Utah Proposition 3, Medicaid Expansion Initiative (2018)

Elections in Utah, 2018

• General election: Nov. 6
• Voter registration deadline: Oct. 9 (mail), or Oct. 30 (online or in-person)
• Early voting: Oct. 23 - Nov. 2
• Absentee voting deadline: Nov. 6

• Online registration: Yes
• Same-day registration: Yes
• Voter ID: Non-photo ID required
• Poll times: 7:00 a.m. to 8:00 p.m.

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Utah Proposition 3
Election date November 6, 2018
Topic Healthcare and Taxes
Status Approved/Altered
Type State statute	Origin Citizens
List of Utah measuresUtah Constitutional Amendment AUtah Constitutional Amendment BUtah Constitutional Amendment CUtah Nonbinding Opinion Question 1Utah Proposition 2Utah Proposition 3Utah Proposition 4Submit

Utah Proposition 3, Medicaid Expansion Initiative, was on the ballot in Utah as an initiated state statute on November 6, 2018. It was approved.

A "yes" vote supported this measure to require the state to do the following: Provide Medicaid for persons under the age of 65 and with incomes equal to or below 138 percent of the federal poverty line and Increase the sales tax from 4.70 to 4.85 percent to finance the state's portion of the costs to expand Medicaid.

A "no" vote opposed this measure to require the state to do the following: Provide Medicaid for persons under the age of 65 and with incomes equal to or below 138 percent of the federal poverty line and Increase the sales tax from 4.70 to 4.85 percent to finance the state's portion of the costs to expand Medicaid.

The ACA established that the federal government would provide 93 percent of funding for expanded Medicaid coverage in 2019, with that portion dropping to 90 percent in 2020 and thereafter. Proposition 3 increased the state's sales tax by 0.15 percentage points (from 4.7 percent to 4.85 percent) to providing funding for the state's portion of Medicaid expansion costs.

During the 2018 session, the Utah State Legislature passed and the governor signed a bill with a modified and restricted Medicaid expansion plan. To read more about this bill and the differences between it and the traditional expansion proposed by this initiative, click here.

Election results

Utah Proposition 3
Result		Votes	Percentage
Yes		555,651	53.32%
No		486,483	46.68%

Results are officially certified.

Source

Aftermath

Legislative alteration

See also: Legislative alteration

Utah Sen. Allen Christensen (R) introduced a bill, Senate Bill 96, that would repeal and replace Proposition 3. Changes made by the bill included limits on eligibility for Medicaid coverage, such as a work requirement; restrictions on the total number of people who could enroll; and changes to the provisions of Proposition 3 concerning the sales tax increase. It was designed to require special approval of waivers from the Federal government for certain provisions and contains contingency provisions that would take effect if the waivers weren't approved. Click here to read Senate Bill 96.

The bill passed in the Senate on February 4, 2019. The bill passed with amendments in the House on February 8, 2019. The Senate concurred with the House's amendments, and the governor signed the bill on February 11, 2019. Utah has a Republican state government trifecta, meaning Republicans control both houses in the state legislature and the governorship.

Utah is one of 11 states that have no restrictions on legislative alterations, which means the legislature can amend or repeal initiated state statutes with a simple majority vote at any time.

Senate Bill 96 vote totals
Vote in the Utah State Senate February 11, 2019 Requirement: Yes No Not voting Total 22 7 0 Total percent 75.86% 24.13% 0% Democrat 0 6 0 Republican 22 1 0 Vote in the Utah House of Representatives February 8, 2019 Requirement: Yes No Not voting Total 56 19 0 Total percent 74.66% 25.33% 0% Democrat 0 16 0 Republican 56 3 0

Statement from Governor Gary Herbert

Governor Herbert said in a statement, "SB96 balances Utah’s sense of compassion and frugality. It provides quality coverage to the same population covered by Proposition 3 in a meaningful, humane and sustainable way. It is now time to set aside differences and move forward to get those in greatest need enrolled on Medicaid and on the federal health care exchanges."

Responses from Proposition 3 supporters

Utah Decides Healthcare, the Proposition 3 support campaign, "This is a dark day for democracy in Utah. State legislators turned their backs on voters and on families in need. This bill leaves billions of our tax dollars in Washington and cuts healthcare for tens-of-thousands of Utahns. While special interests and politicians celebrate the success of their backroom deal, Utah families will be up late tonight knowing they just lost the ability to afford lifesaving care."

Proposition 3 supporter Matt Slonaker, executive director of the Utah Health Policy Project, stated, "This bill is not perfect, and there are significant parts of it that we don't support and will work hard to fix. But Governor Hebert, President Adams, and Speaker Wilson have stated that we will have an April 1, 2019 roll out date of coverage. UHPP, and our partners in the community, should be ready. We will finally be able to get coverage for Utahns that need it badly."

Legislative alteration context

See also: Legislative alterations of ballot initiatives and Legislative alteration rules

From 2010 through 2018, 97 initiated state statutes and two initiated ordinances in D.C. were approved by voters. Of these 99 total initiatives from 2010 through 2018, 28 were repealed or amended as of April 2019. The states with the most total cases of legislative alterations of initiatives approved since 2010 were Maine—with four initiatives altered out of eight approved—and Colorado and Oregon—each with three initiatives altered out of five approved. Among initiatives approved from 2010 through 2018, marijuana was the topic that drew the most legislative alterations, with eight initiatives. Other topics addressed by legislatively altered initiatives included elections and campaigns, term limits, education, business regulation, law enforcement, minimum wage, taxes, and gambling.

The rate of legislative alteration was 13 percentage points higher for initiatives approved in 2016 and 2018 than initiatives approved from 2010 through 2015.

Legislative alteration rates
Year span	# approved	# altered	Alteration rate
2010 - 2024	175	30	17.14%
2016 - 2018	56	20	35.71%
2010 - 2015	43	9	20.9%

Click here for information about all legislative alterations of initiatives approved since 2010.

Overview

What was the status of Medicaid and Obamacare in Utah?

