Two years ago my state representative Greg Hughes held a town hall meeting where he promised his constituents Utah's poor would have better health care access under a Republican president. We now have a Republican president. Speaker Hughes has found that he can't get his special waiver for a capped Medicaid expansion because the person who needs authorize it resigned, the day after meeting with him.

Representative Hughes also argued that the need for Medicaid expansion isn't as drastic as liberals claim because many of those people who were with out coverage could be covered by the exchanges. That is no longer true. All subsidizes for health care to Utahns will be canceled. Representative Hughes has failed to fulfill his promises to his constituents.

When Utah passed criminal justice reform it was done with the expectation that Medicaid expansion would happen. Rather than putting drug addicts in jail we were going to put them in treatment programs. The funding for the treatment programs was going to come from Medicaid. Utah has moved forward with Operation Rio Grande, but with out the funding to place addicts where they need to be. We need this funding for the ill, both physically and mentally.

What can we do now?

1. Create a Utah based health care exchange rather than relying on the federal government. This will restore subsidies to those purchasing plans through the Utah exchange.
2. Accept full Medicaid expansion. Hughes had his chance to implement a customized Utah plan two years ago and he refused. Due to Trump's in ability to staff a cabinet, Utah can not get a waiver. It is time to accept full expansion.

What can we do in the future?

During our debate three years ago Representative Hughes stated that employer based health care is the best system. I disagree, but I'm not sold on single payer either. I believe we should be working to move to a market based system where most individuals and families are purchasing the plan that works best for them. I think the ACA was a step in the right direction, but it's time to update it.

The Republican efforts to force people with chronic health issues on to specific government ran program is a step in the wrong direction. We need to be moving more people on to the exchanges, not off. We need to eliminate the employer mandate. We need a plan to gradually move people off of employer plans and on to plans they have selected themselves. We also need to guarantee subsidies to those us the federal exchange.

Some people will argue that the minimum requirements for plans on the exchanges prevent it from being a true market system. Regulation and minimum requirement exists in many of the markets we participate in. If you go out to eat much of the food has been inspected by federal regulators before it was shipped out of the processing facility. The kitchen is routinely inspected by the county government. The employees have received training from the county. These are basic minimum requirements for food that is served in a restaurant, yet there is still a strong market based system for restaurants. Are the minimum requirements for health care plans on the exchanges too high? Maybe, but that’s a separate argument and shouldn’t stop you from supporting the exchanges.

I support the continuation of government care for the poor and elderly(Medicaid and Medicare respectively). I think it is important to maintain a market based component because I believe it will help us better set price and care levels. Those who are able to work and purchase health care plans will drive the care the plans provide in a traditional market sense. Government plans can then use those prices to assess what the price levels and care should be for their plans. This will help prevent starve the beast type approaches to killing the entire system(keep taking money from the program until it stops working, this is the approach being taken to education in Utah, this is why we will soon have teachers shortages).

Speaker Hughes failed to deliver the Medicaid expansion he promised. People are hurting because of this failure. It’s time we move forward and do the right thing with health care and embrace the hybrid exchange system. Please contact your state official and let them know it's time to embrace full Medicaid expansion and the Utah Health Care Exchange.