A graph from the Utah Department of Health shows that among uninsured populations, the Southeastern Utah District Health Department, of which Grand County is a part, has a percentage of uninsured persons at nearly 20 percent. [Image courtesy of the Utah Department of Health]

Among several propositions on the Utah voter’s ballot this November is Proposition 3, a citizen initiative to expand Utah Medicaid services under the Affordable Care Act.

A change in Medicaid eligibility would have a particular impact on Grand County. According to the Utah Department of Health, the Southeastern Utah District has one of the highest percentages of uninsured people in the state, at 18.8 percent. The state recognizes this as a problem — the department’s Public Health Indicator Based Information System (IBIS) says on its web page:

“Most people need medical care at some time in their lives. Medical care is often quite expensive and is becoming more expensive… Persons with health insurance are more likely than persons without health insurance to have a regular source of primary health care and to have routine preventive care. Persons without coverage often have delays seeking needed care and find services difficult to afford.”

The federal Affordable Care Act (ACA) of 2010 outlined a plan to expand Medicaid services to a larger population — however, a 2012 U.S. Supreme Court ruling made state participation in the expansion program optional. Utah was one of 17 states that chose not to expand.

In the 2018 Utah State Legislature’s session, state lawmakers addressed the problem of uninsured Utahns by passing House Bill 472, which would expand the state Medicaid program with certain provisions.

The plan depends on federal funding, and will not go into effect without federal approval. It has been submitted for review to the Center for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services.

Under the bill, Medicaid services would be extended to individuals making below 95 percent of the federal poverty level, and would require able-bodied adults to hold a job, or be in training for work or volunteering, to be eligible for benefits. It also contains a spending cap — enrollment would close if the Utah Department of Health had insufficient funds to provide services to additional individuals.

In contrast, the Affordable Care Act expansion would open Medicaid benefits to people making 138 percent or less than the federal poverty level, and carries no work requirements. There is no stipulation for closing enrollment for lack of funds. In the ACA model, the federal government funds approximately 90 percent of the expanded program, and the state pays the rest.

Federal approval of House Bill 472 is still pending. Meanwhile, an activist group called Utah Decides Healthcare has collected enough signatures to put Proposition 3 on the 2018 Utah ballot.

Proposition 3 asks citizens to vote “yes” or “no” on a law that would expand Medicaid coverage to low-income adults in compliance with the ACA standards, maintain existing Medicaid programs, including the Children’s Health Insurance Program (CHIP), and increase the state sales tax rate by 0.15 percent to fund the state’s share of the expansion. This would bump the current sales tax rate of 4.7 percent to 4.85 percent on non-grocery items.


Community health care providers have not been passively waiting for lawmakers to draft solutions for people who struggle with affording health care.

Among current options for uninsured people who need medical services are facilities like the Moab Free Health Clinic. The clinic is a nonprofit funded by grants and donations and staffed by medical providers who volunteer their time. In their 2016 annual report, the Moab Free Health Clinic documented serving 2,070 patients, mostly in school-based therapy appointments and primary care visits.

The report also said that 82 percent of patients at the clinic in 2016 had no health insurance, and the remaining 18 percent had catastrophic or high-deductible plans.

Doug Caylor, an employee at the Moab Free Health Clinic, worked with Utah Decides Healthcare on the Proposition 3 initiative.

“Currently, 100 percent of our patients are uninsured,” Caylor said of the clinic. “There’s always going to be a need, but Medicaid expansion would allow our limited dollars to go further and help more patients in the Moab area.”

Moab Regional Hospital (MRH) also serves patients without traditional health insurance plans. Laurie Peter, the marketing and communications specialist at the hospital, estimates that around 25 percent of patients are uninsured, under-insured or covered by Medicaid. MRH has created an initiative to help pay medical costs for those who can’t afford them.

