Search This Blog

Wednesday, July 15, 2015

King v. Everyone

The U.S. Supreme Court’s June 25th decision in King v. Burwell to maintain the premium subsidies created by the Affordable Care Act (ACA) is viewed very differently across our state.

Some Utahns described the King decision negatively.
Sen. Orrin Hatch (R-UT) issued a press release stating: Obamacare has been a series of broken promises from the start. From skyrocketing costs to less access to care and more bureaucratic control of the healthcare system, the President’s law has failed patients and taxpayers.”

Utah House Speaker Greg Hughes reacted this way: “This administration’s damaging healthcare policy continues to undermine real insurance markets and drive up the cost of healthcare, resulting in less access to care for many of our nation’s most needy.”

Meanwhile, Salt Lake City business owner and cancer survivor Victor Saldivar said he was “extremely relieved” by the court’s decision to keep the subsidies. “Without the subsidy, I am not sure what I was going to do. I was thinking of moving out of my apartment and go live in my car to afford coverage.”

And Lisa Patterson of Moab responded to the news by saying, “Oh yes, yes, that is such good news. I feel like I’m going to cry.” Sonja Blackham, who receives a premium subsidy to purchase health insurance for herself and her husband, reacted to the decision by saying, “I think it was the right decision and a good thing. I feel like there’s no going back now… I don’t think they can just take it away now.”

So which is true for Utah?
Are the ACA’s premium subsidies “overwhelmingly harmful to the U.S. healthcare system,” as Rep. Chris Stewart claims? Or do they help real Utahns like Victor, Lisa, and Sonja stay insured and healthy?

We think you know where UHPP comes down on this issue.
Our West Valley City office is a focal point for the Take Care Utah enrollment network, which gives us an up-close perspective on how access to affordable health insurance can improve the financial and health security of Utah families. We recognize that some individuals and businesses believe that the ACA is negatively impacting their choices or their bottom-line. But when we investigate many of those stories, we learn that the blame for their troubles should be placed elsewhere.

We also know that last month’s Supreme Court decision was about a lot more than just premium subsidies. It was about maintaining the trajectory of improving access to affordable and quality health insurance in Utah and across the country. And those goals matter to everyone. As a result, we’ve put together these five reasons why the King v. Burwell decision matters to many more Utahns than the 86,000 who depend on the subsidies for their coverage.
Here’s our list.

(1) Utahns will be able to keep their health insurance.
This one is easy. The 86,000 Utahns who currently receive premium subsidies will keep their insurance coverage. They will continue to be able to see their doctor, receive treatments, access prescription drugs, and get preventive care and check-ups.  As of March 31 over 128,220 Utahans have signed up for health insurance through, and over two-thirds receive subsidies—worth an average of $208 a month—to make their coverage more affordable. In addition, Utah has the nation’s highest percentage of children and young adults enrolled in ACA insurance in the nation. 22% of all ACA sign-ups in Utah are by kids under age 18.

(2) More Utahns will be able to sign up when they need health insurance.
Anyone who loses their insurance coverage due to job loss, divorce, or moving to a new place can sign up for health insurance to maintain continuous and affordable coverage. Plus, parents with new babies can sign up their newborn and their entire family for new insurance. Had the subsidies gone away, any Utahn who needed new insurance would have been stuck without affordable options.

(3) The rest of the insurance marketplace will be more stable and efficient.
Since all of the marketplace (ie. ACA) insurance is sold by the same private insurers that offer other individual and small-group policies, any disruption to the premium subsidies would have hurt those insurers. This means that the 60% of Utahns covered by employer-based insurance will experience fewer disruptions, rate increases, and benefit cutbacks because the ACA subsidies are intact. Had the subsidies been taken away, Utah insurance companies and the Congressional Budget Office had warned that the resulting turmoil would have increased costs and cutbacks for the entire insurance marketplace.

(4) The legislature and governor can continue to work on a solution to Utah's coverage gap.
On the last day of the 2015 legislative session in March, lawmakers passed a bill to create the so-called “Gang of Six,” a special group of policymakers tasked to negotiate a solution to Utah’s coverage gap by a July 31 deadline. Written into the bill was the suggestion that the upcoming King v. Burwell decision would factor into their decision-making process.  Now that we know the premium subsidies are intact, the Gang of Six can negotiate a coverage gap solution based on the reality of ACA insurance being available to Utahns who earn enough to stay out of the gap.

(5) Even if you don't receive subsidies, the decision preserves the ACA so that it will remain available in case you need them in the future.
Although 62% of Americans support the Supreme Court decision to maintain premium subsidies, the same poll shows that the percentage of people with a “favorable” opinion of the Affordable Care Act is still below 50%. We can explain this discrepancy two ways. First, acceptance of the ACA is still hamstrung by widespread misinformation. Second, only about 10% to 15% of Americans directly benefit from ACA insurance at any time. But here’s the silver lining.  Even if you don’t need ACA insurance now, you or a close family member might need it in the future when you 1) retire early, 2) lose your job, 3) move to a new state, or 4) start your own company. Plus, you’re already benefiting from the ACA if you have a pre-existing health condition, are insuring a young adult under age 26, are age 40 or above, or receive Medicare. Many people just don’t realize those new benefits are because of the ACA.  Over the long-term, we see the ACA becoming more like the G.I. Bill, the landmark legislation first passed by Congress in the 1940s to give returning service members access to low-cost mortgages, loans, and tuition assistance. Not everyone benefited from the G.I. Bill, but our society deemed it as a public policy worth supporting because of its overall impact on our workforce, family structure, and economy. The ACA does many of the same things for a specific portion of our society, and we believe its benefits will also be recognized and supported.