Medicaid is a government program that provides medical insurance to groups of low-income people and individuals with disabilities. The Affordable Care Act (ACA), also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level. In 2012, the U.S. Supreme Court ruled in NFIB v. Sebelius that the federal government could not withhold funds from states that refused to expand Medicaid. The ruling had the practical effect of making Medicaid expansion optional for states. In 2019, the federal government financed 93 percent of the costs of state Medicaid expansion. For 2020 and subsequent years, the federal government began covering 90 percent of the costs. As of March 2018, 18 states, had chosen not to expand Medicaid.

During the 2018 legislative session in Utah, the legislature passed and the governor signed an alternative version of Medicaid expansion that would include approximately 70,000 additional people under coverage—compared to the estimated 150,000 that would gain coverage under traditional expansion. The alternative version—which included a work, volunteer, or educational requirement to qualify and certain contingencies—needs special approval from the federal government to become effective.

What did Proposition 3 do?

Proposition 3 was designed to require the state government to provide Medicaid to persons under the age of 65 and with incomes equal to or below 138 percent of the official poverty line. In 2017, this amounted to $16,643 or less for an individual or $33,948 or less for a household of four. As the federal government would contribute 90 percent of the funds needed for Medicaid expansion in 2020 and subsequent years, the state needs to use revenue to cover the remaining 10 percent. The initiative was designed to increase the sales tax 0.15 percent from 4.70 to 4.85 percent to provide revenue for the state's portion of the costs.

Who supported and opposed Proposition 3? One committee—Utah Decides Healthcare—had registered in support of this initiative. The committee reported receiving $3.79 million in contributions—$3.65 million in cash donations and $140,413 in in-kind services.

The largest donor—The Fairness Project—provided $3.54 million to Utah Decides Healthcare.

One committee—No on Proposition 3 had registered to oppose this initiative. The committee had raised $54,858.12, all in the form of in-kind contributions and entirely from Americans for Prosperity.

What states voted on measures related to Medicaid expansion in 2018?

In November 2018, voters in Idaho, Montana, Nebraska, and Utah decided ballot initiatives concerning Medicaid expansion and the funding of expanded Medicaid coverage. In January, voters in Oregon approved Measure 101, thereby upholding 2017 legislation to provide funding for the state's portion of costs for expanded Medicaid coverage through a tax on healthcare insurance and the revenue of certain hospitals.

The Affordable Care Act, also known as Obamacare, was enacted in March 2010. Between 2013 and 2016, no statewide ballots featured measures related to Obamacare. In 2017, voters in Maine approved a ballot measure to expand Medicaid to persons under the age of 65 and with incomes equal to or below 138 percent of the federal poverty line. The measure was the first citizen initiative to implement an optional provision of Obamacare.

2018 measures:

Measure	Description	Status
Idaho Proposition 2	Expand coverage to 138 percent of the federal poverty line
Montana I-185	Extend expanded coverage and increase tobacco taxes	d
Nebraska Initiative 427	Expand coverage to 138 percent of the federal poverty line	a
Utah Proposition 3	Expand to 138 percent of the federal poverty line and increase sales tax
Oregon Measure 101	Upheld health insurance tax to fund expanded coverage	a

Text of measure

Ballot title

The ballot title for Proposition 3 was as follows:

“

Shall a law be enacted to: expand the state Medicaid health coverage program to include coverage, based on income, for previously ineligible low-income adults; maintain the following as they existed on January 1, 2017: eligibility standards, benefits, and patient costs for Medicaid and the Children’s Health Insurance Program (CHIP); and the payment rate for healthcare providers under Medicaid and CHIP; and use the tax increase described below to pay for Medicaid and CHIP? This initiative seeks to increase the current state sales tax rate by 0.15%, resulting in a 3.191% increase in the current tax rate.

”

Impartial analysis

The impartial analysis for Proposition 3 was as follows:

“ Proposition Number 3 makes three main changes to state law relating to Medicaid and the Children’s Health Insurance Program (CHIP). First, it expands the state Medicaid program to include coverage, based on income, for previously ineligible low-income adults. Second, it preserves the existing scope of the state’s Medicaid and CHIP programs. Third, it increases the state sales tax rate from 4.70% to 4.85% and directs the resulting revenue toward paying for the changes to Medicaid and CHIP made by the Proposition. Background Medicaid is a government-sponsored health insurance program for eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid was established by the federal government but is administered by the states through state-run programs. Each state’s program must meet certain minimum federal requirements but can vary widely. The programs are funded in part by the federal government and in part by the state government. Historically, an adult qualified for Medicaid coverage only if the adult had a low income and belonged to a designated eligibility category—pregnant, parent, aged, blind, or disabled. That changed with the federal government’s passage of the Patient Protection and Affordable Care Act. The Affordable Care Act gave states the option of expanding Medicaid eligibility in their state by allowing adults under 65 years of age with incomes below 138% of the federal poverty level to qualify for coverage based solely on their income, without belonging to a designated eligibility category. Individuals in this group are called “newly eligible.” To date, Utah has not expanded its Medicaid program to cover all newly eligible individuals. Similar to Medicaid, CHIP is a government-sponsored health insurance program that was established by the federal government, is administered by the states, and is funded in part by the federal government and in part by the state government. CHIP builds on Medicaid by providing health coverage to low-income children whose families earn too much money to qualify for Medicaid. Effect of Proposition Number 3 Expanding Medicaid Beginning April 1, 2019, Proposition 3 expands eligibility for Medicaid to include all newly eligible individuals under the Affordable Care Act—adults under 65 years of age with incomes below 138% of the federal poverty level who are not currently eligible for Medicaid. Preserving the Scope of Medicaid and CHIP Proposition 3 preserves certain aspects of the state’s Medicaid and CHIP programs as they existed on January 1, 2017 to set a baseline for the scope of coverage and benefits available under each program going forward. By establishing the baselines, the Proposition prohibits future changes to the programs that would reduce the coverage or available benefits, but it allows changes that would expand them. More specifically, the Proposition provides that: the standards, methodologies, and procedures for determining eligibility for Medicaid and CHIP cannot be made more restrictive than they were on January 1, 2017; there cannot be any limits on Medicaid enrollment beyond those in place on January 1, 2017; the categories of care or services and the types of benefits provided under Medicaid and CHIP cannot be made more restrictive than they were on January 1, 2017; any premium, beneficiary enrollment fee, or cost sharing requirements, including co-payments, co-insurance, deductibles, or out-of-pocket maximums, cannot be increased from what they were on January 1, 2017; and Medicaid’s and CHIP’s payments to healthcare providers, like hospitals and physicians, cannot be made at a rate less than the rate paid on January 1, 2017, adjusting annually for inflation. Funding Medicaid Expansion Under the Affordable Care Act as it currently exists, the federal government will pay approximately 90% of the cost of the newly eligible individuals who gain Medicaid coverage under Proposition 3, and the state government must pay the remainder. Beginning April 1, 2019, Proposition 3 increases the state sales tax rate from 4.70% to 4.85% and directs the resulting revenue toward paying the state’s portion. The increase does not apply to groceries. The Proposition requires the revenue from the 0.15% increase to be used primarily for expanding Medicaid eligibility to the newly eligible, but it provides that any remaining revenue can be used to fund Medicaid or CHIP more generally. ”

