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Thursday, April 23, 2015

Calendar: April 2015

Conferences / Events

May 5-6, 2015
5th Annual Conference on Poverty
Organized by the Community Action Partnership of Utah
Location: TBD
Registration (link)

Thursday, May 9, 2015
Susan G. Komen Race for the Cure
Library Square, Salt Lake City, UT
Registration (link)

Thursday, May 14, 2015
Designing a Medicaid Expansion That is Fiscally Responsible
Utah Breakfast Club Event
Utah State Capitol Complex, State Office Building Auditorium
Registration (link)

Thursday, May 14, 2015
Utah Cancer Action Network (UCAN) Conference
DoubleTree by Hilton (SLC Airport)
5151 Wiley Post Way, Salt Lake City, UT 84116
Registration (link)
Flyer (link)

Thursday, May 14, 2015
Panel discussion on Intergenerational Poverty and Utah’s Future
Presented by the Economic Club of Utah
Rose Wagner Theater
138 West 300 South, Salt Lake City, UT
Information / free registration (link)

May 14-15, 2015
AUCH Annual Primary Care Conference
Utah Cultural Celebration Center
1355 West 3100 South, West Valley City, UT 841
Registration (link)

Medicaid Expansion Events / Meetings
Health Care Roundtable
>>A bi-weekly (1st and 3rd Wednesdays) gathering of advocates, stakeholders, and others interested in health policy and legislation in Utah, especially Medicaid Expansion

Wednesday, May 6, 2015
Organization: Health Care Roundtable
Location: American Cancer Society (941 E. 3300 S,  #100, Salt Lake City, UT)
Time: 1:15pm-2:15pm
Contact:  RyLee Curtis (email)
Information: Get added to Friday Digest Email by contacting RyLee Curtis (email)

Wednesday, May 20, 2015
Organization: Health Care Roundtable
Location: Utah Capitol – Senate (West) Building, Olmsted Room (map)
Time: 1:15pm-2:15pm
Contact:  RyLee Curtis (email)
Information: Get added to Friday Digest Email by contacting RyLee Curtis (email)

Wednesday, May 20, 2015
Coverage Gap Event
Utah State Capitol
Information: TBA

Friday, July 31, 2015
Deadline for Committee of Six to reach compromise plan for closing Utah’s Coverage Gap
Rally at the State Capitol
Facebook event information (link)

ACA Events/Deadlines
April 30, 2015
Last day to qualify for a “tax season” special enrollment opportunity on
More information (link)
For assistance - contact Take Care Utah (link) or call 2-1-1

June 15-30, 2015
Expected King v. Burwell decision from the U.S. Supreme Court about the future of ACA subsidies

November 1, 2015
First day of Open Enrollment on
For assistance - contact Take Care Utah (link) or call 2-1-1

Accountable Care Goes Rural

This summer the state of Utah plans to extend the range of the state’s Medicaid Accountable Care Organizations (ACOs) to nine more counties, including rural areas for the first time.

Utah rolled out its ACO project in January 2013 with four Wasatch Front counties—Salt Lake, Utah, Davis, and Weber—that collectively account for 70% of the state’s Medicaid population. Consumers can choose among four separate Medicaid ACO providers: Health Choice Utah, Healthy U, Molina Healthcare, and SelectHealth Community Care.
What are ACOs?
Accountable Care Organizations (ACOs), also called a Managed Care Organizations, (MCOs) are a provider-run organization in which the participating providers are collectively responsible for the care of an enrolled population, and also may share in any savings associated with improvements in the quality and efficiency of the care they provide. ACOs typically replace the traditional “fee for service” model for healthcare delivery in which providers are compensated for each test or service they provide. When operating under the ACO system, participating providers and healthcare agencies (ie. hospitals) are “at risk” for both potential savings and losses created by the coordinated care.
After state funding for the extension as approved during the 2015 Utah legislative session, the Utah Dept. of Health announced that ACOs will start offering managed care coverage in these nine counties by July 1, 2015:
  • Cache
  • Rich
  • Morgan
  • Box Elder
  • Tooele
  • Wasatch
  • Summit
  • Iron
  • Washington
The extension will occur in all nine counties starting July 1, 2015. The state will also schedule public hearings on the extension process in May. Follow UHPP’s website, Facebook page, and future issues of Health Matters for the date, time, and location of these hearings.

Medicaid ACO Open Enrollment
In other news, Medicaid open enrollment for the existing ACOs will take place May 15-June 15, 2015. Consumers can change health plans during open enrollment for any reason. Any changes will take effect on July 1, 2015.

