will Your State Institute Work Requirements?

That depends: Your state’s Medicaid Director would have to include them in a package of policies submitted to the federal government for consideration. Kentucky has already successfully done so, and at least eight other states have submitted what’s known as a “waiver” to request permission to begin instituting work requirements.

The federal policydoes notmandate that all states start using work requirements.

What’s Involved?

This depends on an individual state’s specific policy, but typically, people are required to submit proof that they are working, searching for jobs or participating in an “approved training program” if they want to receive Medicaid coverage. Ifindividuals can’t meet these standards, they will be dropped from the program.

You may have heard that people over 65, pregnant people, single parents of very young or disabled children and people with permanent disabilities would be exempt from work requirements. The disability community, which relies heavily on Medicaid for health care, is veryconcerned aboutthe structure of these regulations, because not everyone who’s disabled will qualify as “permanently disabled” under this rubric — and that could force people who aren’t able to work to take up employment or risk losing their insurance.

Disability determinations can take months and may involve a lengthy legal battle at times. Conditionsthat are substantively disabling aren’t always viewed as such by the government; for example, someone with a serious heart condition that limits their physical activity might not be counted, or someone with severe asthma exacerbated by exercise or being outdoors would be deemed fit for work.

College students would not be exempt from these work requirements, either, which pressures people to start work immediately after high school if they want to retain Medicaid coverage. A college degree can substantially increase future earnings, and among those who are on Medicaid and unemployed, many are high school graduates — or those who never even got a diploma.

Will Work Requirements Boost Employment and Foster Economic Independence?

Proponents ofwork requirementsargue that they will help people get off government benefits so they can live independently. Butconsiderable research indicates that this isn’t the case.

You might be surprised to learn that the majority of Medicaid recipients are already working– many in settings where employers provide little to no insurance coverage. Eight in ten recipients live in a family where at least one person is employed. Those who aren’t working may have disabilities or other issues that make it difficult or impossible to work. And others may be providing care for family members, or may be unemployed because they cannot find work.

Also of note: Some states, like Massachusetts, allow disabled people who want to work but need Medicaid to survive to share cost, in what’s called Medicaid buy-in. This allows people who would be earning too much to be eligible for government funding — but not enough to cover the costs of their care, or the cost of insurance coverage — to shoulder part of the cost for Medicaid benefits.This lets disabled people join the workforce and be a part of society without jeopardizing their care by violating Medicaid asset and income limits.

States with Medicaid expansion programs have higher numbers of employed recipients, illustrating that the Medicaid expansion can be a form of economic empowerment. People who can access health care are more likely to get back to work quickly when injured, and to stay employed.

Health Affairs estimates that about 11 million people could be at risk of losing their coverage if the entire country adopted work requirements.

Take Action!

If you have concerns about Medicaid work requirements, youshouldcontact your state officials to register your protest, and say you want assurances that your state will not seek a waiver allowing it to institute them. If your state has already initiated the process, pressure your officials to put the brakes on.

You can also join Care2 activists in demanding that Congress authorize funding for the Children’s Health Insurance Program, which covers nearly nine million low-income children across the United States. While CHIP recipients wouldn’t be subject to work requirements, withholding healthcare from children as an ideological bargaining chip is a a low blow.

Photo credit: TexasImpact

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Analysis: Edwards proposing Medicaid idea championed by GOP

BATON ROUGE, La. (AP) – Gov. John Bel Edwards‘ announcement that he intends to pursue work requirements for some Medicaid recipients in Louisiana seemed to catch Republicans who have championed the idea by surprise.

They want to make sure the Democratic governor follows through on the proposal they’ve pushed unsuccessfully – and that he doesn’t get all the credit.

Many question marks remain about what exactly Edwards wants to enact, what process he’ll use and how many low-income people would be impacted in Louisiana’s $12.5 billion Medicaid program. It’s unclear how long it will take the Edwards administration to develop something that could be submitted for federal approval.