Fiscal impact

The fiscal impact statement for Proposition 3 was as follows:

“ The following fiscal impact statement is based on figures provided by the legislative fiscal analyst. Proposition 3 may result in approximately 150,000 newly eligible individuals enrolling in the state Medicaid program in fiscal year 2020, and approximately 5,000 additional newly eligible individuals enrolling each year thereafter. Additionally, approximately 20,000 children who are currently eligible for Medicaid but not enrolled may enroll once their parents become eligible. The increase to the state sales tax rate contained in Proposition 3 will generate additional tax revenue for the state to direct toward the cost of expanding Medicaid coverage to the newly eligible. The chart below summarizes the anticipated cost associated with expanding Medicaid eligibility under Proposition 3 and the state revenue Proposition 3 is expected to generate. The figures in the chart assume the enrollment growth described above and no changes to federal law. Total Cost of Medicaid Expansion Under Prop 3 (Federal and State Portions) Utah’s Portion of Total Cost of Medicaid Expansion Under Prop 3 Total Cost of Medicaid Revenue from Increase to the State Sales Tax Rate Fiscal Year 2020 $758 million $53 million $84 million Fiscal Year 2021 $846 million $78 million $88 million The actual cost of Medicaid expansion under Proposition 3 and the amount of additional revenue the state collects from the increase to the state sale tax rate will vary based on numerous factors, including population growth, business investment, consumer behavior, economic conditions, and policy changes. ”

Full text

The full text of the initiative is available here.

Readability score

See also: Ballot measure readability scores, 2018

Using the Flesch-Kincaid Grade Level (FKGL and Flesch Reading Ease (FRE) formulas, Ballotpedia scored the readability of the ballot title and summary for this measure. Readability scores are designed to indicate the reading difficulty of text. The Flesch-Kincaid formulas account for the number of words, syllables, and sentences in a text; they do not account for the difficulty of the ideas in the text. The Office of Legislative Research and General Counsel wrote the ballot language for this measure. The FKGL for the ballot title is grade level 10, and the FRE is 50. The word count for the ballot title is 95, and the estimated reading time is 25 seconds. The FKGL for the ballot summary is grade level 14, and the FRE is 29.5. The word count for the ballot summary is 670, and the estimated reading time is 2 minutes and 58 seconds. In 2018, for the 167 statewide measures on the ballot, the average ballot title or question was written at a level appropriate for those with between 19 and 20 years of U.S. formal education (graduate school-level of education), according to the FKGL formula. Read Ballotpedia's entire 2018 ballot language readability report here.

Support

Yes on 3 - Utah Decides Healthcare led the campaign in support of the initiative.

Utah Decides Healthcare logo

Supporters

The initiative's sponsors included the following individuals:

• Sen. Brian Shiozawa (R-8)
• Bishop Scott B. Hayashi, Episcopal Diocese of Utah
• Beth Armstrong, executive director of the People's Health Clinic
• Alan Ormsby, state director of AARP Utah
• Karina Brown