The Deadline is Here

Utahns have been waiting 1,000 days for a solution to the coverage gap. Now lawmakers have 16 days to deliver it. 

The Republican leadership team in the Utah House
In the aftermath of the U.S. Supreme Court ruling that protected the Affordable Care Act’s (ACA) premium subsidies for over 80,000 Utahns , prospects were looking up for finally closing Utah’s Medicaid coverage gap.

"This ruling lets us really kind of ramp it up,” House Speaker Greg Hughes, (R-Draper) told reporter Glen Mills at ABC-4 on the same day of the Court’s decision. “It's not going to be in the next week or so, but now I think we're a lot closer than we were prior to knowing what the landscape would look like.”

By “us,” Speaker Hughes is referring to the “Gang of Six,” a special group of policymakers created on the last day of the 2015 legislative session to negotiate a solution to Utahs coverage gap by a July 31 deadline. The gang, made up of Gov. Herbert, Lt. Gov. Cox, President Niederhauser, Speaker Hughes, Sen. Shiozawa, and Rep. Dunnigan has been meeting regularly ever since and even took a trip to Washington, DC to see federal officials.

Rep. Jim Dunnigan (R-Taylorsville)
But last week, more statements from a leading member of the Gang of Six put the brakes on meeting the deadline. During a July 7 press conference, Rep. Jim Dunnigan (R-Taylorsville) suggested the gang might only develop a “concept” plan by July 31st, and that even achieving the goal was unlikely. Rumors began to circulate that the some members of the gang wanted to delay a decision for another seven months until 2016 legislative session, or 18 months until the outcome of the next presidential election. Suddenly, the prospect of an August 2015 special session to fix Utah's Medicaid coverage gap seemed less likely.

With just 16 days until the July 31st deadline, and 53,000 low-income Utahns still living in the Medicaid coverage gap, Utahns want our lawmakers buckle down to fix it.

Utahs coverage gap is a man-made, state-wide disaster that requires an effective policy solution that is not beyond the reach of our legislature. Fixing the coverage gap is entirely their job. Everyone in the "Gang of Six" has said that "doing nothing is not an option." There is no one else to blame for continued inaction. Not Congress. Not the federal government. And not the 88% of Utahns who support the Healthy Utah plan. In addition, many of our red state neighbors are ready for our conservative solution to the coverage gap, and Utah is the closest to delivering the template they have been looking for. Our state has an unprecedented opportunity to lead on the biggest health care dilemma facing over a dozen legislatures across the country.

With the King v. Burwell court decision behind us, the policy-based challenges the Gang needs to overcome are 1) budgeting the overall cost of the program, and 2) who bears the risk if the cost to the state goes over projections.

In recent interviews, both Sen. Brian Shiozawa and Speaker Greg Hughes have indicated a desire to have hospitals, providers, and the pharmaceutical industries help the state mitigate the risks of potential cost overruns. This is good news. We are one step closer to a solution when the debate shifts from which plan we should implement (Healthy Utah vs. capped or partial expansion) to how do we pay for the best plan.

Gov. Gary Herbert (R)
No matter the cause, we expect the Gang of Six to develop a funding system that engages the hospitals and providers and enables the state keep some “skin in the game.” So long as the plan follows these key principles and closes the coverage gap completely with a comprehensive health benefit and brings back the maximum amount of tax dollars back to the state—we are on board with finding payment options.

We think a great place to start is to review the significant cost budget savings other states achieved after they expanded Medicaid.

Calendar (July 2015)


July 15-16, 2015
Interim Week at the Utah Legislature
Calendar (html)

Thursday, July 16, 2015
Health Reform Task Force
Time: 1:00pm
Agenda (html) (pdf)
Location: Room 210 Senate Building, Utah Capitol Complex (map)
• King v. Burwell update
• Update on Coverage Gap Negotiations
• Health Insurance Premiums in 2016
• Health Insurance Coverage for Court-Ordered Mental Health and Substance Abuse Services

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, July 15, 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, August 5, 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)

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)

Wednesday, August 19, 2015
This is the most likely day for special session on the Medicaid Expansion solution
Location: Utah Capitol (map)
Time: TBD
Note: Wear red and sit in the gallery for the House of Representatives
More information: Contact Bill Tibbitts at Crossroads Urban Center, (email) 801-364-7765
Sign up for the Facebook event (link)

Saturday, September 12, 2015
Salt Lake City’s 2015 Recovery Day & 5k Run/Walk for Recovery.
Time: 7:00 AM to 3:00 PM
5K Run/Walk for Recovery starts at 8:30 AM
Gallivan Center
239 South Main Street
RSVP: (link)

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