As the debate over how to expand Medicaid for an estimated 53,000 Utahns in the coverage gap continues, some Utah Republican lawmakers who favor expansion are being pressured by a national organization to back down.
Americans for Prosperity (AFP) is the political advocacy group bankrolled by conservative billionaire brothers David and Charles Koch. With local offices in 36 states, including Utah, AFP is not required to disclose its donors because of its tax-exempt nonprofit status.
But, of the many issues AFP advocates for, few engage the public's attention as much as Medicaid expansion. The Kochs oppose it.
That issue was at the center of AFP's first foray into Beehive State politics. In June 2015, it sent out mailers to residents in 11 different Utah House districts touting the death of Healthy Utah, Gov. Gary Herbert's Medicaid expansion plan. (The plan was approved by the state Senate, but was killed in the House during the 2015 legislative session).
According to the AFP, their efforts are meant to engage the public in issues important to lawmakers. Evelyn Everton, director of Americans for Prosperity's Utah office, wrote in an emailed statement, "We hear from Utah legislators every day who are thankful to have an advocate in the fight to help them advance the principles of freedom and economic liberty in Utah."
But some legislators are not convinced the AFP's tactics are helpful. Since June, AFP has sent out wave after wave of mailers blasting Medicaid expansion, particularly targeting mailboxes in Republican districts whose representatives might be open to some form of expansion.
Rep. Sophia DiCaro, R-West Valley City, says her district has been hit three times. The AFP mailers were "one-sided and really just trying to stir up emotions," DiCaro says. "They really touched one angle of the issue."
The mailers often bear the name and likeness of the representative, which has some lawmakers concerned the campaign could confuse voters. DiCaro says she got a lot of calls from upset constituents on both sides of the issue after the mailers started arriving in voters' mailboxes.
The AFP's involvement hasn't always been well-received in other conservative states. Earlier this year, a news story in the Flathead County, Montana, Flathead Beacon reported that conservative voters booed and shouted at the Montana AFP chapter's town-hall meeting, after the group sent out an attack mailer against a Republican legislator who had refused to sign a pledge that he would oppose Medicaid expansion no matter what.
"You have pissed me off," one voter said. "Character assassination does not go down well in Montana. If he has to take a pledge, then I want it to be the Pledge of Allegiance"
The Arkansas Times of Little Rock ran a scathing editorial, accusing the local AFP chapter of misleading voters about the differences between Medicaid and private insurance. "It's almost as if they're willing to toss out any argument against the 'private option' they can come up with," the Times wrote, "even if it bears no coherent relationship to the facts or their ideological position."
Colorado TV station 9News rolled out a fact-checking segment called Truth Test, which spent several minutes debunking AFP claims that "millions of people have lost their health insurance" because of the Affordable Care Act.
While it's true millions of people received cancellation notices because their old plans didn't meet the ACA quality standards, 9News responded, those insurance companies were required by law to replace cancelled plans with more robust coverage.
In Utah, AFP's claims have been just as misleading, says Rep. Ray Ward, R-Bountiful, a physician whose district was hit with AFP Utah mailers. One of these mailers accused the representative of supporting a "sick tax," and featured a black & white photo of a sick child on a hospital gurney.
"It's always discouraging when money from outside the district comes in to attack you, and it's not just the mailers," Ward says—and many House Republicans are getting fed up with the AFP making misleading claims that confuse constituents. "Many of us have also seen AFP making robo-calls to our districts, and we get tied up for days having to explain that there's no such thing as a 'sick tax,'" he says.
But the AFP's Everton does not believe the mailers are misleading. In her emailed statement, she says that fees on doctors in the Utah Access Plus plan "would have inevitably been passed on to patients and the sick"—thus, the AFP's so-called sick tax.
Ward says it's hard to measure how effective the direct-mail campaign has been, but says that the AFP certainly has a leg up on locally elected politicians, since having a well-funded organization "allows them to be organized in a way that home-grown Utah groups can't."
"It's really irritating," says Rep. DiCaro. "All they're doing is hurting Republicans. The approach is just very disappointing."