Organizations AARP Utah Utah Health Policy Project Voices for Utah Children National Council of Jewish Women, Utah Section Action Utah Alliance Community Services Alliance for a Better Utah Comunidades Unidas Crossroads Urban Center Disability Law Center Bags to Beds Legislative Coalition for People with Disabilities United Way of Salt Lake Utah Indivisible Our Revolution Utahns Against Hunger YWCA of Utah League of Women Voters, Utah Utah Support Advocates for Recovery Awareness (USARA) Allies with Families Neighborhood House Statewide Independent Living Coalition Utah Coalition of Manufactured Homes Healthcare Organizations and Professionals Utah Medical Association Salt Lake County Board of Health Salt Lake County Criminal Justice Advisory Council Salt Lake County Behavioral Health Services Advisory Council Utah Association of Addiction Treatment Providers American Academy of Pediatrics, Utah Chapter Association for Utah Community Health (AUCH) Doctors for America NAMI Utah Utah Nurses Association Salt Lake County Alcohol & Drug Coordinating Council House of Hope Ray Ward, M.D. Scott Poppen, M.D. Ellie Brownstein, M.D. Tom Metcalf, M.D. Bill Cosgrove, M.D. Kyle Bradford Jones, M.D. Chad A Spain, M.D. John Berneike, M.D. Jennifer Paul Leiser, M.D. Jennifer Kaiser, M.D. Osman Sanyer, M.D. Julie Day, M.D. Utah Academy of Family Physicians American Cancer Society Cancer Action Network Susan G. Komen National Association of Social Workers, Utah Chapter Epilepsy Foundation, Utah The People’s Health Clinic David Grygla, D.O. Vanessa Galli, M.D. Brett Einerson, M.D. Steve Fehlauer, M.D. D. Ware Branch, M.D. Carissa Monroy, M.D. Maura K. Hanrahan, M.D. John Hanrahan, M.D. Andrew Garrison, M.D. Chrisopher Hutchinson, M.D. Scott Jacob, M.D. Isaac Noyes, M.D. Michael Magill, M.D. Kirsten Stoesser, M.D. José Rodríguez, M.D. Eileen Gallagher, M.D. Claudia Fruin, M.D. Brian Vukelic, M.D. Tyler Yeates, M.D. American Diabetes Association Utah Occupational Therapy Association Utah Public Health Association National Multiple Sclerosis Society, Utah Section Leukemia & Lymphoma Society Utah Section of the American College of Obstetricians and Gynecologists Katherine Shen, M.D. Dot Verbrugge, M.D. Rachelle FIinn, PA-C. Danielle Pendergrass, DNP, APRN, WHNP-BC Aimee McLean, BSN, RN, CCHP Kathleen Kaufman, MS, RN Carolyn “CJ” Ewell, MS, APRN, FNP-BC Lee Moss, MS, APRN, FNP-BC, ANP-C Marilee Rohan, FNP, APRN-C Liz Cose, PhD, RN Angela York, RN, BSN, C-AL Michael Morrison, BS, RN Sally Brush, NP Tanya Chapman, MSW Emily W. Bleyl, LCSW Pat Berckman, LCSW Brett S. Bartruff, LCSW, QCSW Jania Sommers, LCSW Faith Leaders Episcopal Diocese of Utah The Rt. Rev. Scott B. Hayashi Bishop of the Episcopal Diocese of Utah Salt Lake City Reverend Susan Roberts St. Paul’s Episcopal Church Salt Lake Reverend Dr. Lee Mongomery Vicar, St. Jude’s Episcopal Church Cedar City Reverend Monica Hall Trinity Presbyterian Church Ogden Reverend Jerrod B. Lowry, Pastor Community of Grace Presbyterian Church Sandy Reverend Christine Myers-Tegeder Pastoral Associate First Presbyterian Church Salt Lake Reverend Scott Delgarno, Pastor Wasatch Presbyterian Church Salt Lake Reverend Nancy Holve, Pastor Valley Community Presbyterian Richfield Reverend Catherine Putnam-Netto Reverend Derek Forbes First Presbyterian Church Logan Reverend William Germundson St. Francis of Assisi Christian Church (DOC) Draper Reverend Charles Hines St. Francis of Assisi Christian Church (DOC) Draper Reverend Curtis L. Price First Baptist Church Salt Lake Reverend Linda Brewer Chaplain, Huntsman Cancer Institute Salt Lake Reverend Nancy Piggott, BCC ACPE Certified Educator Spiritual Care Center at St. Mark’s Hospital Salt Lake City Pastor Logan Wolf Th.M. CrossPoint Church Provo, Taylorsville Reverend David Nichols Mount Tabor Lutheran Church Salt Lake Rev. Steve Klemz Pastor, Zion Evangelical Lutheran Church Salt Lake Reverend Bruce Kolasch Elim Lutheran Church & Christ United Methodist Church, Ogden & Salt Lake Elder Roy Schmidt Community of Christ Utah County Pastor Blair White Community of Christ’s Utah Mission Ministries, Salt Lake Reverend Joan Bell-Haynes Executive Regional Minister Central Rocky Mountain Region Christian Church (Disciples of Christ) Catholic Diocese of Salt Lake City The Most Rev. Oscar A. Solis Bishop of the Catholic Diocese of Salt Lake City Rev. Samuel Dinsdale Blessed Sacrament Catholic Church, Sandy Rev. Erin Gilmore, Associate Conference Minister, Rocky Mountain Conference, United Church of Christ Rev. William Wheaton Holy Family Catholic Church, Ogden Rev. Rowland Nwokocha St. Pius X Catholic Church, Moab Rev. Manuel Ceron St. Elizabeth Catholic Church, Richfield Rev. John Norman St. Vincent de Paul Catholic Church, Holladay Rev. Omar Ontiveros St. Ann Catholic Church, Salt Lake City Rev. Andrew Skrzypiec St. Ambrose Catholic Church, Salt Lake City Rev. Javier Virgen St. Jospeh the Worker Catholic Church, West Jordan Rev. Jose Rausseo San Andres Catholic Church, Payson; St. Patrick Catholic Church, Eureka; San Isidro Mission, Gunnison Rev. Patrick Elliot Retired, Salt Lake City Rev. John Evans St. Thomas More Catholic Church, Cottonwood Heights Rev. Hernando Diaz Retired, Midvale Rev. Eleazar Silva Sacred Heart Catholic Church, Salt Lake City Rev. Martin Diaz Cathedral of the Madeleine, Salt Lake City Rev. Roberto H. Montoro; Sasía Central Valley Catholic Mission; St. Bridget Catholic Church, Milford; St. John Bosco Catholic Church, Delta; Holy Family Catholic Church, Fillmore; Our Lady of the Light Catholic Church, Beaver Rev. Christopher Gray St. Mary of the Assumption Catholic Church, Park City Rev. Msgr. Colin Bircumshaw Vicar General, Diocese of Salt Lake City Patricia Gamble-Hovey Commissioned Minister Holladay United Church of Christ Holladay Reverend Shesh Tipton Holladay United Church of Christ; Holladay Reverend Jodi Bushdiecker; Bountiful Community Church United Church of Christ; Bountiful Ogden; Coalition of Religious Communities Utah Islamic Center Imam Shuaib Din; Utah Islamic Center; Sandy Chaplain Vicki Neumann; SLIHN Epiphany Fellowship; Sandy Reverend Marijke Rossi; First Congregational Church; Salt Lake Bishop Karen P. Oliveto; Mountain Sky Conference of The United Methodist Church Reverend Dean Nosek; Price United Methodist Church; Price Reverend Elizabeth McVicker; Centenary United Methodist Church; Salt Lake Reverend Kimal James; First United Methodist Church; Marriott-Slaterville Pastor David Sauer; Aldersgate United Methodist Church; Brigham City Reverend Michael Chamness; Shepherd of the Hills United Methodist Church; St. George Reverend Gary Haddock; Community United Methodist Church; Washington Terrace Reverend Brian Diggs; Executive Director, United Methodist Committee on Relief; West Depot Reverend Dennis Shaw; Hilltop United Methodist Church; Sandy Reverend Harold K. Straughn; Salt Lake City Reverend Russell Butler; Christ United Methodist Church; Salt Lake City Reverend Marv Vose; Superintendent of the Utah/Western; Colorado District United Methodist Reverend Cherie Cobb; Mountain Vista United Methodist Church, West Jordan Reverend Olga Hard; Retired United Methodist Clergy; West Jordan Reverend Tevita Ofahengaue; Tongan United Methodist Church; West Valley Reverend Uamuli F. Su’a; EFKS New Jerusalem UCC; Midvale Reverend Vinnetta Golphin-Wilkerson; Granger Community Christian Church; West Valley Reverend Lorrie Gaffney; Congregational United Church of Christ