Minutes from the March 19, 2015 meeting of the Medical Care Advisory Committee (MCAC) 
(See Medicaid ACO Report on page 5)

The Longest Game in Town

As Medicaid expansion heads into overtime, fans of closing the coverage gap must stay in this game 

If you left the 2015 Utah legislative session wondering, “What happened to Medicaid expansion?” you aren’t alone. Many Utahns were shocked when the session ended on March 12 with no solution. 

At first it seemed like something would get done. By mid-February four different coverage bills were competing for attention and votes. It seemed that anyone could create a Medicaid bill by slapping an adjective next to “Utah,” blaming the federal government, and calling a press conference. By early March legislative leaders were begging reporters to stop peppering them with Medicaid Expansion questions and ask them instead about simple issues like the gas tax formula. 
But in the end, Gov. Herbert’s Healthy Utah plan was defeated in a House committee, while competing plans were similarly neutralized. The 72,000 Utahns living in the coverage gap—and their equally numerous supporters—were left with nothing except hoarse lungs and elevated blood pressure. For a session that started with bold pledges to tackle big and transformative issues, the Medicaid expansion debate ended with a whimper and most post-mortems of the 2015 session labeled the whole process a failure in governance.

So is it even worthwhile to review what happened? We think yes, because the strongest arguments and the biggest misperceptions raised during the session still matter as the debate goes into overtime. 

But since a normal legislative recap is boring, we've re-imagined the 2015 legislative session as a playoff-style showdown between Healthy Utah and the field of coverage plans that rose to challenge it. The only caveat to this approach is that Utah’s Medicaid politics isn’t a game when your family’s well-being depends on the outcome--and we know thousands of Utahns waiting for this "game" to end.
So with apologies in advance, let’s review this year’s legislative session like ESPN would. 

Round 1: Healthy Utah vs. Frail Utah
In December 2014 the Health Reform Task Force attempted to disqualify the Healthy Utah Plan even before the competition got underway. During a December 18th meeting, a majority of the task force surprised many in the audience when they bypassed the governor’s plan to recommend a limited Medicaid expansion that would cover 100,000 fewer lives. Despite months of task force discussions on the benefits of closing the coverage gap and meeting the mental and behavioral health needs of the uninsured, the task force decided to pinch-run an untested coverage plan that was later dubbed “Frail Utah” in a clever op-ed written by Rep. Brian King (D-Salt Lake).

Dressed in the uniform of S.B. 153 and sponsored by Sen. Allen Christensen (R-Ogden), Frail Utah would have extended Medicaid coverage to Utahns earning under 100% of the federal poverty level (FPL) who are also medically frail, uninsured, and vulnerable to becoming disabled. And because Frail Utah did not come close to fixing the overage gap, the federal government would only cover 70% of the total cost, leaving the state responsible for 30% of the cost. In contrast, Healthy Utah triggers the “enhanced” ongoing match rate of 90% federal funds and 10% state funds—a significant difference when calculating the total state cost of closing the gap. On February 17 the Senate Health and Human Services (HHS) Committee advanced the Frail Utah bill, but nine days later the full Senate defeated Frail Utah in 17-9 vote, and sent it back to the locker room.

Around the same time S.B. 164, the ball-carrier for the governor’s Healthy Utah plan, also had its debut in the Senate HHS Committee. Like its frail counterpart, the Healthy Utah bill also advanced to the full Senate. But before it could be voted on, sponsor Sen. Brian Shiozawa (R-Cottonwood Heights) changed Healthy Utah from a three-year pilot program to a two-year pilot with an automatic sunset. These changes were designed to make Healthy Utah more attractive to conservative lawmakers concerned about the long-term cost of the plan. After an afternoon of serious debate, the full Senate passed the revised Healthy Utah plan with a 17-11 vote. You can find UHPP’s one-page scouting report about Frail Utah and Healthy Utah here.

Result: Healthy Utah soundly beat Frail Utah in a Senate showdown, but how well would it play as a visiting team in the House?

Round 2: Healthy Utah vs. House Leadership
Healthy Utah’s initial reception at the Utah House is not unlike a football fan wearing Ute red to a BYU game, or BYU Blue to Rice Eccles Stadium. Immediate hostility puts it mildly.

After straw polls were taken in closed House Republican caucus meetings, Speaker Greg Hughes R-Draper) announced that the Healthy Utah bill would not be heard by the House.

“Healthy Utah, as it passed out of the Senate, does not have legs in the House. At all,” he told FOX13 News in late February. Claiming that public hearings on the bill would only be “political pageantry,” Hughes benched the Healthy Utah bill at the House Rules committee.

