Utah Providers: Too Much of Medicaid Tax Falls on Us

Medical providers who are lining up in opposition to a proposed tax plan to pay cover both Medicaid expansion—and the costs that would come when the federal government asks states to pay a share—say they recognize the need.

But if everyone benefits, they say, shouldn’t more people pay?

That’s the message that Governor Gary Herbert and legislative leaders are hearing as Utah weighs a schedule that would target hospitals, doctors nurses, pharmacies, podiatrists and other in an effort to raise $35 million starting in 2017, the year that the states start paying a share of Medicaid expansion under the Affordable Care Act.

Utah has yet to expand coverage to those in the Medicaid “gap,” who earn between 100% and 138% of the federal poverty level, but it’s discussed doing so for some time. The current proposal would add a total of 95,000 state residents to Medicaid, including these gap households, under a plan called UtahAccess.

Hospitals are the one group that has come forward with concrete proposals to find funding to make the plan work and get federal dollars flowing to Utah. That’s been true in other states where expansion has stalled and hospitals are the ones feeling the pain on their bottom lines, as they must care for all who come to the emergency room, regardless of ability to pay. Meanwhile, because the ACA envisioned universal expansion, it has slowly scaled back payments to states and facilities for treating the uninsured and underinsured.

Under the proposal, hospitals would provide $25 million of the total by 2020. There’s been talk of taxing e-cigarettes and restoring a state tax on food, but the current plan is the one under active discussion.

Terry Smith, DPM, a former president of the state’s podiatrists’ association, told KSL.com he didn’t think his group should pay when he already loses money on Medicaid patients. (Smith would be assessed about $600 in 2017). Podiatrists are important in Medicaid, because enrollees are more likely to have diabetes and have to have regular foot checks.

"To tax us again is essentially a double tax," said Smith, who said it’s only fair to include more Utahns in the pool of people paying a tax to give health coverage to all.

“There's no question they need the care," he said. "It seems odd to target a particular group."

Herbert has not signed off on the plan, which is being driven by legislators. His proposal for Healthy Utah was rejected earlier this year. A key difference was that it was paid for entirely with state funds.