Gov. Gary Herbert's Medicaid plan faces a make-or-break vote in the state Senate this week, possibly as early as Tuesday.
The Republican governor's plan is an alternative to expanding the state-federal program as envisioned under President Barack Obama's health care law.
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After months of negotiating with federal officials, Herbert came away with an agreement to enroll thousands of poor Utah residents in private health plans and require them to help pay costs.
It mirrors similar proposals from other Republican governors pushing for a way to expand health coverage under the federal law while keeping it palatable to their right-leaning Legislatures.
This week, Utah's GOP-controlled Senate will have to square Herbert's plan with a competing proposal from Ogden Republican Sen. Allen Christensen.
Christensen's bill, also scheduled for debate this week, would cost the state less and cover fewer people, but leave millions of federal dollars on the table. A similar plan is pending in Utah's House.
If the governor's office can usher Herbert's plan through the Legislature, it will return to the U.S. Department of Health and Human Services for final approval and then get the program up and running.
To allay lawmaker concerns about the state's ability to fund Herbert's plan, the governor's office announced last week that it was scaling back the three-year program to run for two years.
Lt. Gov. Spencer Cox, the governor's key broker with lawmakers on the issue, said the pared-back plan allows the state to pay for the program without raising taxes.
Cox said the two-year program will give the state time to study what's working, and by 2017, a new administration will be in the White House that could offer different options to the states.
Herbert's plan includes plenty of other elements designed to appeal to Utah's GOP-dominated Legislature.
Participants pay some of their costs and can be enrolled in a job search and job training program.
Last year, several Republican lawmakers said they wouldn't support the plan without the ability to revoke coverage for unemployed people who refuse to get a job.
Herbert originally sought a work requirement for participants, but the Obama administration would not approve the idea. Instead, Utah can automatically enroll people in the job program as long as it lets them opt out penalty-free.
To make up for the watered-down deal, Herbert's office has said the state might consider cutting state-controlled benefits to those who refuse to participate in the job program, including taking away their driver's licenses.
"It was brought up as an option several months ago, and it hasn't gone anywhere from there," Cox said Monday.
The idea has been dormant since lawmaker concerns have shifted from whether Medicaid participants will be working to whether the state can pay for the program in the long term.
Cox said the state could revisit the driver's license idea once the Medicaid program launches.
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