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While nearing deal with federal officials, Utah governor has to get his party on board

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SALT LAKE CITY — Gov. Gary Herbert says he's made great progress negotiating an alternative Medicaid expansion plan with officials in Washington, D.C.

But he may still have a tough sell at home.

Some Republican state lawmakers remain skeptical of the plan and a watered-down requirement that participants work in exchange for health coverage.

Federal officials won't allow a work requirement, but Herbert says they're open to a "work effort" that funnels people into job search and training programs.

That evolution is frustrating, Rep. Francis Gibson, R-Mapleton, said Thursday at a meeting of the state's Health Reform Task Force.

"We started at work requirement. That was what we wanted," Gibson said "And we've settled on 'work effort.' Maybe 'work thought' will be next. Just thinking about work will qualify us."

Herbert and other Utah Republicans have said the state-federal Medicaid program aims to help low-income people, and part of that help should include getting them better jobs so they don't need help.

David Patton, the executive director of the Utah Department of Health, told lawmakers Thursday that under the "work effort" proposal, all participants would be signed up for job help.

But they might not be told it's optional.

"That opt-out is not going to be advertised to folks," Patton said.

Patton said people would be able to leave the job programs if they wanted, but officials don't expect many would.

"In effect, we're getting what we asked for," he said.

The work requirement had been one of the key sticking points in negotiations with federal officials.

Herbert, a Republican, said Wednesday that after months of negotiations and his own visit to Washington, D.C., last week, "We're probably within 95 percent of getting all that we've asked for in the beginning."

The governor and Patton said they've gotten many concessions from U.S. Health Secretary Sylvia Burwell, including provisions that require participants to help pay some costs.

The federal Centers for Medicare and Medicaid Services has declined to comment on pending discussions with Utah.

Herbert's Medicaid plan is an alternative to simply expanding the existing government program, an option under President Barack Obama's health care law.

Instead, Herbert is seeking a chunk of federal money for a three-year pilot program to pay for about 110,000 people to buy private health insurance. Utah's Department of Health estimates the program would use $250 million in federal money the first year and grow to about $280 million in the third year.

At his monthly televised news conference Wednesday, Herbert said that he's close to a final deal and hopes to have a plan by the end of the month that he can present to the Republican-controlled Legisalture.

Taylorsville Republican Rep. Jim Dunnigan, one of the chairmen on the task force, said Thursday that the governor's team has done good work and made great progress.

After Thursday's meeting, Dunnigan told The Associated Press that some of his colleagues will only support a plan that requires people to work in exchange for health coverage.

"For some legislators, it is a deal breaker," he said.

Many Republicans have been wary of the federal government's promise to help with the costs of covering more people, saying Washington may not be able to keep its word.

Democrats, who favor expanding the government program, could be key to helping Herbert get enough votes for his plan.

Rep. Rebecca Chavez-Houck, D-Salt Lake City, said Thursday that Democrats are frustrated by the focus on a work requirement but pleased with the progress.

"We would rather see something rather than nothing," she said.


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