Arguments

Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services, said in an interview with Deseret News: "The overall cost of insurance comes down for everybody when Medicaid expands, because when people aren't falling into this coverage gap, the costs aren't getting passed along (by the uninsured). So we've seen an average of a 7 percent reduction in premiums across the country when more people are covered. I think legislators and governors are rightly concerned about, "What's this going to do to my state, can we afford it?" We've now seen in many states … that it's been very good for their economy. (There's) a huge (coverage) gap, and I think this is a state that I think has the compassion and the intellect together to solve these problems and to see to those issues. And so I don't see a state like Utah wanting to let that rest."

Dr. Kyle Jones, a physician in Salt Lake said, "All citizens of Utah deserve the many benefits that Medicaid expansion will bring," said Dr. Kyle Jones, a practicing Family Physician in Salt Lake. "It will provide health care coverage to 150,000 people who sorely need it, bring millions of dollars back into the local economy, and improve the health of Utahns. All at a time when Utah's overall healthcare grades are falling behind other states — it's time for Utah to decide."

Official argument

The following official argument was submitted by Alan Ormsby, AARP Utah State Director; Rep. Ray Ward (R-19); and Bishop Scott Hayashi, Episcopal Diocese of Utah in favor of Proposition 3:

“ Proposition 3 provides access to healthcare 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. It’s money 33 other states already get, but we’ve been losing out on for years. 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 healthcare 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 hard-working Utahns who earn a promotion or take on more hours to get ahead won’t have their healthcare 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 healthcare. The Governor’s Office of Management and Budget concluded that this program would be fiscally sound. It enables Utah taxpayers to expand healthcare access while promoting individual responsibility and smart use of public monies. Proposition 3 is accompanied with a sales tax increase on non-food items equivalent to about one cent on the cost of a movie ticket. This investment enables Utah to bring home nine times that amount in federal dollars every year. AARP supports this measure because “Proposition 3 allows us to be fiscally responsible and significantly improve the lives of our families and neighbors most in need.” This measure lets Utahns take control of our healthcare system, expand access to quality, affordable healthcare, and return Utah’s federal tax dollars to our state. Vote “YES” on Proposition 3. ”

Click [show] to see the rebuttal to the official opposition argument

“ Proposition 3 protects hard-working families and returns taxpayer money to Utah, where it belongs. Medicaid expansion will return taxpayer dollars back to our state every year to benefit Utahns and grow our economy. Proposition 3 will bring home nine federal dollars for every state dollar spent. If someone offered you nine dollars if you gave them one, that’s a deal most of us would take every single time. Thirty-three states have already expanded Medicaid, resulting in substantial job benefits and economic growth compared to non-expansion states. Independent economists say that Proposition 3 will grow our economy by $1.7 billion, creating nearly 14,000 jobs and providing workers and small business owners with nearly $785 million in new income in the next three years. Not one of those 33 states have reversed its decision. Instead, states have determined that expansion has boosted their economies, improved health outcomes and increased healthcare access. Proposition 3’s conservative approach protects taxpayer money and ensures that funds go directly where needed. The 10 percent state match needed to trigger federal funding for Medicaid expansion would come from a sales tax increase on non-food items, equivalent to about one cent on a movie ticket. Those funds will provide healthcare access to 150,000 Utahns, including parents and those with chronic illnesses. Proposition 3 is a commonsense decision to return tax dollars to our state, grow our economy, protect small businesses, and provide life-saving healthcare to individuals earning less than $17,000 annually. ”

Opposition

Opponents

• Utah Governor Gary Herbert (R)
• Rep. Edward Redd (R-4)

The following legislators were listed in the official argument against Proposition 3 as opponents to the initiative:

• Rep. Stewart Barlow (R-17)
• Rep. Scott H. Chew (R-55)
• Rep. LaVar Christensen (R-32)
• Rep. Kay Christofferson (R-56)
• Rep. Kim Coleman (R-42)
• Rep. Bradley Daw (R-60)
• Rep. Francis Gibson (R-65)
• Rep. Brian Greene (R-57)
• Rep. Gregory Hughes (R-51)
• Rep. Ken Ivory (R-47)
• Rep. Jeremy Peterson (R-9)
• Rep. Michael S. Kennedy (R-27)
• Rep. John Knotwell (R-52)
• Rep. Karianne Lisonbee (R-14)
• Rep. Cory Maloy (R-6)
• Rep. Daniel McCay (R-41)
• Rep. Mike McKell (R-66)
• Rep. Jefferson Moss (R-2)
• Rep. Michael Noel (R-73)
• Rep. Val Peterson (R-59)
• Rep. Susan Pulsipher (R-50)
• Rep. Paul Ray (R-13)
• Rep. Adam Robertson (R-63)
• Rep. Adam Robertson (R-63)
• Rep. Mike Schultz (R-12)
• Rep. Travis Seegmiller (R-62)
• Rep. Robert Spendlove (R-49)
• Rep. Norm Thurston (R-64)
• Rep. John Westwood (R-72)
• Rep. Logan Wilde (R-53)
• Rep. Brad R. Wilson (R-15)
• Sen. Stuart Adams (R-22)
• Sen. Jake Anderegg (R-13)
• Sen. Lincoln Fillmore (R-10)
• Sen. Keith Grover (R-15)
• Sen. Daniel Hemmert (R-14)
• Sen. Deidre Henderson (R-7)
• Sen. Howard Stephenson (R-11)

Arguments

Utah Governor Gary Herbert (R) said, "Medicaid is the budget-buster of all budget-busters in our state budget. It should be a concern if you care about balancing the budget and being fiscally prudent."

