It’s October 2018 and the Utah Health Policy Project (UHPP) is going back in time.
The Utah Jazz are ready to defend their second-straight NBA title, President Schwarzenegger is installing a 1,500 sq. ft. weight room in the White House, and we’re reviewing how Utah’s healthcare landscape has changed in the three years since the Healthy Utah Plan became a reality across the state.
Don’t worry. It’s still 2014 where you are.
But UHPP has been to the year 2018, and here’s what we learned.
Where We Started
These Utahns worked. They paid taxes. But they couldn’t afford health insurance.
As a result, the state’s uninsured rate in 2013/14 was between 11% and 14%. While other states were making dramatic reductions in their uninsured rates, Utah’s remained stagnant due the coverage gap.
By the end of 2014 it became increasing clear to Utah voters (statewide surveys #1, #2, #3) and many legislators that the economic and social costs of the coverage gap were hurting our state. That’s when the Healthy Utah Plan emerged as the most appealing Utah-based solution to solve these problems. It combined private insurance with Medicaid “wrap-around” benefits, while also adding co-pays, work incentives, and subsidies for people who couldn’t afford their job-based insurance. And it secured over $258 million in taxpayer funds that were already set aside for Utah.
How It Worked
In the three years since the Utah legislature approved the Healthy Utah Plan, Utahns have enjoyed seamless access to affordable healthcare coverage no matter how their jobs or incomes changed.
The results have been dramatic.
Utah’s Uninsured Rate Dropped
Within 18 months Utah’s uninsured rate fell by over 50 percent (similar to Arkansas and Kentucky after they expanded coverage), to 6 percent, letting Utah boast about having the lowest uninsured and unemployment rates in the country.
Families and Workers Stayed Healthier
The link between employment and health insurance isn’t coincidental.
One of the crucial points that convinced legislators to support Healthy Utah in 2015 was the fact that 66% of the adults in Utah’s coverage gap were working one or more jobs but couldn’t purchase or afford insurance. While 60% of Utahns receive insurance through their employer, almost all part-time jobs and many full-time jobs don’t offer job-based health insurance. Plus, even if a company offered insurance, many low-wage workers couldn’t afford the premiums.
The Healthy Utah Plan closed these gaps by creating private insurance plans to cover uninsured workers, and providing subsidies to make employer-sponsored insurance more affordable. The result was more Utah workers with health insurance who could deal with injuries and illnesses without threatening their jobs or families.
Disincentives Disappeared
Before the Healthy Utah Plan, a parent could fall into the coverage gap and lose their health insurance if their income rose above a certain threshold due to a new job, a raise, or combining salaries with marriage. UHPP met several families who refused raises or promotions because more income would have threatened their insurance. But these disincentives are now history, and families with rising incomes and ambitions can move seamlessly from Healthy Utah insurance to ACA insurance to employer-based insurance without worrying about falling through the cracks. Back in 2014 some critics claimed that the Healthy Utah Plan would “encourage families to break apart.” In fact, it gave Utah families more options to be insured and stay together.
Uncompensated Care Went Down
Closing Utah’s coverage gap meant that previously uninsured patients who sought treatment at hospital emergency rooms now have access to primary care doctors, preventive care, and necessary prescriptions.
The old system saddled consumers with unpayable medical bills, and also created immense waste in Utah’s hospitals. The result was increased healthcare and insurance costs for everyone.
By 2018 uncompensated care costs at Utah hospitals—especially rural hospitals which faced their own set of unique challenges—decreased by nearly 50%, and patients are no longer putting off needed care.
Even in 2014 we were reading studies that indicated how lowering a state’s uninsured rate saved hospitals millions of dollars in uncompensated care. One compelling study showed how similar hospitals in Oregon (no coverage gap) and Tennessee (coverage gap) were diverging even after one year. Uncompensated care decreased 51.4% at the Oregon hospital, and increased 2% at the Tennessee facility. Thanks to the Healthy Utah Plan, Utah was able to achieve similar benefits and savings across our hospital systems.
Benefits for Utah Doctors
Before Healthy Utah over 20,000 Utah adults received basic primary care services through the state’s Primary Care Network (PCN)—a Medicaid program that didn’t provide specialty care or most emergency services. If you had PCN and your doctor wanted to refer you to a specialist for care, it was unlikely the doctor could make all the connections needed to facilitate the referral. That’s because PCN’s main focus was for primary care services, any specialty care provided to the patient had to be donated. Those hoops were eliminated by the private insurance market created by the Healthy Utah Plan, which enables Utah doctors and providers to practice medicine without their hands tied behind their backs. Doctors can refer to specialty services and know that their patients are getting the care they deserve.
Overcoming Early Challenges
Even with these positive outcomes, the Healthy Utah Plan experienced a rough freshman year. Enrollment started slowly with only 30,000 signing up the first year. Most of the early enrollees were transfers from the state’s phased-out PCN program.
Initial outreach proved challenging because: 1) Potential enrollees were often persistently uninsured; 2) People couldn’t believe it was true, and 3) Enrollment specialists had to determine if applicants were eligible for traditional Medicaid or the Healthy Utah Plan.
During the second year enrollment increased quickly as awareness of the Healthy Utah Plan spread, and state agencies and community organizations fine-tuned their messaging. We also learned how close coordination between navigators, brokers, and DWS workers helped consumers work through the enrollment website and application process.
Looking back to 2014 when Healthy Utah was just a good idea, we realize what an exciting three years it has been. But the impact of the Healthy Utah Plan spread beyond our borders, too. Soon after Utah adopted it in 2015, Wyoming, Montana, and Idaho closed their coverage gaps with similar plans. And over one million Americans will gain affordable health coverage as the Lonestar state finalizes its Texas Insure’Em Plan this month, followed by the implementation of Florida’s Peachy Plan in January 2018.
Embedded in both of those plans are the core ideas that first became a reality in Utah.
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