But two weeks of pressure from the local media (including strongly-worded editorials from Utah’s four major newspapers SLT, DN, DH, SE), the public, advocates, and other lawmakers, Speaker Hughes announced that Healthy Utah and a newly created plan called Utah Cares would face-off in the House Business and Labor Committee.

Result: Healthy Utah beat the House leadership in a two-week staring contest after Speaker Hughes blinked and the House suited up a last-minute player called “Utah Cares.”

Round 3: Healthy Utah vs. Utah Cares
H.B. 446, dubbed Utah Cares, was drafted and sponsored by Majority Leader Rep. Jim Dunnigan (R-Taylorsville) as a slightly upgraded version of 2014’s “Access Utah” plan. Utah Cares would extend Medicaid to cover about 21,000 childless adults and parents with dependent children, and use Utah’s Primary Care Network (PCN) to cover 20,000 others earning under 100% FPL. Because Utah Cares did not meet criteria set forth by the ACA, the federal government would only cover 70% of the cost—assuming the plan could even get approved by the federal referees. As a result, Utah Cares would cost the state $64 million (2015-2017) and return only $82 million in taxpayer dollars.

On Wednesday March 4 a standing-room crowd witnessed a head-to-head match-up of Utah Cares vs. Healthy Utah at the House Business and Labor Committee.

First in the arena was Healthy Utah, which Sen. Shiozawa ably presented by highlighting the plan’s two-year timeframe, support for private insurance, and lower overall cost. During the public comment that followed, 20 individuals and organizations spoke in support of Healthy Utah—including the Utah Medical Association, the Salt Lake Chamber, and several Utahns in the coverage gap. But despite these efforts, the committee voted 9-4 to defeat Healthy Utah to end its winning streak and its 2015 legislature season. Two Republican members of the committee; Rep. Gage Froerer (R-Huntsville) and Rep. Curt Webb voted in favor of Healthy Utah that night.

Following the defeat of Healthy Utah, Rep. Jim Dunnigan presented the Utah Cares plan to the committee, claiming it was more conservative and sustainable than Healthy Utah, while providing “good” coverage. Three organizations spoke against Utah Cares during public comment: UHPP, Utah Academy of Family Physicians, and the Disability Law Center. In addition, Salt Lake County resident Kip Griffith explained how PCN limited the ability of his doctor to treat his wife’s persistent medical issue. After several questions to Rep. Dunnigan, the committee voted 9-4 to approve Utah Cares and send it to the next game at the House. You can find UHPP’s one-page comparison of Utah Cares and Healthy Utah here.

Result: The home field advantage of the House Business and Labor Committee proved too much for Healthy Utah, while Utah Cares easily sailed through.

Round 4: Healthy Utah vs. The House
The day after the defeat of Healthy Utah in committee, the dozen House Democrats attempted to resurrect Healthy Utah from the purgatory of the Rules committee. In an unusually dramatic showdown, four Republicans voted with all 12 House Democrats to raise the Healthy Utah bill, but the attempt failed on a recorded 16-56 vote. When the alternative Utah Cares bill appeared before the full House on March 6, Democrats tried a similar tactic when Rep. Rebecca Chavez-Houck (D-Salt Lake City) motioned to substitute Healthy Utah for Utah Cares, eliciting another angry response from House Republicans. But that attempt failed, and after extending minimal mental health access to PCN (ie. the amendment didn’t add mental health benefits, but merely expanded the list of providers could prescribe psychotropic drugs), the House voted 56-18 to approve Utah Cares and send it to the Senate, where it lingered and died with no action.

Result: While attempts to revive Healthy Utah in the House failed, they did force all House members to publicly vote on the plan, a transparent action that leadership wanted to avoid.

Round 5: Healthy Utah vs. Overtime
As final hours of the 2015 legislative session ticked away with no compromise plan to close Utah’s coverage gap, Gov. Herbert held a press conference to announce that this contest would go into overtime. Citing the need for “more time to work together and agree on one specific resolution,” both the House and Senate quickly passed HCR 12 to create a special leadership committee charged with finding a solution before July 31, 2015. The six members of this super healthcare committee are: Gov. Herbert, Lt. Gov. Cox, Speaker Hughes, Senate President Niederhauser, Rep. Dunnigan, and Sen. Shiozawa. Because this committee will meet behind closed doors, some Utah groups have criticized the lack of transparency involved in any deal that can be reached. Democratic lawmakers—who have consistently supported the Healthy Utah Plan—also objected to their exclusion from the committee.

Result: No sports matches (even cricket matches) last three years, but Utah’s Medicaid expansion contest is about to reach that milestone. Plus, the ongoing deliberations by the “Gang of Six” mean that the campaign to close Utah’s coverage gap is far from over. This game could even enter Double Overtime if the super committee fails to reach an agreement by the end of July. In that case, could the fans riot?