In response to questions after a Jan. 8 speech, Edwards said his administration is “actively working” on the concept. It turned out to be a timely comment, coming days before President Donald Trump’s administration announced it will allow states to enact such work requirements for able-bodied, working-age Medicaid recipients.

The governor’s comment was unexpected. Edwards administration officials with the state health department previously expressed concern about similar suggestions, such as when Sen. Sharon Hewitt, a Slidell Republican, proposed the idea last year.

Hewitt is calling on Edwards to support her legislation.

“Providing citizens with additional education or training they need to secure a job can lift them out of poverty and onto a path to improved health outcomes,” Hewitt wrote in a newspaper letter.

Republican U.S. Sen. John Kennedy also has pushed work requirements for years. He’s called on Edwards to submit a waiver quickly.

In Louisiana, Medicaid covers 1.6 million people, one-third of the state population. That includes newborns, pregnant women, elderly nursing home residents, people with developmental disabilities and more than 450,000 working-age adults through the Medicaid expansion.

Any work requirements would fall mainly on the expansion population. Edwards said a majority of people receiving government-financed insurance through the expansion already have jobs. Others, he said, are in school, are sick or are caring for family members.

“For those who are not currently working but are able and eligible to work, we must find reasonable ways to ensure they, too, benefit from the dignity of being employed,” Edwards said.

Critics of work requirements tend to be Edwards‘ allies who say the restrictions can penalize poor people who may be unable to find employment and could lose life-saving health insurance.

Jeanie Donovan, with the Louisiana Budget Project, which advocates for low- to moderate-income families, said the requirements could add new state bureaucracy to check employment and put people at risk of losing coverage because of an administrative mistake. She said it would drive up health care costs elsewhere if people are bumped from their Medicaid coverage.

“While the idea of a work requirement may sound good to some, the reality is that it would take away health coverage, create more red tape and make it harder for many people who want to work to find employment,” Donovan wrote.

Details of what the Edwards administration is developing are scant.

Edwards said he wants the work requirements to include exceptions for people in school or training programs, and he suggested volunteering could take the place of work. The governor’s office didn’t say whether Edwards would seek legislative approval before submitting the request to federal officials.

While Edwards said Louisiana was “working with the same consulting firm that worked with Kentucky” on its waiver approved this month by federal officials, no contract has been signed.

Kennedy appears to be skeptical about whether Edwards is sincere about the proposal. The senator sent a letter Tuesday to Edwards, offering to set up a meeting with federal Medicaid administrator Seema Verma “to help expedite” the waiver request.

“Louisiana needs to have a proposal on the table well before Easter,” Kennedy wrote.

Edwards replied by saying he told Health Secretary Rebekah Gee last year to start developing requirements for work, education or training as “a key component to the successful expansion of Medicaid.” He said Gee already has a meeting scheduled with Verma.

“This requirement needs to be carefully considered and not just designed in a way to score political points,” Edwards wrote. “That is the course I will continue to pursue.”

___

EDITOR’S NOTE: Melinda Deslatte has covered Louisiana politics for The Associated Press since 2000. Follow her at http://twitter.com/melindadeslatte

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Utah’s Legislature plans to react to, and possibly kill, ballot initiatives to fund schools and expanding Medicaid

Utah technically has 104 legislators — 29 senators and 75 House members. But those elected officials are looking over their shoulders at ballot initiatives that may convert the state’s 1.5 million registered voters into the real lawmakers controlling this year’s agenda.

As the 2018 Legislature convenes Monday, leaders acknowledge they want to undercut two ballot initiatives: one that seeks to raise taxes for education by $715 million annually, and one to expand Medicaid fully for the poor.

They hope steps that would not go as far as the initiatives would will satisfy voters.

“I hope they see it and say, ‘Some good things are happening here,’” and that will dissuade them from passing the initiatives, said House Speaker Greg Hughes, R-Draper.

(Rick Egan | The Salt Lake Tribune) House Speaker Greg Hughes announces that he will not run for re-election next year, during a media conference in Midvale, Wednesday, January 10, 2018.

But House Democratic leader Brian King, who supports the ballot drives, says they result from legislators doing too little for too long.

