As of press time, Gov. Gary Herbert plans to retain Avenue H as the state’s small business or SHOP exchange. Speaking to the American Enterprise Institute (AEI) last week, Herbert said “We’re going to do the business. [The] federal government will do the individual side of this and [we’ll] see if we cannot, in fact, coexist peacefully here and provide that to the marketplace.”
Big questions remain about whether the feds will allow Utah to run a small business exchange, or if Utah can make even Avenue H minimally compliant with the Affordable Care Act. Ignoring those details for now, we know that small businesses have a lot of questions about what happens after 2014 when the ACA is fully implemented. That’s why UHPP is reaching out to small business organizations like the Vest Pocket business coalition, local chambers of commerce, and Stone Hill National, Utah’s largest brokerage firm, to form new partnership focused on education and outreach for small businesses. We’ll publish more on these relationships in the coming weeks.
But first, here’s what small businesses owners and their employees need to know about the ACA.
Does the insurance mandate affect me?
It depends how big your business is. Small employers with less than 50 FTEs (full-time equivalencies) are exempt from the penalty for not providing coverage to employees.
What if I have more than 50 employees?
Firms with more than 50 FTEs that do not offer health insurance coverage will pay an annual penalty of $2,000 for every full-time employee beyond the first 30 (so an employer with 75 employees will pay $2,000 x 45 =$150,000). Starting in 2014, this penalty is triggered when at least one employee receives subsidized coverage (that means their income is less than 400% of the federally poverty level) on the state’s individual exchange.
Why is there a penalty?
Because letting large employers who don’t provide coverage to send their workers to the individual marketplace unfairly penalizes other firms who do offer insurance to their workers. To level the playing field, the ACA imposes a financial penalty on companies whose employees receive subsidies on the individual market. This penalty also discourages firms from dropping existing insurance coverage. But if your firm has less than 50 employees, you don’t need to worry about the mandate or the penalty. Instead, you will get incentives like tax credits.
How do the small business tax credits work?
Small business owners can save money now through the tax credits. Those paying at least 50% of their employees’ insurance premiums and have < 25 full-time workers with average annual wages below $50,000 are eligible for tax credits up of to 35% of their costs. Learn more about tax credits here.
Where will my employees find insurance?
The ACA requires that everyone who doesn’t receive insurance from their employer or from Medicare or Medicaid to purchase insurance in the open market or on a regulated exchange. The individual market or AHBE exchange features sliding scale premium subsidies to make insurance more affordable for individuals. These subsidies will be available to individuals and families earning up to 400% of the federal poverty level (FPL) [$92,200 for a family of four]. In Utah, the individual marketplace will be operated by the federal government.
What if my small business employees qualify for Medicaid?
It would help your business and your employees. But Utah’s current Medicaid eligibility rules make it difficult for workers with low incomes to qualify for Medicaid. This creates a coverage gap for workers making less than 100% of the FPL that the ACA won’t solve. But if Utah decides to expand Medicaid to cover individuals making up to 138% of the FPL, more small business employees will be able to take advantage of Medicaid’s efficient and low-cost health insurance.
How will my employees know if they qualify for Medicaid?
Their best bet is to get screened for Medicaid eligibility on the individual (federally-run) marketplace. Gov. Herbert has stated that Avenue H won’t administer Medicaid despite the ACA requirement that exchanges operate as a “no wrong door” for determine eligibility status for all programs. So if a small business employee qualifies for Medicaid, will Avenue H tell him or her? We don’t know yet.
Where to Learn More:
Small Businesses and Healthcare Reform: Frequently Asked Questions
Small Business Majority, 2012
Actual Factual Information About Healthcare Reform
Acension Health, Small Business Majority, 2012
Employer Responsibility in Health Reform
(Center on Budget and Policy Priorities)
Small business owners under the Affordable Care Act
Kaiser Family Foundation, 2012
The Effects of Health Reform on Small Businesses and Their Workers
RWJF, Urban Institute, 2012
Tags: Avenue H, Exchange, marketplace, small business
Posted in Coverage Initiatives, National Health Reform
About 60 people gathered at the State Capitol last Wednesday afternoon to form Real Exchange Utah (RXUtah), a new coalition to respond to Utah’s recent shift to a partnership exchange. The good news was that the federal government will now run the individual marketplace. This new framework increases the opportunities for the state’s 400,000 uninsured residents to gain access to affordable, quality health care coverage. In addition, community-based organizations will gain a seat at the table in guiding the new individual marketplace—and play a larger role in the navigator program.
