The scene Wednesday was very much like one where rescuers had rushed to a coal mine collapse or a crash involving a school bus.
After quickly determining that maybe 20 people were already dead, they turned to the urgent task of rescuing two people who were still clinging to life and, after many hours of intense but delicate efforts, succeeded in setting them free.
The joy and celebration felt at the success of that rescue is genuine and well earned. But it comes at the expense of ignoring what was lost.
As of Wednesday, the state of Utah’s decision to refuse the expansion of Medicaid under the original Affordable Care Act had cost Utah taxpayers, health care providers and patients a total of $1.1 billion since the offer was first made in 2014.
That water over the dam, elected officials and activists of all levels and stripes were understandably elated that the federal government announced its approval Wednesday of the state’s plan to debase itself to accept a tiny fraction of that amount to provide health care services — specifically substance abuse and mental health treatment — mostly to some 6,000 individuals who are homeless and/or in the criminal justice system.
It is good news.
Utah is better off with this program than without it. The need is real. The services the federal money will provide are key to the success of Operation Rio Grande, the multi-jurisdictional effort to attack the interrelated curses of homelessness, addiction, mental illness and crime that had become so visible in the Pioneer Park neighborhood in recent months.
The long-term goal of that operation, in keeping with the philosophy of the Legislature’s 2015 Justice Reinvestment Initiative, was to adopt an approach that was at once fiscally responsible and humane. One that stresses rehabilitation over incarceration for drug abusers and treatment over warehousing for the mentally ill.
The only flaw in the plan was that the funding for detox, rehab and treatment facilities— even though they cost less than the prison beds they would replace — never completely came through. Wednesday’s news goes a long way toward filling that gap.
To join with state officials to win the very limited waiver to federal Medicaid rules to serve such a narrow group of beneficiaries required local officials and advocates for the poor to set aside any concern they might — should — still have had about the tens of thousands of other Utahns who would have had access to 21st century-levels of health care years ago if full Medicaid expansion had been accepted.
Or if the Legislature had accepted Gov. Gary Herbert’s state-specific Healthy Utah plan, first rolled out in 2014, that would have covered maybe 146,000 low-income Utahns and clawed back millions more of the federal taxes Utah residents have already paid.
This narrowly targeted Medicaid program was unlikely to be approved by the Obama administration (or a Clinton administration) as it ignored the whole purpose of the ACA. Only with Donald Trump in office was acceptance likely.
Wednesday, that’s what happened. It is very good news for a very few people.
So, yes, celebrate and share the credit. But don’t forget what was lost.