Rep. Edward Redd (R-4) said, “I’m concerned about it because I don’t know how sustainable it is. What happens during an economic downturn?”

Official argument

The following official argument was submitted by Rep. Robert Spendlove (R-49) in opposition to Proposition 3:

“ Expanding Medicaid eligibility as originally envisioned by the Affordable Care Act (Obamacare), as this initiative does, is bad policy. Medicaid was designed to help the most needy obtain healthcare, but this initiative incentivizes more spending on able-bodied adults than on the vulnerable. Similar expansions in other states have led to reductions in services for the disabled as state budgets have been squeezed by increases in funding for the expansion population. Many have also experienced budget shortfalls that could ultimately require even greater tax increases, or spending cuts to things like education, other programs for the needy, roads and public safety. This initiative contains a tax increase on Utah families of $90 million annually, amounting to nearly $1 billion over 10 years. 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. Social, health and human services already represent the largest portion of our state budget. This initiative would leave taxpayers with a program on autopilot, a zombie program that would be financially devastating to our state. If federal officials do not approve all portions of the initiative, Utah will be forced to pay for it in its entirety, which is estimated to cost over $700 million per year. The state would have no choice but to cut other essential services even further. Utahns expect and deserve a responsible and compassionate solution to care for the most vulnerable among us. Greater access to healthcare 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. Those who suggest that opposing this initiative indicates a lack of compassion are simply wrong. Even those who support a broader social safety net should be wary of this deeply flawed, one-size-fits-all model. We already have a responsible, compassionate Utah solution to care for our most vulnerable. This initiative goes too far. Please join us as we respectfully vote “no thank you” to the federal government’s offer to create yet another new entitlement program by voting against Proposition 3. Representatives: Greene McCay Roberts Wilde Grover Barlow Hughes McKell Robertson Wilson Hemmert Chew Ivory Jeff Moss Schultz Senators: Henderson Christofferson Kennedy Noel Seegmiller Adams Stephenson Coleman Knotwell Jeremy Peterson Spendlove Anderegg Daw Lisonbee Pulsipher Thurston Christensen Gibson Maloy Ray Westwood Fillmore ”

Click [show] to see the rebuttal to the official support argument

“ Don’t Be Swayed by False Claims and Misguided Analysis The Utah Legislature already expanded Medicaid to close the coverage gap created by Obamacare. Those who currently have access to health insurance through that law will be able to keep it, while those who make too little to qualify will have access to Medicaid. This solution will be paid for with no sales tax increase and no additional state spending. To say that those who earn a promotion or work to get ahead will have their healthcare taken away as a result of earning more money is simply not true. Medicaid always ends when the recipient makes a dollar above what is allowed. Proposition #3 does nothing to change that fact, nor would the federal government permit it. The Governor’s Office of Management and Budget (GOMB) also responded to claims made by the proponents of Proposition #3 by stating: “The Argument FOR Proposition #3 blatantly mischaracterizes GOMB’s fiscal impact statement and willfully ignores express communication about the limited scope and use of the fiscal impact estimates. GOMB has not concluded that this initiative program is fiscally sound. To the contrary, GOMB explicitly warned in its fiscal estimate that Proposition #3 could be fiscally unsound in future years.” Proposition #3 is not fiscally responsible. It exposes Utah to great risk and uncertainty by taking away state flexibility to innovate and address the underlying problems at the heart of poverty. Voters should not be swayed by false claims and misguided analysis, and should vote NO on Proposition #3. ”

Media editorials

See also: 2018 ballot measure media endorsements

Support

• The Salt Lake Tribune said: "The people of Utah have already left more than a billion dollars in federal support on the table over the last five years due to our stubborn, partisan and hurtful refusal to go along with the provisions of the original Affordable Care Act and expand eligibility for Medicaid to thousands of our uninsured relatives and neighbors. If Prop 3 passes, Utah voters will have commanded their reticent state government to accept the expansion, take the money, and provide coverage to some 150,000 working and low-income Utahns who now, through no fault of their own, lack the kind of access to health care that the residents of 33 other states — and every nation considered civilized — take for granted... [Utah Propositions 2, 3, and 4] individually and collectively, stand to improve both our quality of life and our democratic institutions. The voters should give them their resounding assent."

Opposition

• The Wall Street Journal: "Utah is proposing to raise the sales tax to 4.85% from 4.7%—yes, a regressive tax on the poor to pay for health care for those above the poverty line. [...] Medicaid expansion is a bad fiscal and health-care bargain that looks worse as time passes. States like Kentucky are already looking for reforms like work requirements before the “free” money drowns their state fisc. Voters would be wise to reject the phony compassion and focus scarce resources on the poor and disabled."

Campaign finance

One committee—Utah Decides Healthcare—had registered in support of this initiative. The committee reported receiving $3.79 million in contributions—$3.65 million in cash donations and $140,413 in in-kind services.

The largest donor—The Fairness Project—provided $3.54 million to Utah Decides Healthcare.

One committee—No on Proposition 3 had registered to oppose this initiative. The committee had raised $54,858.12, all in the form of in-kind contributions and entirely from Americans for Prosperity.

	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Support	$3,649,595.62	$140,412.97	$3,790,008.59	$3,535,947.12	$3,676,360.09
Oppose	$0.00	$54,858.12	$54,858.12	$0.00	$54,858.12
Total	$3,649,595.62	$195,271.09	$3,844,866.71	$3,535,947.12	$3,731,218.21

Support

The following table includes contribution and expenditure totals for the committees in support of the measure.

