Utah passed sweeping changes to a voter-approved Medicaid expansion Monday, cutting the number of people covered nearly in half and adding work requirements that the Trump administration is expected to approve.
Republican Gov. Gary Herbert signed the plan hours after it cleared a final vote in the Republican-led Legislature, calling it both "humane and sustainable."
It's drawn vocal protest from advocates who say the changes go further than any of the four other conservative-leaning states where voters expanded Medicaid after state lawmakers refused.
"This is a dark day for democracy in Utah," said Andrew Roberts, a spokesman for the group Utah Decides. "State legislators turned their backs on voters and on families in need."
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Lawmakers' plan would extend Medicaid coverage to an additional 80,000 people, just over half of those that would have been covered under the ballot measure that voters passed in November, Republican Sen. Dan Hemmert said.
An additional 70,000 people can instead buy heavily subsidized insurance on the federal health care marketplace created under President Barack Obama's health care law, he said.
"I think we are doing the long-term responsible thing," said Republican Sen. Allen Christensen, who sponsored the changes that easily passed the GOP-dominated Legislature, largely along party lines.
He said changes are needed to control future costs. Voters also approved a sales tax increase to pay for the expansion, but a subsequent state analysis found it would fall $10 million short by 2021.
Advocates argue there's plenty of money to roll out the program, and if it falls short, adjustments could be made in the future.
The ballot measure would have fully expanded Medicaid to about 150,000 people making less than $17,000 a year.
The legislation scales that back to people earning just over $12,000 a year and adds spending caps and work requirements. Utah's plan hinges on waivers from the federal government to scale back the expansion, add work requirements and make other changes. It also includes millions of dollars to keep an April 1 rollout date.
Lawmakers say they have been assured the Trump administration will approve the waivers, but if they fall through, the measure would revert back to much of what the voters originally approved.
Utah's move stands out among the four conservative-leaning states where voters have passed Medicaid expansion through the ballot box, according to The Fairness Project, a group that's supported all four proposals.
In Maine, the former Republican governor initially blocked the effort, but it's now being implemented, executive director Jonathan Schleifer said.
Two other Republican-leaning states also passed similar expansions in November. The rollout appears on track in Nebraska, while Idaho lawmakers are considering legislation that would end the expansion if the federal government changes how much it pays for the program.
In Utah, the changes leave people like Christie Sorensen, 28, without access to Medicaid. She can't work full time because she's still recovering from a grueling bout with cancer, but her part-time income is just above the poverty line, about $13,000.
She has to forgo tests, oxygen and drugs recommended by her doctors because she can't afford them. She's shopped the federal marketplace, but with her medical needs and meager income, health care is out of reach even with subsidies.
"Here I am, trying to make some money a month to support myself, and I'm punished for it," said Sorensen, who also volunteers with American Cancer Society Action Network. "I just feel forgotten."