SALT LAKE CITY, Utah — In November, Utah’s voters defied their state legislature and moved to adopt Obamacare’s Medicaid expansion in the state. With strong majority support, Utahns passed Proposition 3, a ballot initiative that would expand Medicaid coverage to all poor and near-poor adults. Joining Idaho and Nebraska, Republican-led states that passed similar initiatives in November, Utah reflected a divide between political leadership in ruby-red states—which has often opposed anything to do with Barack Obama’s signature policy—and the will of even Republican voters, who often like the plan and the prospect of more affordable coverage for more people.
But Utah, like some other Republican-led states where the Medicaid expansion has received support from the electorate, is now seeing immediate challenges to the law passed by popular democracy. With legislators tasked with crafting the sales tax and the budgetary changes needed to implement Proposition 3’s coverage, the GOP is pushing to add restrictions to benefits and eligibility of the expanded Medicaid program. Citing budgetary concerns, Republican legislators say they are doing what they can to advance the wishes of voters and the mandate to expand insurance, while also being fiscally responsible. But supporters of the proposition see in these plans a stealthy maneuver to repeal and replace the expansion before it even exists, and see it as part of a larger movement by Republicans nationwide to stonewall the progress of expanded health insurance, even when it runs counter to what their constituents want.