UPCOMING MEETINGS
Utah Health Exchange Consumer Roundtable! New Consumer Advisory Group
for Utah’s Health Exchange!
The Utah Health Exchange (UHE) invites all Utahns who work for small businesses, all Utahns who buy their health insurance in the individual market, and all uninsured Utahns to the first UHE Consumer Roundtable, Friday, November 18 in the Multi-Purpose
room at the State Capitol.
Join Patty Conner, UHE Director, as she takes us through a virtual tour of the Utah
Health Exchange and presents Utah’s options for future insurance exchanges. This will be followed by a roundtable discussion to identify important consumer issues concerning Utah’s Health Exchange.
Let your voice be heard!
Utah Medicaid Partnership (UMP)
Tuesday, Nov. 15th 2011
10:00-11:30 in the Olmsted Room at the Capitol- Senate Building
Agenda items: Update on prospects for the session; Developments on the cost-sharing front; Draft principles for Handling Medicaid Decisions for the General Session 2012.
U-SHARE
Tuesday, Nov. 15th 2011
11:30-1:00 in the Olmsted Room at the Capitol- Senate Building
Agenda Items:
Join us for a discussion about the future options for implementing health insurance exchanges in Utah.
Invited guests: Norm Thurston, Health Reform Advisor to the Governor; Patty Connor,
Director, Utah Health Exchange; Tomi Ossana, Executive Director, HIPUtah
Medicaid Pilot Program (proposal by Rep. R. Menlove) PUBLIC HEARING
The Department of Health invites public input on a proposed pilot program that will require a group of fewer than 100 Medicaid enrollees (actually PCN enrollees) to give service to the community in exchange for their health program benefit.
Formal Public Hearing
Thursday, Nov. 17, 3:30 – 5:00 p.m.
Cannon Health Building (288 North 1460 West, Salt Lake City), Room 125
House Bill 211 (2011), sponsored by Rep. Ronda Menlove, directed UDOH to develop a pilot program and submit a waiver amendment to the Centers for Medicare and Medicaid Services (CMS). If approved [UHPP: we don’t expect this will be approved and will work directly with CMS to make sure], the amendment would allow the state to modify enrollment rules for the Primary Care Network (PCN), which will create a new eligibility group for the pilot participants. Applications will be accepted only during open enrollment periods and approved applicants will receive the same medical benefits afforded to other PCN clients.
Medicaid officials believe the service donation will help build a sense of contribution
to the program and enhance the client’s experience [UHPP will share an opposing perspective. For the meager primary care benefits that The waiver application will be available for review and comment on November 15, 2011 at http://health.utah.gov/medicaid/HB211proposal.htm.
In addition to providing comment during the public hearings, written comments will
also be accepted through December 2, 2011. Comments may be submitted to the Utah Department of Health, Division of Medicaid and Health Financing, PO Box 143102, Salt Lake City, UT 84114-3102 or to cdevashrayee@utah.gov
Monthly Meeting
(No meeting in November)
Remember that Monthly Meeting happens every other month, according to this
schedule…
- December 7 (at DWS)
- February 1 (at DOH)
We find Monthly Meetings are most productive when topics are generated by the community! Please email ideas for DWS topics to Gina Cornia of Utahns Against Hunger: cornia@uah.org; health topics to Jason Cooke at Utah Health Policy Project jason@healthpolicyproject.org.
GETTING TO THE UTAH STATE CAPITOL
Public Transportation: If you are downtown, the UTA bus is a great option to get up to the Hill. Route 500 will take you right to the East Building’s front door! The Capitol is in the Downtown Free Zone and buses run every 15 minutes. You will find the bus and Trax schedules, routes, and trip planner at their website: http://www.rideuta.com/
Driving from outside of Salt Lake: take I-15 (either north or south) to the 600 South exit and head east on 600 South. Turn left on State Street and head up the hill to the State Capitol.