Real Exchange Utah (RXUtah)
Next meeting: Wednesday, February 13, 1:00pm
Location: Olmsted Room, Utah State Capitol (map)
But as people spoke out, they realized that Utah’s partnership approach is generating more questions—and more concerns—than answers. For instance: Will the state run the navigator program, or give control to the feds? Can navigators work with both exchanges—and who will license them? Will Utah retain a defined contribution model for Avenue H? In addition, we’re not even sure that Utah’s unique partnership model will survive. We expect HHS to make a final decision by this Friday, February 15th.
Most of the group’s concerns focused on the potential friction between the separate state and federal marketplaces. Given Utah leaders’ dislike of ACA rules, it’s likely that the two entities won’t share information in the “seamless” manner the law requires. For instance, will small business employees seeking coverage on Avenue H be advised if their coverage is “unaffordable” (costing >9.5% of income) and directed to the individual marketplace? The ACA requires it, but Gov. Herbert has said “we will not administer Medicaid through Utah health exchange.” Does that mean that Avenue H won’t tell employees if they qualify for Medicaid?
Despite concerns about the state-run small business exchange, RXUtah decided to focus primarily on the individual marketplace, realizing that it is where the majority of Utah’s uninsured and underinsured will find better coverage. To move forward, RXUTah will meet every Wednesday afternoon at 1:00pm in the Olmsted Room at the Utah State Capitol (map). The meetings are open to everyone. RX Utah also developed the following five initial focus areas:
RXUtah Focus Areas:
1-Seamless interaction between the SHOP and individual market exchange; and all other entities where there are navigators
2-Where navigators will be based (federal or state?), plus funding, governance, and interaction with brokers
3-Exchange governance: Individual exchange (federal) will have consumer representatives on advisory boards; state governance is TBD
4-Finding hard-to-reach populations in the state (ethnic minorities, small business owners)
5-Identifying best practices from other states to stop reinventing the wheel
Next Meeting: Real Exchange Utah (RXUtah)
Next meeting: Wednesday, February 13, 1:00pm
Location: Olmsted Room, Utah State Capitol (map)
Tags: Avenue H, Exchange, marketplace, realexchange
Posted in Coverage Initiatives, National Health Reform
Just two days old, the 2013 Legislative Session is shaping up to be the most important session for health care reform we’ve ever seen. Big decisions loom on how Utah addresses the ACA. Not only will we learn whether Utah has a state-run or federal exchange, but we’ll see key legislation about how these exchanges will be operated (Rep. Dunnigan). Other bills or initiatives seek to expand accountable care (Rep. Mike Kennedy), increase the number of medical school slots (Sen. Valentine), integrate mental, behavioral, and physical health care (Rep. Sanpei), and boost rural and community health workers (Sen. Robles). That is the short list of priority bills or amendment efforts for UHPP. Since this is Utah, there will probably be a few bombs and surprises tossed in the mix.
Please note the high number of bill requests with health-related titles. UHPP is doing our best to track these down and create better opportunities for input. Here’s what we do know.
Affordable Care Act
“Utah will have an ACA-compliant exchange.” That’s what Gary Cohen, director of CCIIO, the HHS department in charge of the ACA exchanges, told us during a December 28, 2012 conference call. What did he mean? Whether we end up with a state-run or federally-run exchange, Cohen is confident it will satisfy ACA requirements for quality, affordability, and accessibility. But his pledge doesn’t mean that we can relax and wait for the perfect exchange to materialize. How closely Utah’s exchange mirrors the goals of the ACA is directly related to our actions during the rest of 2013. That’s because the bias in Utah is to chip away at key elements of the ACA like governance, funding, and Medicaid eligibility until it becomes a shadow of the law it was meant to be. Unfortunately, the federal government seems willing to accommodate obstinate states like Utah in order to get them to play along.
Right now the governor’s health reform team is attempting to make Utah’s exchange plan more ACA-compliant, despite opposition from legislative leadership. Could the legislature try to derail the governor’s goal of a state-run exchange. Absolutely. Ironically, these conservative legislators want the federal government to run Utah’s exchange! And we’ve heard rumors that they plan to claim Gov. Herbert doesn’t have the authority to negotiate with HHS. At the same time the legislature will consider Rep. Jim Dunnigan’s (R-Taylorsville) omnibus health reform amendments that will reauthorize the Health System Reform Task Force, set navigator policy for Utah’s exchanges, and improve the governance language. We see several different ACA factions developing in the 2013 General Session—with no clear sense of where the issues will land.