Post-Game Analysis
The silver lining is that each year the goal of closing Utah’s coverage gap advances one more step towards a successful conclusion. And 2015 is following that trend, with the governor and the Senate—along with over 70 Utah organizations and overwhelming public opinion—lining up behind the Healthy Utah plan. Only the Utah House stands in opposition, mainly, we think, due to their lingering misconceptions about the Medicaid coverage gap and funding details for the Healthy Utah Plan.

As advocates for Utah’s underserved and uninsured, our work remains the same: Close Utah’s coverage gap with comprehensive, affordable healthcare insurance that protects taxpayer investments. Except now we have a new audience—the Gang of Six—in addition to our previous focus on lawmakers and their constituents. To keep this issue in focus across the state, we need to continue to share real stories of Utahns living in the coverage gap, to tell our legislators that we support the Healthy Utah Plan, and to educate and activate more Utahns by writing powerful and persuasive letters to the editors and op-eds.

Here’s how you can get involved:

  • Send a persuasive message to your legislators from the Cover the Gap website (link)
  • Write a Letter to the Editor (Deseret News or Salt Lake Tribune)
  • Share your coverage gap or healthcare story at
  • Come to our bi-monthly round table meetings (email RyLee Curtis to be added to the mailing list)

# # #

Take Care Utah to the Rescue

Many of the people and organizations featured on KUTV’s investigative series Get Gephardt would rather be anywhere else. But not Take Care Utah (TCU). In late March KUTV’s Matt Gephardt profiled how TCU navigators help Utah families learn about their new health insurance options.

Here’s how it happened.

In February Gephardt aired a news report about three Utah families who struggled to enroll their new babies onto the health insurance they purchased on According to the Affordable Care Act (ACA), a birth or adoption triggers a 60-day window to enroll anyone in the family on new insurance. 

But Gephardt showed how these families were denied coverage by their insurers, or given inadequate information by the health insurance marketplace—leaving them with thousands of dollars in uncovered bills. After intervention by Gephardt’s staff, each of these families was able to enroll their new baby in coverage.
But KUTV and Gephardt kept getting calls from other Utah families who struggled to enroll their new babies on ACA insurance.
That’s where Take Care Utah stepped in. We called Get Gephardt and explained how Take Care Utah’s statewide network of trained experts can troubleshoot ACA or Medicaid enrollment glitches.

So on Monday March 30th Get Gephardt aired a follow-up segment reporting how TCU’s team of navigators helped many more families who contacted KUTV after the original story aired. In each case, Take Care Utah staff unraveled the complicated timelines and paperwork to get everyone in these families insured. 

You can read the story and watch the video at the links below.

Take Care Utah on KUTV’s Get Gephardt (3/30/15)
Story (link)
Video (link)

This KUTV story represents the second time the troubleshooting work of Take Care Utah has been shown in the media.
After the Salt Lake Tribune reported how a Utah mother was unable to sign up for health insurance on, and incorrectly told that her daughter didn’t qualify for Medicaid, a TCU navigator was able to sit down one-on-one and finish her application in a few days.

“Alicia Hobson, whose attempt to get insurance last year was bungled by bureaucratic mistakes, says she was able to get insured more easily this time around. A navigator from Community Health Connect in Provo, a partner, met her at the library near her Lehi home, and helped her with some of the questions on, she said. "I even decided to splurge and get dental insurance," said Hobson, who cannot afford the $500-per-month insurance her employer, a call center, offers.  Dental coverage added $15 per month to the $75 per month she'll pay for her and her daughter, who apparently qualifies for Medicaid even though last year that was not clear.  
(“Feds say more than 109,000 Utahns have signed up for health insurance,” Salt Lake Tribune, 1/17/15)

About Take Care Utah
Take Care Utah (TCU) is the Utah-based enrollment expert for and the Affordable Care
Act (ACA). TCU is a partnership between the Association for Utah Community Health (AUCH), the Utah Health Policy Project (UHPP), and the United Way of Salt Lake 2-1-1. 

Take Care Utah’s 120+ trained navigators and application counselors offer outreach and enrollment assistance to Utah residents across the state free of charge. Most Utah navigators and applications counselors are based in health clinics, hospitals, nonprofit organizations, schools, libraries, and insurance brokerages. Over the last two years TCU’s affiliates have helped over 180,000 Utahns to better understand their new insurance options. You can locate your nearest Take Care Utah assistor by going to, or by calling 2-1-1 from anywhere in the state.