“You have these initiatives crop up because people get so frustrated that the Legislature is not responding to their desires,” the Salt Lake City Democrat said. That’s important for us to take to heart at the Legislature” and may finally prod real action.

A raft of other topics high on this year’s agenda including fights over Utah’s new toughest-in-the-nation drunken driving law, tax reform, homelessness, air quality and restructuring the scandal-tainted Utah Transit Authority.

The session may also be spiced by a number of other debates: outlawing hand-held cellphone use while driving, cutting back on the number of days fireworks are allowed, maybe blocking state-paid health care for children of legal immigrants and even a bill to make the Utahraptor the official state dinosaur (and leave the Allosaurus as the state fossil).

Education/tax reform

Legislative leaders and Gov. Gary Herbert all say, as they do just about every year, that improving education is the state’s top priority. And extra pressure for that comes from the Our Schools Now initiative that would raise taxes for education by $715 million per year.

Herbert contends such a tax hike would hurt Utah’s economy, and essentially kill the golden goose of low taxes that attracts new industry, creates jobs and fuels what has been one of the nation’s strongest economies.

So Herbert and GOP leaders are planning to cobble together more education money through a mixture of state tax changes, use of a possible windfall from recent federal tax bill and taking advantage of extra revenue the state projects it will receive in next year’s budget.

With all that, “We can get close” to matching what the initiative would produce, Lt. Gov. Spencer Cox said last week.

Francisco Kjolseth | The Salt Lake Tribune Scott Anderson, President and CEO of Zions Bank speaks in support of Our Schools Now as they formally launch its tax increase initiative during a press event at the Capitol on Tuesday, June 6, 2017.

For example, the state estimates it will receive $382 million more in the coming year than previously expected in ongoing tax revenue. Herbert proposes to use 72 percent, or about $275 million, of that for education. Legislative leaders support using much of it for schools, but warn current laws may mandate spending a lot of it elsewhere.

Herbert has been pushing to remove earmarks that funnel some taxes for specific purposes, such as highways, to give policymakers greater discretion to fund other priorities, including schools. He also is angling to eliminate scores of tax exemptions for various industries that have accumulated through the decades.

Cox, last week, also called for taxing more online sales. Some large online retailers such as Amazon recently voluntarily agreed to collect such tax in Utah, “but much more could be done,” Cox said.

Senate President Wayne Niederhauser seeks another interesting tax reform: forcing highway users to cover more of the state’s transportation costs so the $600 million now coming annually from the state general fund to subsidize highways could be transferred to schools. Hughes endorses the idea.

Niederhauser, R-Sandy, supports increasing the gasoline tax as one method to do that. Also, he notes that electric and alternative-fuel vehicles now escape the gas tax entirely, and he backs proposals to raise their registration fees or charge a per-mile-traveled tax on them.

In this Tuesday, May 2, 2017, photo, a motorist prepares to select regular gas at a pump at a Chevron station in Miami. Gas prices are still quite low, historically speaking, and were fairly steady in 2017. But 2018 may be a bit more rocky, according to Tom Kloza, global head of energy analysis at the Oil Price Information Service. (AP Photo/Alan Diaz)

At the same time, Niederhauser has introduced a bill to make collection of electronic tolls easier. He said that could lead to a toll road in Little Cottonwood Canyon and maybe elsewhere.

Leaders are also looking at the recent federal tax bill as a way to funnel money to schools.

State income taxes are based on federal definitions. If the state makes no changes to its system, some estimate the federal reforms might generate an additional $75 million to $150 million, although most caution the state still is unsure of the amount.

“I think there is a windfall. We just don’t know how much yet,” Niederhauser said. It “will now allow [state] tax reform to move forward in some degree.

King, the House Democratic leader who says not enough has been done for education, agrees that legislative action on these fronts “would make it easier for the Legislature to go back to the people to say, ’Look don’t write us off so quickly … we are serious that when we get extra money, that [education] is where we are going to put it.”