Where we stand: UHPP will advocate for Utah to adopt a fully ACA-compliant state exchange built on the backbone of Avenue H, the state’s existing small business exchange. We will push for improved navigator policy, mental health parity, and improved governance within Rep. Dunnigan’s Health System Reform Amendments. We will work to strengthen the moderate coalitions in the legislature that favor moving Utah’s health reform process towards full compliance with the ACA.
Get Involved:
Join us at the Capitol every Wednesday for these strategy meetings in the Olmsted Room at the Capitol, Senate Building (East Side)
Family Investment Coalition
Wednesdays, 12:15-1:00pm
Utahns for Medicaid Expansion (U4ME)/ Utah Exchange Action Today (U-EAT)
Wednesdays, 1:10-2:00pm
UHPP Briefing Papers:
The Affordable Care Act 2013 – The Road Ahead for Utah
Tags: Exchange, legislative session, National Health Reform
Posted in National Health Reform, Quality Watch
To be, or not to be? That is still the question about the future of a state-run insurance exchange in Utah.
Thanks to deadline extension last month, Utah has until Friday, December 14th to decide whether to run its own healthcare exchange—and until next February to decide on a federal/state partnership. But some advocates and policymakers claim that deadline is meaningless, and that Utah’s leaders are set to join about 20 other states letting the federal government operate the exchanges (get the map here). But plenty of doubt remains, and here’s why.
During the December 4th meeting of the legislature’s Health System Reform Task Force. Dr. Norm Thurston, Governor Gary Herbert’s point-man on health reform, reported to the committee that the governor was playing a strategy “that leaves all options open.” Three weeks earlier, on November 18th, Herbert sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius announcing that Utah won’t operate its own health exchange, but that his ultimate decision “could change as we receive more information and answers to critical questions.” Much less ambiguous was the letter the Legislature’s Republican leadership sent to Herbert the week before, telling him that “Utah should not spend any state time or money to build and run a federal exchange program.”
These mixed messages are leaving Utah health care advocates, planners, and providers in limbo–either waiting for a HHS deadline that sticks, or an executive decision that doesn’t include a back-door exit. One thing, however, is certain. As the days go by, we’re learning more details about how the Affordable Care Act will be implemented thanks to a steady release of new rules and regulations.
While the major benefits of the healthcare law are already known, these new rules give states the working details they will need to fully enact the law by the 2014 deadline. UHPP will provide more detailed analysis of these new regulations and talking points to submit comments—and others to be released—in the coming days, as well as recommendations for Utah advocates and policymakers as we enter an important period of decision-making. For a quick summary of the ACA regulations released so far, check out this simple spreadsheet put together by the Office of Legislative Research and General Counsel.
As we prepare for the next deadline for a state-run exchange on December 14th—this Friday—here’s a look at some of the scenarios we might encounter in Utah.
Scenario A: Utah opts for a federally-run exchange
The most-likely scenario. Utah health care advocates will become best friends with the folks at Center for Consumer Information and Insurance Oversight (CCIIO), the division of HHS charged with implementing the provisions of the ACA related to private health insurance.
Scenario B: Utah opts to run its own exchange under current rules
Advocates will work with state leaders to build an exchange, focusing on shaping key legislation during the 2013 General Session, especially Rep. Jim Dunnigan’s omnibus health care bill that governs navigators, re-insurance, and the establishment of the state’s basic health benefits. Some questions remain, such as what happens to Avenue H (the state’s fledgling small business exchange), and the reinsurance market.
Scenario C: Utah wins new flexibility from the federal government to run its own exchange according to its own rules
Advocates will need to influence and monitor the state’s efforts to set up an exchange—especially related to good government and transparency, as well as following all the requirements of the Affordable Care Act related to quality of benefits and cost-control.
What You Can Do:
>>Call, write, or email Governor Gary Herbert and tell him your thoughts on the health care exchanges.
>>Attend the final 2012 Health System Reform Task Force meeting on Monday, December 17, 1-5pm, in Room 30 of the House Building
>>Attend the weekly Advocates Meetings during the 2013 General Session. They occur every Wednesday, starting January 30 and ending March 13 in the Olmstead Room of the Senate building.
