Originally published in Utah Business.

I serve on the board of Primary Children’s Hospital. At a recent board retreat we heard a compelling presentation about Healthy Utah from David Patton, the executive director of the Utah Department of Health. Healthy Utah is Utah’s alternative to full Medicaid expansion, and Patton is on point for Gov. Gary Herbert. I think the governor has created and negotiated an innovative and elegant policy solution to a difficult and complex policy problem. The Utah Legislature should support the Healthy Utah proposal.

At first blush, a children’s hospital board seems like the wrong audience for discussing Medicaid expansion because Medicaid already covers children from low-income families. But it didn’t take long for me, and many of my fellow board members, to recognize the connection between children and adults. Family issues are children’s issues. Utah families suffer when they don’t have health insurance.

The success of Utah’s economy is widely known. Unemployment is low, job growth is healthy and every major industry is growing. But there is a dark shadow still present in the state’s economy. Far too many Utahns live at or near the poverty level and are without health insurance. We pride ourselves on being a state with strong family values, but there is nothing pro-family about an estimated 377,000 Utahns without health coverage. We can do better.

A Laudable Goal

The Utah Department of Health estimates Healthy Utah will provide 92,000 low-income Utahns with health insurance coverage. These individuals are adults between the ages of 19 and 64 who earn less than $15,521 per year. The federal government will pay the full costs for the first two years of this coverage (we lost a year of federal funding by not acting sooner). In subsequent years federal government support will be less, but never lower than 90 percent.

Providing this insurance is a laudable policy goal and right for Utah families so long as it is done correctly. We have to carefully navigate the balance between fiscal prudence and needed assistance. The governor’s plan finds this balance.

First, the plan promotes individual responsibility. Herbert’s plan does this by charging premiums for higher-income adults, charging co-pays from all adults, offering incentives for healthy behaviors and providing support for job training. Nobody gets a free ride under the Healthy Utah proposal. Everyone has skin in the game.

Second, the plan supports private markets. Herbert’s plan uses employer-sponsored insurance when available and provides assistance to purchase private market plans. In Utah we believe in free enterprise, and the governor’s plan places as many people in the private market as feasible.

Third, the plan maintains Utah’s fiscal discipline, a trademark value of the Utah Legislature and a hallmark of Utah public policy. The governor says the state will terminate the plan if federal funding fails to be provided as promised. Importantly, the state recoups approximately $258 million annually in taxes we pay to the federal government. By passing Healthy Utah, our Legislature will bring this money back to our state and secure needed healthcare services.

An Ongoing Debate

Some will say we shouldn’t take the federal money. This sentiment is so strong that an old Utah saying about Utah-federal relations has been twisted to go like this: “We use to say send us your money and leave us alone. Now we just say leave us alone.” I understand this sentiment. It’s a hard sale to co-mingle Utah’s fiscally responsible budget practices with the irresponsibility of the federal government. Still, I don’t think it is fiscally smart, nor in the state’s long-term interest, to deny Utahns health insurance coverage when we have a carefully crafted approach like Healthy Utah. Vulnerable populations can’t go at it alone. Under Herbert’s carefully crafted plan we land the right balance.

The Affordable Care Act isn’t for Utah, but Healthy Utah is. We are different than the nation. Our population is younger and healthier. The portion of our population that is uninsured is higher. Our healthcare system provides greater value than most states, and we get a favorable Medicaid match rate. In Utah we value fiscal discipline, individual responsibility and free enterprise. For all of these reasons we are advantaged if we approach Medicaid expansion with caution. It’s all about creating an original and well-designed solution for a unique state. It’s about serving Utah children and families.