Maps of the buildings are posted here.
Utah and Federal Health Reform. Cathy Dupont, Associate General Counsel, reviewed the basic features of Utah Health Reform, pointed out where it is compatible with federal statute and regulations, and suggested key policy issues and choices the Task Force might want to consider.
Dupont recalled the guiding principles of Utah’s health reform:
1) Individuals and families should own their own health insurance, which should be portable (not tied to employer);
2) Utahns should be able to choose the plan that best suits their situation;
3) Families should be able to aggregate premium contributions from multiple sources to pay for one policy;
4) Insurers should compete on risk–not avoid it; and
5) The government should act as a facilitator.
One of the main features of Utah’s health reform is, of course, the Utah Health Exchange. Utah’s
Exchange is essentially a “SHOP” (Small Business Health Option Program)—one of two types of Exchanges included in the ACA, the other is for the individual market—and could be ACA compliant with a few tweaks, according to Dupont. Utah’s Exchange would only need to include businesses with up to 100 employees (currently the limit is 50 employees); put plans into the federal tier system (bronze, silver, etc) for apples-to-apples comparison; and “beef up” Utah’s rate review process. “Utah is in a very good position to meet the 2013 deadline for SHOP… but there are significant policy decisions for the Task Force to consider,” stated Dupont.
Dupont then presented 5 implementation policy choices for consideration by the Task Force. We found
her comments helpful in terms of summarizing the differences between federal and state health reform, giving us a sort of to-do list for the state.
- Statewide risk adjuster: Utah has a risk adjuster for the Utah Health Exchange, but not for the small group market outside of the Exchange. To ameliorate the adverse selection (when a market becomes a magnet for the sickest and highest cost individuals) that typically occurs when all people are guaranteed issue of health insurance (cannot be turned away because they are or have been sick), the ACA requires statewide risk adjustment, If Utah does not want to do this, the federal government will.
- Eligibility and calculation of federal premium subsidies/tax credits: The American Health Benefit Exchange (for individuals seeking insurance) must include eligibility determination for the subsidies that will be available in the individual market (people who don’t have employer sponsored insurance and buy an individual policy). Since this is a federal program, Utah may want to consider letting the feds run this.
- Individual mandate: Utah has a statute that prohibits a mandate to buy insurance. Utah will have to decide if they will take on the enforcement of a mandate, and if so, the state would need to change the statute. Alternatively, Utah can let the federal government enforce this. UHPP comment: The Feds might as well oversee this, as it will be enforced through the IRS’ income tax filing process.
- Essential benefit package: Utah should voice an opinion about what should be in the essential benefit package, as this will determine costs of products offered.
- Medicaid: States are expected to have a “no wrong door” approach to Medicaid enrollment beginning in 2014. In addition, Medicaid will be expanded to cover everyone with incomes up to 133% of the Federal Poverty Threshold—with the feds picking up the tab for the newly eligible. Utah needs to consider whether it wants to include eligibility in the Exchange, or if this duplicates services.
UHPP comment: Missing from Dupont’s list is whether Utah will operate an American Health Benefit Exchange in the first place—that’s the one for the individual market—or let the feds do it. And while, yes, Utah’s Exchange, with some changes, might be deemed a credible SHOP by Health and Human Services, Utah policymakers have yet to address affordability: how will Utahns, especially those in lower wage jobs in small businesses or the self-employed, pay for rising premiums without resorting to high deductible
policies that carry too high out-of-pocket costs? When the Task Force talks about “cost containment” we ask “for whom?” We also ask: how does the Utah Health Exchange measure up to the state’s own principles for reform? The Exchange does allow employees to choose the plan that works best for them from a dizzying array of options (over 140 plans!), but Utahns getting insurance through the Exchange are not owners of their own insurance nor is it portable—it’s still employer sponsored insurance. The Exchange is designed to
allow aggregation of premiums from multiple sources, but it’s still too small (157 small businesses so far) to make this an effective tool to assist Utah consumers, or no real effort has yet been made to use the premium aggregator to motivate more small business to offer coverage in the first place.