“Access to care is one of the most important health topics that’s been identified in our community,” Peter said. “As a hospital, we feel that everyone that needs care should have access to it. If [patients] don’t qualify for Medicaid, but they can’t afford to pay 100 percent, we have a sliding scale so you pay what you can afford — but you have to qualify for it. We’ve developed that internally — it’s the program that we’ve developed based on the needs of the community.”

The hospital is also able to give a 39-percent discount on medical services for payments made on the day of treatment, and an additional 20-percent discount for payments made in cash.

“Most individuals who are seeking care are in that 75 percent where they have coverage,” Peter acknowledged. “This is really getting the word out to those who feel like they can’t afford to come see the doctor.”

In its 2017 Community Benefits report, MRH said that 2,300 patients received financial assistance at a cost of $2.8 million, including uninsured charity care and uncompensated care.

Opponents of Proposition 3 express concerns that accepting federal funding will mean that the state of Utah has little or no control over how Medicaid programs are implemented. They also foresee difficulties in balancing the state budget while continuing to fund expanded Medicaid. Republican Utah House of Representatives member Robert Spendlove, who sponsored Utah House Bill 472, submitted an official argument opposing Proposition 3. It reads, in part:

“Before we raise taxes and spend more on working age, able-bodied adults, we should first clear out the waiting list of 2,900 disabled Utahns who currently don’t have access to home and community-based care.

“With this full ‘Obamacare’ expansion, the state loses the ability to change or modify the program, as the federal government has complete control and will force compliance. We would have no ability to limit enrollment or implement cost controls to protect Utah taxpayers, who would be forced to pay an ever-growing bill.

“Greater access to health care for those in need has already been achieved through careful study and consideration. The state, through legislation, has extended Medicaid to the poor and needy in a responsible way that will help people move from poverty to self-reliance, with no new state money. It also allows us to make adjustments to coverage to keep the program from growing to an unsustainable level… We already have a responsible, compassionate Utah solution to care for our most vulnerable. This initiative goes too far.”

The official argument in favor of Proposition 3 was submitted by a group of advocates, including Alan Ormsby, Utah state director of the American Association of Retired Persons, Republican Rep. Ray Ward of District 19 and Bishop Scott Hayashi of the Episcopal Diocese of Utah. The argument reads, in part:

“Proposition 3 provides access to health care for more than 150,000 Utahns and brings nearly $800 million in federal funding back to our state every year from Washington, D.C. — money that is already set aside for Utah … Proposition 3 creates nearly 14,000 new jobs and generates $1.7 billion in new economic activity for our state.

“Medicaid expansion is a good deal for Utah and helps provide life-saving health care to Utahns who earn less than $17,000 a year, including parents and people with chronic illnesses who are often forced to choose between putting food on the table and getting treatments for diseases like cancer or diabetes.

“Proposition 3 was also crafted to ensure that hardworking Utahns who earn a promotion or take on more hours to get ahead won’t have their health care taken away. With this initiative, Medicaid covers working Utahns as they pull themselves out of poverty, and it rewards hard work — instead of punishing it by cutting off somebody’s health care.

“The Utah Governor’s Office of Management and Budget concluded that this program would be fiscally sound. It enables Utah taxpayers to expand health care access while promoting individual responsibility and smart use of public monies.”

Vote-by-mail ballots have been sent to registered voters in Utah, and the ballot drop-box is open in the Grand County Clerk’s office.

Citizens can send in their opinions on Proposition 3 and other issues.

RyLee Curtis is the campaign manager for Utah Decides Healthcare, and she encourages people to take the time to cast their ballots.

“This is a unique year for Utah voters, with several initiatives before you,” she said. “No matter how you vote, it’s important that you vote.”

This article was updated on Nov. 7 to reflect that Doug Caylor is an employee of the Moab Free Health Clinic but was not the clinic’s executive director up until February 2017 as the article previously stated. Caylor will become the clinic’s executive director in January 2019, according to the Moab Free Health Clinic Board. 

Southeastern Utah has one of the highest percentage of uninsured people in the state

“Access to care is one of the most important health topics that’s been identified in our community. As a hospital, we feel that everyone that needs care should have access to it.”