GOP lawmakers are talking about some expansion of Medicaid, the federal-state program to provide health care for the poor, even though Republicans for years have voted down all but tiny expansions for the most vulnerable populations — such as homeless adults.

One reason is the initiative that calls for fully expanding Medicaid, which would cover up to 120,000 more Utahns who earn 138 percent of poverty level or less. Another reason is the Trump administration has signaled willingness to provide waivers for a less-than-full expansion that Utah lawmakers have long sought.

Hughes said the House had previously rejected expansion of Medicaid largely because it would need to be open-ended to cover anyone who qualified, making it hard to determine how much it would cost annually.

(Al Hartmann | The Salt Lake Tribune) Health care advocates Alan Ormsby, AARP, left, Karina Andelin Brown, a Logan resident, and Bishop Scott Hayashi, Episcopal diocese of Utah deliver a ballot initiative to fully expand Medicaid in Utah to the Lt. Governor’s office Monday Oct. 2. Utah has been trying to fully expand Medicaid for many years to no avail. Many advocates say this is a chance to finally make some real change.

Also, House members wanted to offer Medicaid only for those at 100 percent of the poverty level, and the Obama administration wanted expansion for those up to 138 percent of that level. The Affordable Care Act offers subsidized insurance to those between 100 percent and 138 percent of poverty already, said Hughes.

Senate Democratic leader Gene Davis of Salt Lake City said he will introduce a bill to seek full Medicaid expansion, not a watered-down version. He doubts it will pass, but says it will draw attention to what the initiative could do if lawmakers don’t act.

Other initiatives

Groups are gathering signatures for several other initiatives — such as allowing medical marijuana, using an independent commission to draw political boundaries to reduce gerrymandering and cementing into law a signature-gathering route to the primary ballot.

“My guess is we will have bills that will address them,” or at least some of them, Niederhauser said. Lawmakers prefer dealing with them rather than through initiatives, he added, “because it’s easier in the future to deal with any changes we need to make.”

An exception may be medical marijuana. He said lawmakers feel strongly that drugs “ought to be distributed through a pharmacy,” and “we’re concerned the federal government now is going to potentially enforce their law [banning marijuana] instead of overlooking it.”

However, Rep. Brad Daw, R-Orem, and Sen. Evan Vickers, R-Cedar City, a pharmacist, have introduced HB195, a bill to create a “right to try” cannabis-based treatment for terminally ill patients.

Homelessness

Hughes, the House speaker, said continued support of Operation Rio Grande — cleaning up crime in the area around the homeless shelter in downtown Salt Lake City, and getting aid to the homeless — will be a continuing focus.

He said its current $67 million budget will likely need to be boosted by a few million dollars.

“We will have some additional requests that will come from additional jurisdictions” for help as the homeless and some problems with crime have dispersed from the Rio Grande area. That will include some help with law enforcement, and some for facilities elsewhere.

(Steve Griffin | The Salt Lake Tribune) UHP Troopers make an arrest on 500 west as law enforcement officers from several agencies increase their presence in the Rio Grand homeless area in Salt Lake City Monday August 14, 2017.

Hughes wants to guard against a bandwagon effect in which groups may try to gain money for loosely related projects by arguing they are needed for Operation Rio Grande.

Davis, the Senate Democratic leader, said, “Have we cured homelessness? No. Have we put frustration into drug dealers? Yes. They are still selling, but they are frustrated. We are helping people.”

Drunken driving

Last year, legislators passed a law that will lower the blood-alcohol level to be considered drunk while driving from 0.08 to 0.05. It goes into effect on Dec. 30 and when it does, Utah will have the toughest DUI law in the nation. Groups have pushed for a repeal, saying it will hurt Utah tourism or possibly allow police to arrest some who have as little as one drink.

“There will be some minor tweaks to that, but it looks like that will be here to stay,” predicts Niederhauser. Hughes, who had opposed the bill for unintended consequences, isn’t so sure. “I can’t predict its fate.”

Rep. Norm Thurston, R-Provo, sponsor of the new law, introduced HB98 to make a minor change. His original bill banned “novice drivers” from having even a drop of alcohol before driving, which would affect older adults who obtain licenses later in life or immigrants who obtain licenses here. He wants to remove that provision.