We’ve updated our webpage about Utah’s state-wide health reform. See our new section on the Utah Health Exchange, Utah’s key piece of reform and the new Utah Exchange Watch—our tool to assess the Exchange’s progress toward increasing affordable health insurance coverage for Utah’s small businesses.
Judi Hilman Receives the Families USA Consumer Health Advocate of the Year Award!
(A quick staff announcement for those who don’t already know:)
Judi Hilman was presented with the Consumer Health Advocate of the Year Award at the Families USA annual Health Action conference in DC January. The award, presented every year since 1998, recognizes outstanding contributions on behalf of our nation’s health care consumers. The award was presented to Hilman for her commitment to improving access to quality, affordable health care for all Utah Residents.
Join us in congratulating Judi for her leadership, dedication, and hard work!
Join UHPP on Facebook
Love Facebook? Then become a fan of UHPP’s Facebook page and join our Facebook Cause!We’re working to bring you essential information in the easiest way possible. Receive up-to-date information in on our work, upcoming events, and more!
Help us reach our goal of 500 Fans by the end of the session, March 10th!
Health Action Calendar:
Keep track of health-related events happening during the session. UHPP’s Health Action Calendar has dates, time, and information. Please join us for weekly meetings of Utah Medicaid Partnership and U-SHARE (Health Reform Coalition): every Wednesday 1:15-2:00 PM, Olmstead Room of East Capitol Bldg. A wonderful chance to compare notes and coordinate strategy on the many Medicaid, CHIP, and health reform issues for the Session.
Legislator Contact List!
Check out our handy 2011 spreadsheet of legislators and their contact information. Use it to track your conversations with legislators, find out who sits on the committees that oversee health issues, count votes on bills, or mail merge to contact legislators individually! To download in Excel, click here: http://www.healthpolicyproject.org/Publications_files/legislative/UtahElectedOfficials1-23-11.xls
Getting to the Utah State Capitol
Public Transportation: If you are downtown, the UTA bus is a great option to get up to the Hill. Route 500 will take you right to the East Building’s front door! The Capitol is in the Downtown Free Zone and buses run every 15 minutes. The bus schedule is posted here, along with the route map here. UTA has a great trip planner tool, as well.
Driving from outside of Salt Lake: take I-15 (either north or south) to the 600 South exit and head east on 600 South. Turn left on State Street and head up the hill to the State Capitol.
Where to park?
There are two parking lots available to the public. The largest is on the NE Corner of the Capitol Complex. The second lot is right next to East Building (now also know as the Senate Building). Thus there should much more street parking available to the public this year. If you must drive, your best bet is to carpool and arrive early.
Background
On September 1, after a very informative meeting with our broker, Davis Pacific Insurance, the Utah Health Policy Project decided to sign up for the re-launch of Utah’s Health Insurance Exchange. Davis Pacific Benefits was able to answer our questions and provide assurance around this initial stage of the application process. We learned there’s no risk to employers and employees from filling out the initial application. But note: Employers have until September 15 to take this first step on the Exchange website: http://www.exchange.utah.gov/. The health questionnaire will be reviewed by 1-2 randomly assigned underwriters from one of the carriers participating in the Exchange. If UHPP can accept the new rates and terms, staff will be able to make their selection of plans starting on November 1.