12:30-1:15 PM Family Investment Coalition
1:15-2:00 PM UHPP-Hosted Coalitions (Utahns for Medicaid Expansion and U-SHARE)
Tags: Exchange, Governor Herbert, Health Reform Taskforce, National Health Reform
Posted in National Health Reform
Thanks to the Affordable Care Act (ACA), signing up for health insurance is about to get a whole lot easier. The new insurance exchanges for individuals and small businesses will give consumers options and cost-savings they never had before. Helping consumers take advantage of these options will be “navigators”—trained professionals who can explain insurance options, encourage participation and outreach, and assist with the enrollment process.
But before these benefits of the ACA kick in, policy makers will have to decide who plays that role of navigator, what qualifications they will have to meet, and what kind of training they should have (learn what the ACA expects at a minimum here). Consideration of those questions took up the first half of the November 1st meeting of the state’s Health System Reform Task Force Insurance Market Work Group.
The jumping off point for the Work Group’s discussion was draft legislation which you can review here. The draft assigns most of the responsibility for licensing, training, and regulating navigators to the Utah Insurance Department. UHPP and other community advocates believe the draft bill is putting the cart before the horse and urged the Work Group’s legislative members to focus on designing the navigator program before creating regulations for navigators. Read our feedback on the draft legislation here.
In addition, we believe navigator policy and standards should be developed in consultation with community-based nonprofit organizations who are best suited to be navigators. These organizations—and not traditional insurance brokers—already understand the cultural, language, and socio-economic barriers that navigators will need to cross in order to reach hundreds of thousands of uninsured Utahns. To this end, we proposed forming an ongoing community advisory panel and formal collaboration with other government departments to guide the Utah Insurance Department in its oversight of navigators.
As a follow up to the Work Group’s discussion, UHPP will be facilitating a discussion on the draft legislation in early December with Rep. Jim Dunnigan, chair of the Health System Reform Task Force. The session is intended for community-based nonprofits that currently provide direct enrollment assistance or that are interested in being navigators. For more information, contact Randal Serr, UHPP’s Take Care Utah Director, at randal@healthpolicyproject.org or 801.433.2299, extension 4.
On a related note, community-based nonprofits hoping to serve as navigators can help UHPP determine navigator interest and capacity in Utah. Be part of Utah’s navigator policy development by completing a brief survey. To participate, please send an email to randal@healthpolicyproject.org.
Tags: Exchange, Health Reform Taskforce
Posted in National Health Reform, Quality Watch
Utah’s Health System Reform Task Force voted on August 16, 2012 to recommend that the PEHP Utah Basic Plus (UB+) plan be used as Utah’s EHB benchmark plan (listen to the audio or read the minutes). This means that Utah will build their EHB based on what is offered in UB+.
The EHB will be the minimum package of benefits that must be offered by all insurance policies sold in the small group and individual markets beginning in 2014 (including Medicaid and Basic Health Programs). Visit the Health System Reform Task Force website for information about the scope of benefits.
The next step in the process happens on Tuesday, September 11, at the Health System Reform Task Force meeting. The Department of Insurance (DOI) must enact an emergency rule adopting UB+ as Utah’s EHB and will be reporting to the Task Force on Tuesday (open to the public, and streamed live online). After enacting the emergency rule, the DOI has 120 days to enact the permanent rule. The public can comment during that 120 day period.
What we think
UHPP is particularly concerned that the coverage offered by UB+ in three of the 10 categories that must be covered by the EHB is not sufficient. They are:
- mental health and substance use disorder services, including behavioral health treatment
- pediatric services, including oral and vision care
- rehabilitative and habilitative services and devices.
If the U.S. Department of Health and Human Services finds UB+’s coverage in any one of the 10 categories insufficient, the state would have to substitute benefits from a different plan to make the benchmark complete. While we wait on more specific guidance from HHS on the process, UHPP is moving forward to craft recommendations to make those categories sufficient. Read more in our new paper “Essential Health Benefits: Filling the Gaps.
What you can do
Are you concerned about this issue? UHPP is in the process of researching how to make the benefits in these categories sufficient. We will encourage the Department of Insurance to craft essential, not minimal, benefits in the three deficient categories. If you would like to help, contact UHPP (801) 433 2299 or email shelly@healthpolicyproject.org and find out how.
