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Utah leaders face many hurdles despite reaching rough agreement on expanding Medicaid

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SALT LAKE CITY — A group of six officials have agreed on the broad outlines of a deal to expand Medicaid in the state. But plenty of hurdles remain to keep the plan from collapsing in Utah's Republican-dominated Legislature, as another deal did earlier this year.

Taylorsville Rep. Jim Dunnigan, one of the six officials involved in the closed-door talks, said Monday it's a breakthrough that the group is agreeing to expand Medicaid eligibility to those earning up to 138 percent of the poverty level, as called for under President Barack Obama's health care law.

Their rough plan would have doctors, hospitals and others who would benefit from expanding the program to help pay costs, but Dunnigan said those stakeholders have not yet signed on. The federal government and the rest of Utah's Legislature, which killed a similar plan earlier this year, also need to agree to the plan.

Dunnigan said the plan announced Friday meets a self-imposed July 31 target to resolve the issue. "We still need to put the flesh and muscle on the bones," he said.

Herbert's spokesman, Jon Cox, agreed. "We're closer than we've ever been, but we haven't quite gotten there yet," he said Monday.

Dunnigan said they've only had early talks with doctors, hospitals and others who would benefit from Medicaid expansion about helping to pay for Utah's program, which is estimated to eventually cost the state about $78 million a year.

Hospitals, which would gain from having fewer uninsured people that leave them with unpaid bills, are willing to help pay about $25 million of those annual costs, said Greg Bell, president of the Utah Hospital Association.

But for hospitals to be willing to chip in, likely through a tax, they want to would like to see other stakeholders who would benefit, like doctors and pharmacists, step up and help pay their share as well, Bell said.

Jennifer Dailey, the executive director of the Utah Academy of Family Physicians, said her organization of primary care doctors is open to helping defray costs but needs to see specifics on what Utah officials propose.

"While we all want to be answer as far as figuring out how to pay for it, we want to be sure that it's not painted in these broad strokes that says 'Well, doctors are going to make tons of money so therefore they should pay the bills,' " she said.

Earlier this year, legislators floated the idea of increasing doctor licensing fees to help pay for Medicaid, but Dailey said doctors opposed that idea because they wanted to keep licensing fees separate.

She said one idea that's been raised is creating an "accountable care organization," or ACO, which is a partnership among hospitals, doctors and other providers to try and boost care for patients while sharing in cost savings.

Dunnigan said the group of six doesn't have any specific proposals ready or details on how much of the state's cost they would look for stakeholders to help cover.

The group is weeks or months away from having legislation ready and also plans to seek more flexibility from the federal government, which must approve the state's Medicaid plan, he said.

There is no deadline to approve a plan.

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