These are just some of the questions floating around Utah’s Capitol Hill in response to voters passing a measure last November that makes full Medicaid expansion under Obamacare the law.
These are indeed important questions. But let’s not kid ourselves. They’re also just the latest manifestation of a rule of thumb that has brooded over Utah since the turn of the 20th century.
It’s a simple one to understand. Voters like having the power to write laws from time to time through petitions and initiatives. Lawmakers hate it.
As Sen. Don Ipson, R-St. George, reminded reporters at the Senate’s daily briefing Tuesday, Utah is a republic, not a democracy. People elect representatives to take the time to study issues, make important decisions and to pass a budget that reflects all the state’s many needs and obligations.
Which works fine until voters get the impression their representatives are, for whatever reason, continually ignoring something they want. The 53 percent who voted to extend Medicaid to people earning 138 percent of the poverty level has put this will-of-the-people gap into the spotlight at the moment.
It also has brought back even more age-old questions that won’t go away, such as:
Just how closely do voters really read initiatives? How well do they understand them in the context of the entirety of state government? Does the will of the people include every word and comma in an initiative, or just the general concept?
The Medicaid initiative, Proposition 3, called for a sales tax increase of 0.15 percent. Is that the exact amount, nothing more or less, voters would tolerate? Or were they just generally in favor of expanding Medicaid and raising taxes to do it?
When I asked Sen. Dan Hemmert, the majority whip, what he heard voters saying, he said it was exactly what the initiative said — 0.15 percent, and no more, in order to give more people Medicaid.
But then, realistically, what else could he say? Deviate from the letter of an initiative and you are merely speculating.
It’s just that a lot of lawmakers believe 0.15 percent won’t cut it. That’s why a bill that would impose limits on Proposition 3 (and also add a $15 million hospital tax) is quickly advancing through the Legislature.
And it’s why people are protesting.
Lawmakers have some good reasons to be concerned, other than their dislike of laws written by voters. A recent report from the non-partisan Government Accounting Office predicts states will have a hard time keeping up with growing costs over the next 50 years, and the biggest culprit will be health care.
As people age and health care costs rise, “Medicaid expenditures are expected to rise, on average, by 1 percentage point more than GDP each year,” the report said.
Senate President Stuart Adams puts it this way: “Our No. 1 priority is … trying to make sure whatever we do is sustainable. We don’t have the ability to print money, so we have to either take away from another program or we have to live with the program we’re working with.”
Hemmert added the observation that Question 1 on the ballot, which said up front it wanted to raise gasoline taxes to fund education, failed miserably, while Proposition 3, which mentioned the sales tax hike in the middle of the text, passed.
“I do think the way they (initiatives) are presented and making sure they are transparent in the way they are presented is important,” he said.
One hundred and nineteen years ago, Utah voters amended the state constitution to allow for citizen initiatives, making this only the second state to do so. Lawmakers at the time were so impressed it took them another 16 years to pass a law defining how the process was the work. Then it took the state Supreme Court, over many years, to nudge them to make the process something voters actually could use.
Little has changed, apparently.
Expect some sort of bill this year trying to tweak the initiative process once again to make it fit some definition of fiscally responsible. The battle over an age-old rule of thumb continues.