A record 377,700 Utahns do not have health insurance according to the latest report released by the Utah Department of Health (see the Salt Lake Tribune article about the report here). That’s 13.4 percent of Utah’s population. Fifty-six percent of Utah’s uninsured adults are employed—and almost all of them stand to benefit from the implementation of federal health reform. Most live in low-income households.
- 95% of the uninsured in Utah are in households with incomes less than 400% FPL, meaning if they buy private health insurance in the new individual health insurance exchange they will qualify for premium tax credits.
- 76% are in households with incomes less than 200% of poverty, meaning they would potentially be eligible for the Basic Health Plan if Utah chooses to adopt it, or if they are children, they are eligible for the Children’s Health Insurance Program (CHIP).
- 57% are in households with incomes below 133% of poverty meaning they will potentially be eligible for Medicaid if Utah expands the program to 138% FPL (see our article in this month’s newsletter).
By these numbers, most Utahns who will be using the new health exchange will have no or little experience with health insurance. What they need are “Navigators”
Navigators are an integral part of expanding coverage through the ACA. Navigators will be trained, unbiased helpers who will do outreach to those who are eligible for coverage, assist them through the process of choosing plans, and provide guidance for prudent use of benefits.
Utah legislators face some policy decisions in the design of the Navigator program:
- formalizing the standards that all entities must meet in order to be eligible to be awarded Navigator funds through the new exchange
- creating the set of training standards all entities awarded Navigator funds must meet
- deciding if Navigators have to meet any licensing, certification, or other standards
- deciding how entities will be awarded Navigator funds
- deciding how Navigators funds will be generated (for example, a service charge through the exchange).
What we think:
UHPP encourages Utah’s decision makers to design Utah’s Navigator program with the population that will be using Navigator services in mind: 76% of Utah’s uninsured will benefit from public health insurance.
UHPP also encourages Utah’s decision makers to adopt the “no wrong door” approach to coverage—that is, where ever someone interacts with the health care system, they should be able to find help in getting coverage. One way to implement this approach is to create a competitive process for awarding the Navigator contracts, allowing multiple entities (within the guidelines) to function as Navigators in Utah.
What you can do:
The Insurance Marketplace Workgroup (a workgroup of the Health System Reform Task Force) will be discussing Navigators on Tuesday, September 11 at 10:15 AM in room 415 in the Capitol building. Come and join the conversation.
Tags: Exchange, National Health Reform, uninsured
Posted in Coverage Initiatives, National Health Reform
A quiet corner of the Affordable Care Act (Section 1322) created “nonprofit health insurance issuers.” These cooperative “Consumer Operated + Oriented Health Plans” (CO-OPs) will be sold as qualified health plans through the state insurance exchanges coming in 2014. To get the member-driven plans off the ground so they are actuarially sound, the ACA sets aside $6 billion (now down to $3.8 billion) in start-up funds. CO-OP nonprofit health plans will be designed to be more accountable and responsive to their members than typical plans available on the market today, and will be able to devote more of the premium dollar to better coordination of care and payment of claims. Read more about this promising tool for mission-driven nonprofit insurance here.
Utah has a CO-OP plan in the works called Aarches Community Health Care. If approved by Federal HHS officials, Aarches will be operational on January 1, 2014. Aarches’ primary goal is to set up value-based benefits that focus on the needs of its members. Aarches Founders’ Board members have robust ideas on payment and benefit reform that should help people get better value out of their health insurance. UHPP’s Hilman is honored to serve on the Founders’ Board. Her principal role will be to engage the Utah community in shaping the Aarches Health Plan so that it meets the community’s needs for a member-driven, evidence-based, and wellness-oriented health plan. Linn Baker, former UHPP Board Chair and former CEO of Utah Public Employee Health Plan, is Aarches’ CEO. The Board Chair is Dr. Kim Bateman, former medical director of HealthInsight (Utah’s quality improvement organization). Also serving on the Board are representatives from the Association for Utah Community Health, United Way of Salt Lake, and Midtown Community Health Center. Talk about an all-star line-up!
Please join us for a Community Forum to Learn about Aarches and give input on plan design.
When: March 21 3:30-4:30 pm (refreshments included)
Where: Westside location given with RSVP
RSVP: volunteer@healthpolicyproject.org
This meeting is followed by a discussion with Latino community leaders (4:30-5:30 pm).