As the person who manages UHPP’s money, I can’t say that I’m entirely at peace with the whole exchange idea. I operate with the mindset, “if it ain’t broke, don’t fix it.” Since UHPP started offering health insurance in 2006, our broker has been able to score us good premiums and a decent benefit package. It probably helps that our average age is 35 and that we’re all in reasonably good health. Over the past 3 years our premium increases have been minimal, but that’s not to say the entire staff has been entirely happy with the 1-size-fits-all benefits available…
Since Exchanges are here to stay, we figured, why not join? We want to see if the program really does provide employees with better choices at a reasonable cost. So here is our experience, from day one, enrolling in the Exchange…
Step 1: Employer Application Process
I found to the Exchange site here: a simple page that breaks down the basics of enrolling. I found clear information about the application process, defined contribution, working with a “producer,” (a fancy term for broker), etc. I like how this page lists the participating carriers: SelectHealth, United Healthcare, Regence, and Humana. To start the application, I clicked on a link that brought me to the login page for employees. Since the UHPP has yet to enroll, I had to click on another link to register as an employer. Quite a few clicks to get to the right place, but not too bad.
Due to the paperwork requirement, I must have re-started the registration process at least 3 times! The Exchange site provides a list of everything you need to complete the registration, and while I am a reasonably organized individual when it comes to paperwork, the enrollment page does not offer the opportunity to save for a later time…
Lesson #1: You need to have everything ready to go, before you start. Get all your information scanned and in one place—before you apply! Information I did not have on hand and wished I did: Our broker’s license # and their Health Equity ID #. I also had to download a form from the site to my desktop, fill it out, and upload it again. This, too, timed out my registration, so I had to start all over again!
Aside from the paperwork, the employer application was a piece of cake. Not long after clicking the SUBMIT button, I received an email from a United Healthcare underwriter, who kindly asked for the wage statement that I failed to upload the first time around.
When the application was completed, I wasn’t really informed about when employees can shop around for insurance, other than it can take up to 2 weeks to see our new rates and find out whether we qualify to join the Exchange.
So now we wait… are you waiting too?
What was your experience like? If you are an employer, broker or “producer” considering the Exchange for your employees or clients, please consider joining the Exchange Learning Network (ELN). The ELN is an interactive blog discussion group (click to check it out) for employers like UHPP who want to give their employees more choice of plans and decent benefits—but only if the price is right, for employers and employees. ELN participants will have the opportunity to share their experiences (positive or negative) and pose questions to UHPP, Exchange administrators, and brokers. To join the ELN, send email to wendy@healthpolicyproject.org. Participants will be given instructions and ground rules from there.
As an advocate for low income households, I interact daily with families and individuals who are uninsured for many different reasons: they are not offered employer sponsored insurance, they cannot afford their share of the premiums for employer sponsored insurance, pre-existing conditions prevent them from finding affordable insurance, or they are young adults who are working or going to school and can’t afford individual plans. For many, there is uncertainty about public programs such as Medicaid, CHIP, and Utah Premium Partnership (Utah’s premium subsidy program) and whether they will qualify. For all of these reasons, I am thrilled with the recent passage of the Patient Protection and Affordable Care Act by Congress.
Many provisions of the bill begin in 2010, with the most significant changes like insurance market reforms and coverage expansions, coming in 2014. Additional improvements, like the closing of the ‘donut hole’ in seniors Medicare Part D coverage continue through 2020. In truth, most of us won’t notice any difference in our insurance arrangements, although just about everyone will benefit from the many insurance market reforms. Only 10% of Americans will have a different insurance arrangement come 2019; however, many of the families and individuals described above will be able to count on more secure health insurance arrangement. Health care will be there when we need it most.
What will the new health reform law do in the first year? Here are a few of the major benefits to look forward to in 2010:
Small businesses will receive help with insurance costs. . Effective 2010, the new law will establish new tax credits of up to 35% of the employer premium contribution. Small employers with no more than 25 employees and an annual average wage of less than $50,000 that provide coverage and pay at least 50% of the premium cost will qualify. Find a helpful calculator and other tools to orient small business owners here: http://www.healthpolicyproject.org/HR_SmallBiz.html
Uninsured people with pre-existing conditions may qualify for immediate help. The new law creates a new temporary insurance program for people who have been uninsured for six months and who have a pre-existing condition. Premiums will be the same as those that individuals without a pre-existing condition pay for the same coverage.
