Federal health reform is officially the law of the land, and Utah small businesses will be among the first groups to see positive, on-the-ground results.

As part of phase 1, small businesses can receive a tax credit for their 2010 contributions towards purchasing health insurance for their employees. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $25,000. Small employers with fewer than 25 employees and average annual wages of less than $50,000 are eligible for a sliding scale credit. To be eligible for a tax credit, the employer must contribute at least 50 percent of the total premium cost or 50 percent of a benchmark premium.

But wait…it gets better from there! In 2011 through 2013, eligible employers can receive a small business tax credit for up to 35 percent of their contribution toward the employee’s health insurance premium. Non-profits meeting those same requirements are eligible for tax credits of up to 25 percent of their contribution. That’s real savings you can put towards growing your business or paying higher salaries!

In 2014 and beyond, eligible employers who purchase coverage through the State Exchange can receive a tax credit for 2 years of up to 50 percent of their contribution. Non-profits meeting the above requirements are eligible for tax credits of up to 35 percent of their contribution.

You can calculate how much your small business stands to save with these new tax credits here

We will explain more about these tax credits and other reforms especially for small businesses in a Utah Business Group on Health conference call on Wednesday April 13th from 4:00 to 5:00 pm.  RSVP to jessica@healthpolicyproject.org

For more information about how health reforms will help small businesses, check out this report from Small Business Majority

Spring, the season of hope and new beginnings, must be right around the corner, because we’ve made it to the end of the Utah General Session.  Health care issues faired pretty well this year, despite huge budget shortfalls.  Check out the final results on bills in our Health Bill Tracker.

Utah Medicaid survived largely unscathed this session.  Despite declining state revenues and 12% enrollment growth over the last year (25% enrollment growth since 2008), the budget was brought into balance without any cuts in eligibility.  For most of the Session we stood to lose low-income women’s access to cost-effective prenatal care along with the medically needy program for critically ill and injured children.  Even better, ongoing funding was found in the last days to continue Medicaid physical and occupational therapy for adults and people with disabilities.

However, despite these remarkable victories, Utah Medicaid is left with serious challenges going forward, including:

(1)  Failure to restore critical services eliminated over the last two and half years;
(2) large fiscal structural imbalances in the program created by failing to fund enrollment growth with ongoing funds.

Critical Services Not Restored

Since the beginning of the recession in late 2007, Medicaid has lost a number of critical services for people with disabilities, low-income seniors, and parents, including dental, vision care and outpatient audiology.  None of these services were considered for restoration this session.  In order for Medicaid to provide high quality care as cost-effectively as possible, these services must be restored .

Medicaid’s Fiscal Imbalance

Since 2007, Utah Medicaid has grown by nearly 25% from 160,000 enrollees to over 210,000 enrollees today.  In the last two sessions the Legislature has funded this enrollment growth using onetime funds.  However, there is no indication that enrollment in Medicaid is slowing down; in fact, all indications suggest enrollment will continue to grow through FY2011.  Because of the Legislature’s decision to provide one-time funds for past enrollment growth and to provide no funds for future enrollment growth,  Medicaid will likely need funding in excess of $50 million in FY2012 in order to maintain current eligibility levels. Needless, to say, this sets us up for yet another defensive battle.

This fiscal imbalance makes it very difficult to pursue funding for other worthy needs in the program like the service restorations, increases in provider reimbursement rates, or investments in cost avoidance or cost-effective coverage expansions.

Congress passed legislation last week extending the American Reinvestment and Recovery Act’s enhanced funding for state Medicaid for all of FY2011.  Originally this funding was supposed to end at the close of calendar year 2010.  For Utah this means an additional $55 million in federal Medicaid funding.   The funds that will be freed up by the ARRA money can be spent anywhere; however, UHPP strongly believes the bulk of these funds should remain within Medicaid.   These funds provide an opportunity to make wise structural changes that will produce cost-savings and efficiencies into the future.

Recommended Uses of ARRA money for Medicaid

1. Provide family planning services to all women below 133% of poverty.  This would require an initial investment of $720,000 but would produce ongoing savings of $820,000.
2. Fund a Medicaid medical home pilot project for all Medicaid beneficiaries with chronic illness or disease.
3. Fund E-REP, Utah’s public program eligibility database,  programming changes required to make public programs operate within the Utah Health Exchange.