Committees in support of Proposition 3
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Utah Decides Healthcare	$3,649,595.62	$140,412.97	$3,790,008.59	$3,535,947.12	$3,676,360.09
Total	$3,649,595.62	$140,412.97	$3,790,008.59	$3,535,947.12	$3,676,360.09

Donors

The following were the top donors to the committee.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
The Fairness Project	$3,484,340.42	$57,171.00	$3,541,511.42
R. Scott Poppen	$100,000.00	$0.00	$100,000.00
Utah Health Project	$0.00	$57,974.38	$57,974.38
AARP	$30,000.00	$8,824.50	$38,824.50
The Exoro Group	$37,620.00	$0.00	$37,620.00

Opposition

The following table includes contribution and expenditure totals for the committees in opposition to the initiative.

Committees in opposition to Proposition 3
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
No on Proposition 3	$0.00	$54,858.12	$54,858.12	$0.00	$54,858.12
Total	$0.00	$54,858.12	$54,858.12	$0.00	$54,858.12

Donors

The following were the top donors to the committee.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
Americans for Prosperity	$0.00	$54,858.12	$54,858.12

Methodology

To read Ballotpedia's methodology for covering ballot measure campaign finance information, click here.

Polls

See also: Ballotpedia's approach to covering polls

See also: 2018 ballot measure polls

Dan Jones & Associates conducted a series of polls on Medicaid expansion in Utah. Across polls in October 2017, November 2017, and February 2018, support ranged from 59 percent to 62 percent. The highest support was featured in the May 2018 poll. The percentage of those opposed to the Medicaid expansion proposed by this initiative increased from October 2017 through February 2018 from 29 percent to 34 percent—although the opposition dropped two points from November 2017 to February 2018. The percentage of respondents that were undecided fell from 9 percent in October 2017 to 6 percent in February 2018.

In February 2018, a poll also by Dan Jones & Associates fond that 68 percent of Utah residents approved of Medicaid expansion with work requirements, state contribution caps, and coverage contingent on the federal government providing 90 percent of funds—which were features of the partial Medicaid expansion passed during the 2018 legislative session.

Utah Proposition 3, Medicaid Expansion Initiative (2018)
Poll	Support	Oppose	Undecided	Margin of error	Sample size
Dan Jones & Associates 5/15/2018 - 5/25/2018	63%	30%	7%	+/-4	615
Dan Jones & Associates 2/9/2018 - 2/16/2018	61%	34%	6%	+/-4	609
Dan Jones & Associates 11/16/2017 - 11/21/2017	59%	36%	4%	+/-4	600
Dan Jones & Associates 10/10/2017 - 10/13/2017	62%	29%	9%	+/-3.98	605
AVERAGES	61.25%	32.25%	6.5%	+/-4	607.25
Note: The polls above may not reflect all polls that have been conducted in this race. Those displayed are a random sampling chosen by Ballotpedia staff. If you would like to nominate another poll for inclusion in the table, send an email to editor@ballotpedia.org.

Background

Medicaid expansion under the ACA

See also: Medicaid and Obamacare

The Affordable Care Act (ACA), also known as Obamacare, was signed into law on March 23, 2010. The ACA provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level, which amounted to $12,140 for individuals and $25,100 for a family of four for 2018. The law was designed to provide 100 percent of funding to cover the new recipients for the first three years and to cut off federal Medicaid funding to states that chose not to expand coverage. However, the United States Supreme Court ruled in National Federation of Independent Business v. Sebelius (2012) that the federal government could not withhold Medicaid funds from states that chose not to expand eligibility. According to the Kaiser Family Foundation, this ruling had the practical effect of making Medicaid expansion optional for states. By January 1, 2017, 19 states, including Utah, had chosen not to expand eligibility.

From 2014 to 2016, the federal government covered 100 percent of the costs of state expansion of Medicaid. In 2017, the total cost that the federal government financed decreased to 95 percent. The ACA was designed to decrease the amount the federal government covers to 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020 and subsequent years.

The Affordable Care Act had not provided tax credits to adults with household incomes less than the federal poverty line because the law had aimed to cover these people under Medicaid. In states that did not expand Medicaid, many of these adults fell into a coverage gap in which they neither qualified for Medicaid nor for federal tax credits to purchase health insurance. As of 2016, around 2.6 million people fell into this coverage gap across the 19 states that did not expand Medicaid.

Adoption of Medicaid expansion under the ACA

As of January 2022, a total of 38 states and Washington, D.C., had expanded or voted to expand Medicaid, while 12 states had not. The map below provides information on Medicaid expansions by state; for states that expanded, hover over the state to view the political affiliation of the governor at the time of expansion.

Utah Medicaid expansion in the 2018 legislative session

During the 2018 session, the Utah State Legislature passed a bill—House Bill 472—with a modified Medicaid expansion plan. The bill was designed to expand Medicaid coverage to include those at or below 95 percent of the federal poverty line with additional provisions that effectively expanded coverage to 100 percent of the federal poverty line. The bill also included provisions establishing a work, volunteer, or vocational education requirement as a condition of coverage; limits on enrollment expenses; and an automatic repeal in place for if the federal government paid any less than 90 percent of costs. On March 28, 2018, Gov. Gary Herbert (R) signed the bill. It required special approval from the federal government because of the alternative version of Medicaid expansion and the special provisions and contingencies. The limited expansion would have made an estimated 70,000 additional people eligible for Medicaid, compared to 150,000 additional covered people under traditional expansion to 138 percent of the federal poverty line.

Path to the ballot

See also: Laws governing the initiative process in Utah

The state process

In Utah, the number of signatures required to qualify an initiated state statute for the ballot is equal to 10 percent of the votes cast in the state for presidential candidates in the previous presidential election. Petition circulation must be distributed so that signatures equal to 10 percent of votes cast for President are collected from each of at least 26 of the 29 Utah State Senate districts. Signatures must be submitted 316 days from the application date or by April 15, whichever is earliest.

