As the federal negotiations wind down, all eyes turn to the Utah legislature and their necessary but uncertain role in closing the coverage gap.
These are some of the tough questions we get at UHPP.
- What is the Healthy Utah Plan?
- Why hasn’t Gov. Herbert moved faster to close the coverage gap?
- Who serves the best fry sauce in Utah?
After two years of glacial progress—and occasional retreats—efforts to close Utah’s coverage gap are moving towards the legislative finish-line.
As a reminder, the Healthy Utah Plan (1-page overview) is Gov. Herbert’s proposal to offer subsidized private health insurance to Utahns caught in the coverage gap. These are the 45,000 Utahns who earn too much or otherwise don’t qualify for Medicaid, or earn too little to receive premium subsidies to buy insurance on healthcare.gov. These Utahns—mostly working adults, many with kids—represent the last missing piece to Utah’s health coverage puzzle.
So far 27 states have either expanded Medicaid or pursued “private option” plans similar to Healthy Utah. According to the Advisory Board, the unofficial Medicaid Expansion score-keeper, Utah is among three states “considering expansion,” a category that does not include the “heck no” states like Mississippi, Alabama and Texas.
So what happened in Utah during the summer of 2014?
In a word: Tons. And the best-case scenario is that the Healthy Utah Plan will be debated and voted on in a special legislative session, or more likely during the 2015 Legislative General Session that begins in late January.
But we all know that best-case-scenarios rarely happen. Especially in Utah. Especially in the state legislature. Plus, the "conceptual" agreement between Gov. Herbert and the feds could unravel over the next few weeks.
What we can say is that a host of stakeholders including local chambers of commerce, the hospital association, and the advocate community have made significant progress over the last two years—and leaps and bounds during the last few months.
Here’s a brief update on what’s been happening on all fronts:
Negotiating with the Feds
Since March Gov. Herbert has been giving frequent updates on the state’s ongoing negotiations with the federal Department of Health and Human Services (HHS). Staffers from both sides have whittled down the list of outstanding issues to about half a dozen. These issues—ranging from Utah’s requirement for higher cost-sharing for consumers earning above the poverty level, to extra charges for inappropriate use of the emergency room—were slowly turned from “red lights” to “green lights” as Utah gained approval from HHS. One of the last remaining “red lights” was Utah’s demand that participants seek work training or job assistance in order to receive their new health benefits.
On September 9th Gov. Herbert reported from Washington, DC that he reached a “conceptual” agreement on the Healthy Utah Plan that cast the “work effort” requirement as component of coverage, not a prerequisite for coverage. The governor also described the negotiations as being 95% approved. After he announced the tentative agreement, he said Utah and the federal government should have the remaining details worked out within two to three weeks—which indicates a final agreement date in late September. We are now waiting for more detailed language on the “work-effort requirement” and whether it will be an “opt-in” or “opt-out” program administered in conjunction with the Healthy Utah coverage.
Gaining Public Support
Over the past few months we’ve seen numerous independent polls showing significant support among Utah voters to increase access to affordable healthcare coverage in Utah. These polls also show strong support for the Healthy Utah Plan in direct comparison to other plans, or doing nothing.
Here’s a summary:
- UtahPolicy.com/Dan Jones Poll (link | 54% of Utah voters prefer the Healthy Utah plan, 23% prefer traditional Medicaid expansion [September 2014]
- Dan Jones/Notalys Poll (link) | 70% of Utah voters prefer the Healthy Utah plan, 30% prefer traditional Medicaid expansion (88% of Utahns support Healthy Utah over doing nothing) [June 2014]
- BYU Data Points Poll (link) | 43% of Utah voters prefer the Governor’s plan, 33% prefer traditional Medicaid expansion, 13% prefer to do nothing, 11% prefer the Speaker’s plan [May 2014]
Healthy Utah Roadshow
From Logan to Provo to St. George, a group of community organizations including UHPP, Voices for Utah Children, AARP, and AUCH have been inviting community stakeholders to learn about the Governor’s Healthy Utah Plan from the experts who are putting it together. The events include a policy briefing, followed by an opportunity for local leaders to ask questions of representatives from the Utah Department of Health and the Governor’s Cabinet. Each event has encouraged a lively exchange of ideas and generated significant local media coverage on this important issue.
So far we’ve held events in Provo, St. George, Clearfield, Logan, Ogden, and will hold one more in Taylorsville in early October.
Winners & Losers in Healthcare Reform
In August a national survey (Gallup Healthways Well-Being Index) indicated that the states who sought to maximize the benefits of the Affordable Care Act (ACA) also saw a dramatic drop in their uninsured rate. In one year, the uninsured rate in Arkansas dropped from 22.5% to 12.4%--a 45% decline. Kentucky saw a 42% drop. The ten states that reported the largest declines in uninsured rates (see chart here) expanded Medicaid and established a state-based marketplace exchange or state-federal partnership.
Utah prides itself on being unique for a variety of reasons.
Some of Utah’s unique factors include:
- A low unemployment rate
- A lower prevalence of disease
- Lower than average healthcare expenditures
- A competitive insurance market.
But unless Utah increases access to healthcare coverage for its low-income residents, our uninsured rate—and the host of medical and economic burdens generated by inefficient health-care access—will continue to drag down our state
The Next Steps (Really) on the Healthy Utah Plan:
As Gov. Herbert’s staff finishes the federal negotiations over the Healthy Utah Plan, attention will turn to the Utah Capitol and the task of convincing enough legislators to vote their approval.
And if Gov. Herbert thought federal bureaucrats were tough and intransigent, then he hasn’t been attending enough Health Reform Task Force meetings.
For the past two years we’ve listened to earnest arguments like:
- Giving parents access to health insurance will make their kids worse off (link)
- Employers will drop their insurance plans for
400,000(link), or maybe 200,000 workers (link)
- Expanding coverage to 45,000 people will eliminate 14,000 jobs (link)
- Charity care is a good alternative to access to health insurance (link)
- Access to hospitals can be dangerous for Utahns (link)
All of these arguments have been countered by facts and common sense. It is time for Utah lawmakers to face this issue, learn the detailed arguments, listen to their constituents and special interests, and make a decision. After all, the upcoming general session will be the third legislative gathering in Utah to debate this issue—while 45,000 Utahns continue to live without access to affordable health insurance.
Want to Get Involved?
Refer to our this issue of Health Matters in
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