This is it. Yesterday (Sunday) House Democrats released their final reconciliation package (for details or to read the 2,300-page bill, click here).  AT LAST, we are in the final act, but before the curtain closes, we need you to do 1 thing:

Please, please take a minute to call Congressman Matheson right now and ask him to vote YES on the final health reform package. This week, Congressman Matheson will be voting again on federal health reform.  We need each and every pro-reform voice, starting with yours, to speak out loud and clear. This is not the time to suppose someone else will make the call.  Please pick up the phone NOW.

You can reach him toll-free in D.C. at 1-866-279-5474. Tell him you want to Get It Done!
Salt Lake: (801) 486-1236
St. George: (435) 627-0880
Email him through his website

While the rest of our Congressional delegation has made their position clear, Congressman Matheson is still undecided. This means he really needs to hear from you that you will stand beside him if he chooses to vote YES.

Make sure you say:

• Please vote YES on the final reform package
• why YOU support reform—is your coverage becoming more and more unaffordable? Have you been denied coverage because of a pre-existing condition?
• The status quo is unsustainable, and health reform is the right thing to do

Even if you have called before, you need to call again. The curtain is falling on this historic opportunity, and now more than ever you need to make your voice heard.  Every last vote, starting with Congressman Matheson’s, will be needed to get health reform across the finish line.

This week, Families USA released a report outlining in detail how health reform will help Utah.  The report identifies the major gaps in Utah’s current health care system—gaps that allow insures to discriminate against people with pre-existing conditions, to charge premiums that are unaffordable for families and businesses, and to put care increasingly out of reach for those who have insurance.  The good news is that the health reform proposals being voted on this week in Congress will guarantee that everyone—businesses large and small, seniors, children, those who currently have insurance, and those who don’t—has access to quality health coverage they can afford.

This great report outlines how things work now and how the proposed health reforms will,  close the gaps using premium subsidies, incentives for small businesses, and quality improvements for all.

You can read the full report here

Also, check out this Health Care 101 Consumer’s Primer on the Final Health Reform Bill from Associated Press.

By the end of the session, state health reforms survived more or less intact, and for this we must thank Speaker Clark and his colleagues on the task force, starting with Rep. Biskupski, for insisting on learning from the Exchange’s disappointing pilot launch. Here we present results on state health reform in terms of wins and losses.  Possible wins and losses (time will tell) are indicated in italics.

This year’s reforms will reflect that a clean majority of state leaders are willing to entertain a handful of the changes needed to succeed in insurance market based reforms. Yet, this year’s changes still fall short of the paradigm shifts needed to achieve the broader goals of reform—not just cost and quality, but also access.

National leaders on both sides of the aisle agree that insurance industry practices must change in fundamental ways. There is broad consensus that insurers should no longer be allowed to make money by how well they avoid risk. Instead they should compete on the basis of how well they keep us healthy. Insurers, for their part, can only accept this radical change in their business model if it is coupled with an individual mandate. This is a non-starter in Utah, which makes achieving some of the goals of health reform at the state level more difficult.

Utah state reforms this year continued making small incremental steps towards addressing the growing burden of health care costs, mainly for small employers.  However, some of steps taken this year may be premature.  The shift to a defined contribution (rather than defined benefit) before other cost containment measures are taken may result in employees being asked to pay too much of the cost for their care and coverage, ultimately resulting in an increase in the number of uninsured and under-insured Utahns.

Before making the shift toward greater “individual responsibility” for purchasing insurance, a number of other changes are needed. Affordability thresholds and mechanisms are needed along with improved portability to help consumers combine premiums from different employers. Instead, we may see a race to the bottom. Under the current reforms, small groups that employ young and healthy consumers will be motivated to purchase lower cost, high-deductible plans. This will work for groups that remain healthy. The rest will see their costs rise as their ability to share risk is further diminished.

Before the state reform process goes any further, we must delineate clear measures of success. We could start with the problem areas outlined in the Families report mentioned in another post. This, along with an exhaustive affordability study, will be our main priority for year 3 of the Health Reform Task Force.

THIS IS IT. Charge your phone…catch up on your email…

Brace yourself for a week of action on multiple fronts. We are down to the last 2-3 weeks in the battle for federal health reform.  For as hard as we have all been fighting these past months and years, we must now make the final push, pushing stronger than ever before, to bring health reform across the finish line.  Let’s get it done.