FILE – In this Dec. 29, 2011 file photo, a car approaches a sobriety checkpoint set up along a busy street in Albuquerque, N.M. A prestigious scientific panel is recommending that states significantly lower their drunken driving thresholds as part of a blueprint to eliminate the “entirely preventable” 10,000 alcohol-impaired driving deaths in the United States each year. (AP Photo/Susan Montoya Bryan)

Just last week, the National Academies of Sciences, Engineering and Medicine called for all states to adopt a 0.05 level.

Still King, the House Democratic leader, said he expects to see bills to delay or repeal the law, or perhaps offer different penalties for driving at 0.05 or 0.08.

UTA/transportation

Legislative leaders expect debate and possible action on restructuring the Utah Transit Authority.

A legislative task force has recommended replacing its current board and CEO with a three-member commission appointed by the governor, similar to the State Tax Commission.

Hughes, a former UTA chairman, said the proposed change would install full-time commissioners who would “really have their eyes on what’s going on there, and be a little bit more directly accountable.”

(Francisco Kjolseth | The Salt Lake Tribune) People go about their day as the Salt Lake City Council, Salt Lake County, and the Utah Transit Authority gather on the North Temple Bridge/Guadalupe TRAX station in Salt Lake to announce Free Fare Friday to encourage greater use of transit during periods of poor air quality. On Friday, Dec. 22, no cash fares will be required on trains or buses in an effort to get infrequent or first-time riders to try out transit and use it more frequently.

He said that could restore enough trust that voters in Salt Lake and Utah counties may reconsider their 2015 defeat of Proposition 1 to raise sales taxes for transit and local roads. “We need to make sure that everyone is a good partner and can go to the public and win their confidence,” Hughes said. “We hope that change will help that.”

King also seems to be on board for a change at UTA.

“For 10 to 15 years, we’ve heard about scandals, self-dealing, compensation that is really quite high,” King said. “The facts suggest that something is wrong. I want to see something done there because UTA’s image suffers.”

The legislative task force also recommended a change to allow state highway funds to be shared with transit. Leaders say restructuring UTA would need to happen first to win support for that — but that highway funds going to some transit could help reduce congestion and pollution.

Air quality

Pollution always is a big issue early in legislative sessions when inversions hang in the Salt Lake Valley. The governor is proposing more money for better monitoring and research, which Democratic leader King praises.

“It sounds like a ‘nothingburger,’ but it really isn’t,” he said. “If we can get more money to study more effectively where the clean air problems exist and which neighborhoods they affect disproportionately, we can do a better job of directing solutions.”

He notes a few bills are coming, including possibly requiring emissions testing for diesel vehicles in Utah County and one to increase penalties for “rolling coal” vehicles that intentionally emit dark emissions.

Other legislation

Among proposals that have sparked early interest is HB64 by Rep. Carol Moss, D-Holladay, that seeks to fully outlaw using hand-held electronic devices while driving, but would permit using hands-free technology.

She notes that University of Utah studies have said cellphone use while driving is as dangerous as drunken driving. The expected debate on tougher drunken-driving laws might improve chances to finally pass the talking-while-driving ban, Moss said.

After fireworks-ignited blazes last year destroyed some homes, Rep. Jim Dunnigan, R-Taylorsville, is introducing HB38 to make it easier for cities to ban or control them — and cut back the number of days fireworks are allowed statewide.

Leah Hogsten | The Salt Lake Tribune Fireworks named Thrill Seeker, Bring It, Large and in Charge and You ‘Da Man can be purchased at the TNT Fireworks stand at 2700 S. State. Fireworks went on sale Wednesday, July 1, 2015.

Fireworks now can legally be set off for seven days around Independence and Pioneer days. The bill would cut that back to July 2 to July 5 and July 22 to July 25. It would also continue to allow fireworks around New Year’s Day.

