Danica Jones

Prof. Jorgensen
ENGL 1010
October 26, 2014
Ending the Medicaid Gap
Utah Filmmaker Paul Gibbs recently made a film about healthcare in Utah, and one of the
stories Paul researched was that of Emily Young. Emily was 43 year old woman with breast
cancer who lost her job and did not qualify for Medicaid. I say was because she has since died
from her illness. Gibbs says that one of the saddest things about Emilys story is that even her
doctor will tell you that her cancer was treatable but because she is one of those that are in the
Utah Medicaid gap, she died without receiving the treatment she needed. According to Gibbs,
Tens of thousands of Utahns who fall within the Medicaid Gap are losing their health or their
lives to the delay on expanding Medicaid, a delay which is occurring purely because of the
ideological stubbornness and willful ignorance of the Utah State legislature, who consistently
avoid opportunities to hear from the people in the gap and learn who they are and what they
need. Utahs decision not to expand Medicaid is a decision hurting, and in some cases, killing
low income employed Utahns.
In March of 2010 Congress passed the Patient Protection and Affordable Care Act (ACA)
after an arduous and mostly partisan battle. The legislation had first been introduced in
November 2009 and proposed to make health insurance a requirement for all American citizens.
In order to do this several issues needed to be addressed, primarily, how low-income people
would pay for the required health care. The two health insurance programs already in place for
low-income Americans are Medicare and Medicaid. Medicare is specifically for American
citizens over the age of 65, while Medicaid is a program for Americans under the age of 65

where eligibility is based on their income and household size. One of the major elements to
PPACA was that Medicaid would expand the eligibility to cover more citizens to ensure that
health insurance was attainable for all. Since ACA was signed into law there have been many
court cases involving states who felt that their rights to govern locally were being hindered by
some aspects of the new law. When one of those cases (NFIB v. Sebelius) reached the Supreme
Court, the ruling was made that individual states could not be forced to participate in Medicaid
expansion. Utah has chosen to be one of the 23 states that has opted out of the Medicaid
expansion.
There is a commonly held misconception when it comes to Medicaid, the general
assumption is that people who are on Medicaid are lazy or unemployed. While it is true that
Medicaid can cover citizens who are unemployed, a 2014 University of Utah study found that
64.8% of the 103,124 Utahns who would be eligible for insurance under the Medicaid expansion
are full or part time employed. (Waitzman, N.J. Exhibit 6, 8) Also of those who would benefit,
another 26.3% are not in the workforce because of disability, retirement, school, or taking care of
family. Utahs governor Gary Herbert said this in his reaction to the [proposed] Medicaid
expansion, In Utah, Medicaid consumes 21.5% of our budget, nearly double what it was a
decade ago, encroaching on critical education funding and elbowing out social service,
transportation and corrections needs. What Governor Herbert neglects to mention is that under
the current Medicaid program the state pays 30% of the funds needed for Utahns on Medicaid
while the other 70% is covered under by the federal government. Furthermore, if Utah agrees to
a Medicaid expansion the federal government would pay 100% of the funding needed for
Medicaid until 2016 when Utah would gradually reacquire Medicaid costs that would cap at
10%. (Families USA)

Utahs citizens are paying for the partisan paranoia which has kept the state from
expanding Medicaid to citizens who need it. I spoke with filmmaker Paul Gibbs about his
documentary, Entitled to Life, which documents the stories of Utahns who would benefit from
a Medicaid expansion. Six years ago Paul needed to have both of his kidneys removed after
being diagnosed with end stage kidney failure; he required two expensive surgeries, and through
Medicaid he was able to pay for the surgeries that saved his life. He decided to make his
documentary after attending a legislative session at the state capitol where citizens were
testifying about how Medicaid expansion would benefit them. Gibbs felt after leaving the session
that the legislators didnt seem to care or really understand the stakes and he felt compelled to
make his film. In the time since his film has been available, health advocacy groups in other
states have taken notice and Gibbs has been hired to make similar documentaries in both Florida
and North Carolina.
One of the arguments that many states, including Utah, make against expanding Medicaid
is that the additional cost would be too much for taxpayers to handle. Governor Herbert said,
My job as governor is to make sure Utahns get the full economic benefit from their taxes, I am
not recommending an expansion of the federal Medicaid program. What possible disadvantage
could there be for state governments to gain a healthier populace? However as stated before, the
federal government would pay 100% of the Medicaid costs until 2016 when Utah would still be
paying 20% less of Medicaid costs than they do currently. In a nonpartisan study done by the
Public Consulting Group of Boston, they determined that without Medicaid expansion the ten
year average cost to Utah taxpayers for health insurance would be over $2 billion dollars.
Similarly if Utah were to expand Medicaid, in the same ten year period Utah taxpayers would
pay only $11 million dollars from their taxes in healthcare costs. Costs will continue to be an