Here’s what you can do:

1. Call Congressman Matheson and ask him to vote YES on the final reform package.   His spokesperson has said the Congressman is undecided.  This is the moment to make your voice count!  You can call him in D.C. at (202) 225-3011, in SLC at (801) 486-1236 or in St. George at (435) 627-0880.  You can also call toll free: 1-800-828-0498.
2. Sign the Health Reform Can’t Wait petition and pass it along
3. Write a letter to the editor. Instructions on how to submit it are posted here or email volunteer@healthpolicyproject.org if you want us to help you.

Remember, health insurance reform will:

• Stop insurance companies from denying coverage to people with pre-existing conditions or cutting people off when they get sick;
• Require insurance companies to spend money on health care, not CEO salaries and profits. Right now they get to spend too much of their income on CEO salaries, profits, lobbyists, advertising, and armies of bureaucrats who do nothing but deny claims;
• Strengthen Medicare and close the “donut hole” in drug benefit plans for seniors;
• Help small businesses afford health insurance for their employees;
• Control costs and make good health insurance affordable to everyone.

The legislative process hasn’t been pretty, but those opposed to health reform have made the process much more partisan than the American people want – despite a year’s worth of consultation and inclusion of many ideas from the opposition including medical malpractice reform.

But we cannot let the perfect be the enemy of the good.  No excuses; no more politics.  It’s time for Congress to show they can take on the powerful special interests and fight for Utahns.  We need good health care we can count on now.  The door is closing on this historic opportunity.  THANK YOU FOR TAKING SWIFT AND DECISIVE ACTION TODAY.

Or, call these numbers while the legislators are in session, generally M-F 8:00 AM to 5:00 PM:

House:  (801) 538-1029                                  Senate: (801) 538-1035
Toll-free: (800) 613-0677                               Toll-free: (800) 908-4261

At first blush it may seem like Utah’s Medicaid program has fared well during the 2010 General Session.  Until late last week recommendations to restrict eligibility for Medicaid’s prenatal care program (Baby Your Baby), to eliminate the Medically Needy program for critically ill and injured children and to restrict dental and vision benefits to expectant mothers seemed unstoppable.  Happily, and thanks to your persistent efforts, all of these cuts were reversed.  However, a closer look at the budget will show that Medicaid has not escaped totally unscathed this session.

The scars to the program come in three forms this year:

(1) Failure to continue funding for services and provider reimbursement levels that were paid with one-time monies last year;

(2)  Failure to restore critical services that have been eliminated over the last two and half years;

(3) large structural imbalances in the Medicaid budget created by failing to fund enrollment growth with ongoing funds.

1. Services Yet to Be Restored this Session
   During the 2009 General Session, the Legislature decided to cut funding for outpatient occupational therapy and physical therapy and then backfilled this cut using onetime funds.  Given that state revenues were down once again in 2010, there was little appetite among legislators to restore programs that were saved last year through “backfill.”   While the Governor’s budget called for continued funding for physical therapy and occupational therapy services , the Legislature has not yet granted his (and our) request. In these final days of the Session, we will be working to get these restored: PLEASE HELP BY CALLING AND EMAILING MEMBERS OF LEADERSHIP. For talking points, check out our new Hot Spots factsheet
2. Other Critical Services not Restored
   Since the beginning of 2007, Medicaid recipients have lost a number of critical services, including dental, vision care and outpatient audiology services.  None of these services were restored this session.
3. Medicaid’s Fiscal Imbalance
   Since 2007, Utah Medicaid has grown by nearly 25% from 160,000 enrollees to over 210,000 enrollees today.  In the last two sessions the Legislature has funded this enrollment growth using onetime funds.  However, there is no indication that enrollment in Medicaid is slowing down; in fact, all indications suggest enrollment will continue to grow through FY2011.  Because of the Legislature’s decision to provide one-time funds for past enrollment growth and to provide no funds for future enrollment growth,  Medicaid will likely need funding in excess of $50 million in FY2012 in order to maintain current eligibility levels. Needless to say, this sets us up for yet another defensive battle in 2011.

This fiscal imbalance makes it very difficult to pursue funding for other worthy needs in the program like restoration of services, increases in provider reimbursement, much less any investments in cost avoidance or cost-effective coverage expansions.