Sen. Allen Christensen, R-North Ogden, created controversy with SB48 to require new legal immigrants to wait five years before they could receive Medicaid or Children’s Health Insurance Program coverage. It would strip coverage from about 475 immigrant children.

Christensen says he is proposing the measure to promote self-reliance and combat creeping socialism. Critics said it is a mean-spirited attack on immigrants, mostly Latinos.

And a literally big fight may have been avoided between whether the Utahraptor should replace Allosaurus as the state fossil. Sen. Curt Bramble, R-Provo, has rewritten SB43 to keep Allosaurus the official state fossil, but add Utahraptor as the official dinosaur to allow honoring both.

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Edwards proposing Medicaid idea championed by GOP

Gov. John Bel Edwards’ announcement that he intends to pursue work requirements for some Medicaid recipients in Louisiana seemed to catch Republicans who have championed the idea by surprise.

They want to make sure the Democratic governor follows through on the proposal they’ve pushed unsuccessfully — and that he doesn’t get all the credit.

Many question marks remain about what exactly Edwards wants to enact, what process he’ll use and how many low-income people would be impacted in Louisiana’s $12.5 billion Medicaid program. It’s unclear how long it will take the Edwards administration to develop something that could be submitted for federal approval.

In response to questions after a Jan. 8 speech, Edwards said his administration is “actively working” on the concept. It turned out to be a timely comment, coming days before President Donald Trump’s administration announced it will allow states to enact such work requirements for able-bodied, working-age Medicaid recipients.

The governor’s comment was unexpected. Edwards administration officials with the state health department previously expressed concern about similar suggestions, such as when Sen. Sharon Hewitt, a Slidell Republican, proposed the idea last year.

Hewitt is calling on Edwards to support her legislation.

“Providing citizens with additional education or training they need to secure a job can lift them out of poverty and onto a path to improved health outcomes,” Hewitt wrote in a newspaper letter.

Republican U.S. Sen. John Kennedy also has pushed work requirements for years. He’s called on Edwards to submit a waiver quickly.

In Louisiana, Medicaid covers 1.6 million people, one-third of the state population. That includes newborns, pregnant women, elderly nursing home residents, people with developmental disabilities and more than 450,000 working-age adults through the Medicaid expansion.

Any work requirements would fall mainly on the expansion population. Edwards said a majority of people receiving government-financed insurance through the expansion already have jobs. Others, he said, are in school, are sick or are caring for family members.

“For those who are not currently working but are able and eligible to work, we must find reasonable ways to ensure they, too, benefit from the dignity of being employed,” Edwards said.

Critics of work requirements tend to be Edwards’ allies who say the restrictions can penalize poor people who may be unable to find employment and could lose life-saving health insurance.

Jeanie Donovan, with the Louisiana Budget Project, which advocates for low- to moderate-income families, said the requirements could add new state bureaucracy to check employment and put people at risk of losing coverage because of an administrative mistake. She said it would drive up health care costs elsewhere if people are bumped from their Medicaid coverage.

“While the idea of a work requirement may sound good to some, the reality is that it would take away health coverage, create more red tape and make it harder for many people who want to work to find employment,” Donovan wrote.

Details of what the Edwards administration is developing are scant.

Edwards said he wants the work requirements to include exceptions for people in school or training programs, and he suggested volunteering could take the place of work. The governor’s office didn’t say whether Edwards would seek legislative approval before submitting the request to federal officials.

While Edwards said Louisiana was “working with the same consulting firm that worked with Kentucky” on its waiver approved this month by federal officials, no contract has been signed.

Kennedy appears to be skeptical about whether Edwards is sincere about the proposal. The senator sent a letter Tuesday to Edwards, offering to set up a meeting with federal Medicaid administrator Seema Verma “to help expedite” the waiver request.

“Louisiana needs to have a proposal on the table well before Easter,” Kennedy wrote.

Edwards replied by saying he told Health Secretary Rebekah Gee last year to start developing requirements for work, education or training as “a key component to the successful expansion of Medicaid.” He said Gee already has a meeting scheduled with Verma.