Insurers will be prohibited from denying coverage for children with pre-existing conditions.
Plans will offer free prevention benefits. In the first year, all newly sold insurance plans (private or public) will be required to cover prevention and wellness benefits with no deductibles or cost sharing!
No more arbitrary limits on coverage. Insurance companies will be prohibited from imposing lifetime limits on benefits. They will also be tightly restricted in the use of annual limits in new plans. In 2014, annual lifetime limits will be prohibited entirely for all plans offering essential benefits.
Unfair insurance rescissions will be banned. Insurance companies will be prohibited from arbitrarily revoking coverage for people when they file a claim for benefits. People, who have paid their premiums, can no longer be dropped because they become sick.
More young adults will stay insured. Young adults who do not have an offer of coverage through an employer will be allowed to stay on their parent’s policy until their 26th birthday.
The Medicare doughnut hole will start to shrink. Medicare beneficiaries (seniors and people with disabilities) who fall into the Medicare Part D prescription drug coverage gap in 2010 will receive a $250 rebate. In January 2011, beneficiaries in the doughnut hole will receive a 50% discount on brand name drugs and other discounts on generic drugs. These discounts will continue every year until the doughnut hole is closed in 2020.
Employers will receive incentives to keep early retirees insured. A new reinsurance program will be created for employers providing health insurance coverage to retirees over age 55, who are not eligible for Medicare. This program will help protect coverage while reducing premiums for employer-based and retiree coverage for people aged 55-64.
Premiums will pay for health care services, not overhead. Insurance companies will be required to spend at least 80% (individual market) or 85% (employer market) of the premium dollar they collect on health care services and improvements in the quality of care. If they fail to do so, they must provide a rebate to consumers.
Small business owners will find it more affordable to insure their families and their employees; children and adults with pre-existing conditions will no longer be denied coverage; seniors will find it easier to pay for their medications; and all of the nation’s insured will benefit from greater insurance protections. There will be further changes in future years, but many will benefit in this first year of implementation.
Sheila Walsh-McDonald is a Health Care Advocate with the Salt Lake Community Action Program and a member of USHARE, Utahns for Sustainable Health Reform.
Small businesses are one of the first groups to see immediate and tangible benefits from the new law of the land. Those with 25 or fewer employees, with average wages of less than $50,000, and paying at least 50% of the premium, are eligible for up to a 35% tax credit…THIS YEAR!!
Calculate what your tax credit will be here: http://smallbusinessmajority.org/tax-credit-calculator The question mark buttons on the calculator will help explain how you define full-time employees, etc
Small Business Majority has also put together a really helpful FAQ that you can read here
The IRS also has a very thorough FAQ here. These will answer most of your questions. But if you have a specific, unaddressed question, email us at ask@healthpolicyproject.org
Now that health reform is the law of the land, you are wondering how the legislation will impact you, your family or your business. Look no further…
Today, UHPP is launching our Implementation Station–your one-stop-shop to help you make sense of it all. Visit www.healthpolicyproject.org/NationalReform.html to see for yourself!
Want to know how health care reform will affect you? We break down the nuts and bolts in clear & simple language.
- Looking for credible sources? We’ve searched the web to find the most useful links.
- Have a specific question? We’ll do our best to answer it for you.
- Looking for timely analysis and practical tools on turning the 2,700 page bill into real results? We’ve created a hub of useful information for you.
We will update this website frequently! For example, you can look forward to a Small Business & Health Reform Factsheet, interactive timeline, and Enhancing Utah’s Exchange Brief.
We are looking for ways to educate Utahns about the impacts of health reform–some benefits begin right away! Invite us to come speak at your next get-together, whether it’s your book club, professional association meeting, church group, rotary meeting, etc. Email jessica@healthpolicyproject.org or call 801-433-2299 to arrange a presentation.
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