The requirements to get an initiated state statute certified for the 2018 ballot:

• Signatures: 113,143 valid signatures were required.
• Deadline: The deadline to submit signatures was April 15, 2018. Each initiative also has an initiative-specific deadline 316 days following the initial application.

Each signature is verified by the county clerks in the county where the signature was collected. After verification, the petition forms are delivered to the lieutenant governor, who counts the total number of certified signatures and declares the petition as either sufficient or insufficient.

Cost of signature collection:
Sponsors of the measure hired AAP Holding Company to collect signatures for the petition to qualify this measure for the ballot. A total of $1,329,013.50 was spent to collect the 113,143 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $11.75.

Details about this initiative

The initiative petition was filed with the lieutenant governor on October 2, 2017.

As of March 26, 2018, the office of the lieutenant governor reported that 51,951 signatures had been submitted to it from county clerks and that 39,588 had been verified. Proponents stated that over 110,000 had been collected and were either being verified by county officials before submission to the lieutenant governor or had not been submitted to county clerks yet.

Proponents of this initiative reported submitting about 165,000 signatures before the deadline on Monday, April 16, 2018.

On May 29, 2018, the lieutenant governor certified the measure for the ballot. Proponents submitted 147,280 valid signatures in 26 of 29 state Senate districts. To qualify for the ballot, the initiative needed at least 113,143 valid signatures statewide and needed to meet signature thresholds in at least 26 of 29 state Senate districts.

How to cast a vote

See also: Voting in Utah

Poll times

Utah is an all-mail voting state that offers vote centers for voters that choose to vote in person. All vote centers are open from 7 a.m. to 8 p.m. local time. Utah voters are able to vote in person at any vote center. An individual who is in line at the time polls close must be allowed to vote.

Registration requirements

Check your voter registration status here.

To register to vote in Utah, an applicant must be a citizen of the United States, a resident of Utah for at least 30 days prior to the election, and at least 18 years old by the next general election. Pre-registration is available for 16- and 17-year-olds. 17-year-olds may vote in primary elections if they will turn 18 by the general election. Registration can be completed online or by mailing in a form. The deadline to register online or by mail is 11 days before Election Day. After this deadline, voters may register in person at a vote center by casting a provisional ballot and providing two forms of identification.

Automatic registration

See also: Automatic voter registration

Utah does not practice automatic voter registration.

Online registration

See also: Online voter registration

Utah has implemented an online voter registration system. Residents can register to vote by visiting this website.

Same-day registration

See also: Same-day voter registration

Utah allows same-day voter registration at polling places during the 10 days preceding and on Election Day.

Residency requirements

Prospective voters must be residents of the state for at least 30 days before the election.

Verification of citizenship

See also: Laws permitting noncitizens to vote in the United States

Utah does not require proof of citizenship for voter registration. An individual must attest that they are a U.S. citizen when registering to vote. According to the state's voter registration application, a person who commits fraudulent registration is "guilty of a class A misdemeanor" under Utah Code 20A-2-401.

All 49 states with voter registration systems require applicants to declare that they are U.S. citizens in order to register to vote in state and federal elections, under penalty of perjury or other punishment. Seven states — Alabama, Arizona, Georgia, Kansas, Louisiana, New Hampshire, and Wyoming — have laws requiring verification of citizenship at the time of voter registration, whether in effect or not. In three states — California, Maryland, and Vermont — at least one local jurisdiction allows noncitizens to vote in some local elections. Noncitizens registering to vote in those elections must complete a voter registration application provided by the local jurisdiction and are not eligible to register as state or federal voters.

Verifying your registration

The Utah lieutenant governor’s office allows residents to check their voter registration status online by visiting this website.

Voter ID requirements

Utah requires in-person voters to present non-photo identification while voting.

The following list of accepted ID was current as of May 2025:

“

"Valid voter identification" means: a form of identification that bears the name and photograph of the voter which may include: a currently valid Utah driver license; a currently valid identification card issued under Title 53, Chapter 3, Part 8, Identification Card Act; a currently valid identification card that is issued by: the state; or a branch, department, or agency of the United States; a currently valid Utah permit to carry a concealed weapon; a currently valid United States passport; or a currently valid United States military identification card; one of the following identification cards, regardless of whether the card includes a photograph of the voter: a valid tribal identification card; a Bureau of Indian Affairs card; or a tribal treaty card; or two forms of identification not listed under Subsection (79)(a) or (b) but that bear the name of the voter and provide evidence that the voter resides in the voting precinct, which may include: before January 1, 2029, an original or copy of a current utility bill, dated no more than 90 calendar days before the date of the election; before January 1, 2029, an original or copy of a bank or other financial account statement, dated no more than 90 calendar days before the date of the election; a certified birth certificate; a valid social security card; an original or copy of a check issued by the state or the federal government, dated no more than 90 calendar days before the date of the election; an original or copy of a paycheck from the voter's employer, dated no more than 90 calendar days before the date of the election; a currently valid Utah hunting or fishing license; certified naturalization documentation; a currently valid license issued by an authorized agency of the United States; a certified copy of court records showing the voter's adoption or name change; a valid Medicaid card, Medicare card, or Electronic Benefits Transfer Card; a currently valid identification card issued by: a local government within the state; an employer for an employee; or a college, university, technical school, or professional school located within the state; or a current Utah vehicle registration.

”

Click here for the Utah statute defining accepted ID to ensure you have the most current information.

See also

2018 measures

• 2018 ballot measures
• Healthcare on the ballot
• Taxes on the ballot

Utah

• Utah ballot measures
• Utah ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls

External links

• Utah Lt. Governor: 2018 Statewide Ballot Questions

Support

• Yes on 3 - Utah Decides Healthcare website
• Yes on 3 - Utah Decides Healthcare Facebook
• Yes on 3 - Utah Decides Healthcare Twitter
• Yes on 3 - Utah Decides Healthcare YouTube

Opposition

Email links to editor@ballotpedia.org.