“This requirement needs to be carefully considered and not just designed in a way to score political points,” Edwards wrote. “That is the course I will continue to pursue.”

___

EDITOR’S NOTE: Melinda Deslatte has covered Louisiana politics for The Associated Press since 2000. Follow her at http://twitter.com/melindadeslatte

An AP News Analysis

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Analysis: Edwards proposing Medicaid idea championed by GOP

Gov. John Bel Edwards’ announcement that he intends to pursue work requirements for some Medicaid recipients in Louisiana seemed to catch Republicans who have championed the idea by surprise.

They want to make sure the Democratic governor follows through on the proposal they’ve pushed unsuccessfully — and that he doesn’t get all the credit.

Many question marks remain about what exactly Edwards wants to enact, what process he’ll use and how many low-income people would be impacted in Louisiana’s $12.5 billion Medicaid program. It’s unclear how long it will take the Edwards administration to develop something that could be submitted for federal approval.

In response to questions after a Jan. 8 speech, Edwards said his administration is “actively working” on the concept. It turned out to be a timely comment, coming days before President Donald Trump’s administration announced it will allow states to enact such work requirements for able-bodied, working-age Medicaid recipients.

The governor’s comment was unexpected. Edwards administration officials with the state health department previously expressed concern about similar suggestions, such as when Sen. Sharon Hewitt, a Slidell Republican, proposed the idea last year.

Hewitt is calling on Edwards to support her legislation.

“Providing citizens with additional education or training they need to secure a job can lift them out of poverty and onto a path to improved health outcomes,” Hewitt wrote in a newspaper letter.

Republican U.S. Sen. John Kennedy also has pushed work requirements for years. He’s called on Edwards to submit a waiver quickly.

In Louisiana, Medicaid covers 1.6 million people, one-third of the state population. That includes newborns, pregnant women, elderly nursing home residents, people with developmental disabilities and more than 450,000 working-age adults through the Medicaid expansion.

Any work requirements would fall mainly on the expansion population. Edwards said a majority of people receiving government-financed insurance through the expansion already have jobs. Others, he said, are in school, are sick or are caring for family members.

“For those who are not currently working but are able and eligible to work, we must find reasonable ways to ensure they, too, benefit from the dignity of being employed,” Edwards said.

Critics of work requirements tend to be Edwards’ allies who say the restrictions can penalize poor people who may be unable to find employment and could lose life-saving health insurance.

Jeanie Donovan, with the Louisiana Budget Project, which advocates for low- to moderate-income families, said the requirements could add new state bureaucracy to check employment and put people at risk of losing coverage because of an administrative mistake. She said it would drive up health care costs elsewhere if people are bumped from their Medicaid coverage.

“While the idea of a work requirement may sound good to some, the reality is that it would take away health coverage, create more red tape and make it harder for many people who want to work to find employment,” Donovan wrote.

Details of what the Edwards administration is developing are scant.

Edwards said he wants the work requirements to include exceptions for people in school or training programs, and he suggested volunteering could take the place of work. The governor’s office didn’t say whether Edwards would seek legislative approval before submitting the request to federal officials.

While Edwards said Louisiana was “working with the same consulting firm that worked with Kentucky” on its waiver approved this month by federal officials, no contract has been signed.

Kennedy appears to be skeptical about whether Edwards is sincere about the proposal. The senator sent a letter Tuesday to Edwards, offering to set up a meeting with federal Medicaid administrator Seema Verma “to help expedite” the waiver request.

“Louisiana needs to have a proposal on the table well before Easter,” Kennedy wrote.

Edwards replied by saying he told Health Secretary Rebekah Gee last year to start developing requirements for work, education or training as “a key component to the successful expansion of Medicaid.” He said Gee already has a meeting scheduled with Verma.

“This requirement needs to be carefully considered and not just designed in a way to score political points,” Edwards wrote. “That is the course I will continue to pursue.”

___

EDITOR’S NOTE: Melinda Deslatte has covered Louisiana politics for The Associated Press since 2000. Follow her at http://twitter.com/melindadeslatte

An AP News Analysis

Go to Source