increasing burden on taxpayers if low-income earners are left without viable ways to pay for
insurance.
One positive aspect to the Medicaid expansion, besides healthier citizens, would be the
jobs that it would create in the state of Utah. Utahs unemployment rate as of September 2014
was 3.5%. The Salt Lake Tribune reported that if Utah had expanded Medicaid at the beginning
of 2014, the state would have gained 2,264 new jobs and added more than $135 million dollars
to the gross state product. (Salt Lake Tribune) Too much of the argument against Medicaid
expansion has focused on the politics of the party that introduced the law and a misperception
that the federal government is trying to interfere with states rights. Instead the focus should be
on the benefits that a Medicaid expansion would have for both the citizens and economy of Utah.
Is there legitimacy to the claims that expanding Medicaid will increase taxes and take
money from programs that are already struggling like public education? According to research
done by independent organizations like the Public Consulting Group of Boston, the effect of a
Medicaid expansion on individual taxes is minor compared to the expense of covering those who
would remain uninsured. Is the expansion, as its critics say, just another unnecessary entitlement
program that allows citizens to receive government help without making an effort to help
themselves? Its true that there are always people who will work the system to their benefit. But
according to a 2013 study of U.S. Bankruptcy Courts and statistics from the CDC, Nerd Wallet
found that 57% of bankruptcies in the United States are a result of medical expenses. Nerd
Wallet also estimated that in 2014 alone, 10 million Americans with year-round insurance will
have medical costs that they are unable to pay. How many of those 10 million people are Utahns
that could benefit from a Medicaid expansion?

To his credit, Governor Herbert has made an effort to find another solution for the Utahns
who are unable to afford health insurance but dont qualify for subsidies or Medicaid. What
Herbert is now facing is opposition from within the Utah Legislature for his alternative plan,
called Healthy Utah, which proposes to use funds that would have been used for a Medicaid
expansion to partially cover uninsured Utahns. The argument that Republicans make about
entitlement programs is that it encourages the unemployed to stay unemployed and makes
working Americans pay for the inadequacies of the poor. But what is clear if we examine the
facts is that the majority of people who would benefit are not unemployed, but hard working
citizens. Employment does not guarantee financial stability any more than avoiding the sun
guarantees you are immune to skin cancer.
Consider the following scenario: a 33 year old woman is working 30 hours a week and
taking 15 credit hours at the local community college. She has not had consistent medical
insurance since being removed from her parents insurance at the age of 26. Prior to ACA she
was denied insurance for a preexisting medical condition that required her to take prescription
medication on a daily basis. Because she was uninsured the pharmacy would match the lowest
prescription price available, a mere $10 a month. She was gainfully employed at a local Utah
company until the economic collapse of 2008 after which she was laid off from her job. In order
to pay her bills and be a responsible citizen she was forced to take a low wage part time job
because there were no full time jobs available to her. Now imagine that with PPACA she was
told that her low income qualified her to receive health care that she had been unable to afford
for the last seven years.
When the deadline came in April 2014 for getting health insurance, I was told by the
federal government that I dont currently qualify for any of the subsidies offered because my

income was too low and that I should qualify for Medicaid. I was warned, however, that
according to Utah, I do not qualify for Medicaid because my income is too high. At the time
the school district I worked for did not offer health insurance unless you worked more than 30
hours a week and we were warned explicitly in writing not to exceed 29 hours of work a week or
we would be terminated. Many of the previously 30 hour positions were changed to instead be
done by one person working 19 hours a week and another person working 11 hours a week
instead of 1 full time person. This was done so that the school district could keep employees
under 29 hours and avoid the additional cost of providing health insurance.
I have not been to a medical doctor in over 7 years because I have not been able to afford
health insurance. The only doctors I have seen on a regular basis is the optometrist and my
psychiatrist once a year so that he can refill my prescription. I have been counseled by my
optometrist not to wear contacts anymore because he was able to see from my last exam that I
have inflamed optic nerves resulting from excess fluid around my brain, a condition for which I
am unable to seek treatment for because of my insurance status. Because I am uninsured I must
pay $95 for my 15 minute visit with my psychiatrist. Health costs have skyrocketed
As my own personal experience shows, a Medicaid expansion is not something that
would only benefit the unemployed. Medicaid is a program that can help thousands of uninsured
Utahns have the security of health insurance. The decision made by Utah governor Gary Herbert
and Utah Legislators is having a real effect on real people. An expansion of Medicaid would not
only benefit the unemployed but those that are underemployed. Americans, and Utahns in
particular, can only benefit from a healthier populace and the best way to accomplish that is to
give everyone access to the benefits that until now were accessible to only those with the means.

Works Cited

Bureau of Labor Statistics. (2014) Economy At A Glance: Utah. Web.

http://www.bls.gov/eag/eag.ut.htm
Families USA Closing the Coverage Gap in Utah: Health Insurance for Working Individuals
and Families Web.

Gary Herbert on Medicaid Waiver (2013) www.garyherbert.com/issues/medicaid-waiver/

Gibbs, Paul. Personal Interview. November 9, 2014.

Gibbs, Paul. "Entitled to Life" Online video clip. YouTube. YouTube, 3 Jun. 2014. Web. 9 Sept.
2014.

"Eligibility | Medicaid.gov." Eligibility | Medicaid.gov. Web. 12 Sept. 2014.

Nat. Fedn. of Indep. Business v. Sebelius, 132 S. Ct. 2566, 567 U.S. 1, 183 L. Ed. 2d 450 (2012).
Social Security Administration 2014. Social Security: Medicare Web. 23 Oct. 2014.

"NerdWallet Health Finds Medical Bankruptcy Accounts for Majority of Personal Bankruptcies Health." Health. Web. 1 Dec. 2014.

State of Utah Medicaid Expansion Assessment: Impact Analysis 2014-2023. Public Consulting
Group, Inc.

Stewart, Kristen. "Utahns in the Medicaid gap are working; heres where." Salt Lake Tribune
21 May 2014. Print.

Utah Governor Gary Herbert. (2014) Web. February 27, 2014 www.utah.gov
Waitzman, J.N. Who Would Be Newly Eligible for Coverage Under the Healthy Utah Plan, or
Full Medicaid Expansion Health Society and Policy Program