One of the most underserved populations in Utah is the Latino community. Utah Latinos are 2-3 times more likely to be uninsured than any other population cohort. This is true even when accounting for income, employment, and education levels. Obviously there is something about the current structure of health insurance that is not working for Utah’s Latinos. Aarches wants to fix that.
Aarches would like to create a health plan specifically designed to be attractive to Utah’s Latino community. This would include selecting culturally appropriate health care professionals and benefits. For that, Aarches is seeking input from the community it hopes to serve.
During the meeting Aarches founders will outline our current plans, get some immediate feedback, and identify individuals and organizations that would be a resource for us in developing this product during the summer of this year.
Tags: affordability, Exchange, National Health Reform, Quality Watch
Posted in National Health Reform, Quality Watch
FEDERAL HEALTH REFORM’S GIFT TO SMALL BUSINESSES: MAKING HEALTH INSURANCE MORE AFFORDABLE
Did you know that Federal Health Reform Law, called the Affordable Care Act (ACA), helps small businesses right now? If you own a small business, you know how difficult (nearly impossible) it is to include health insurance in your budget.—and the cost of insurance continues to spiral out of control. Premiums for employer-sponsored health coverage have more than doubled over the last decade. The ACA includes many provisions to help insurance become more affordable for small businesses, including the tax credit available right now for small businesses that provide insurance for their employees. You can try out
UHPP’s “Business Group on Health’s” online tax credit calculator to see if your small business qualifies.
In addition, states will create a Small Business Health Option (SHOP) insurance market place that pools risk and purchasing power for small businesses (Utah’s Health Exchange doesn’t do this yet, and will need some tweaking to be fully federally qualified) and federal rules require that insurance companies limit the amount of your premium dollar that can go to administrative costs (known as the “Medical Loss Ratio”). For more information about how the Affordable Care Act will help your small business see the report by the Small Business Majority by clicking here. For more information and resources for small businesses visit their website www.smallbusinessmajority.org.
Tell your story: If your small business is struggling to offer health insurance or simply can’t afford to, or if your small business is benefiting from the tax credit, share your story and help UHPP work to help bring the costs of health insurance down! Call Shelly or Luis at 801-433-2299 or email at shelly@healthpolicyproject.org or (en Español) luis@healthpolicyproject.org.
GOVERNANCE: HOLDING UTAH’S HEALTH EXCHANGE ACCOUNTABLE
Governance turns out to be a tricky subject in Utah when it comes to health insurance
exchanges (web-based insurance marketplaces). One way to think of how an exchange is governed has to do with where the exchange is housed. Does it belong to a state entity, like the insurance or health department, or is it a stand-alone entity—a private nonprofit organization? Today Utah’s health exchange is situated in the Office of Consumer Health Services (OCHS), which was created to house the exchange inside the Governor’s office of Economic Development (GOED). Another way to think of how an exchange is governed has to do with who makes decisions. Utah’s health exchange decision-makers seem to be Norm Thurston, the Governor’s Health Reform Implementation Coordinator Patty Conner, the Director of the Utah Health Exchange, and the Risk Adjuster Board, which consists of 3-5 actuaries from insurers who sell in the exchange, 1 individual employer or employee, 1 director from OCHS, 1 actuary from PEHP, and the Insurance Commissioner (or representative). It’s obvious the decision-making structure of the Utah Health Exchange currently is weighted heavily to the insurance industry. Where are the consumers?? See our October HealthMatters article on the recent change to the Utah Health Exchange Advisory structure.
Governance: state or independent entity?
Utah’s Health System Reform Task Force considered governance options for Utah’s Health Exchange on October 19, 2011—that is, they considered options for where the exchange could be housed. Cathy Dupont, Associate General Counsel, presented the 4 structures in the Utah Code that could serve as alternatives for future exchanges in Utah: an existing state agency, an independent state agency, an independent public corporation, or an independent quasi-public corporation. Each of these options carries rules and regulations with it. For example, Utah’s Health Exchange is currently housed in a state agency (GOED), meaning it is subject to state administrative, purchasing, and hiring rules. If Utah’s exchange were housed outside of the state, in an “independent public corporation,” federal
health reform law would require it to have a governing board, to consult with all stakeholders on a regular basis, and to ensure that decision-makers not have conflict of interest. For more information about the related issues policymakers need to address see Tim Jost’s article “Health Insurance Exchanges and The Affordable Care Act: Eight Difficult Issues.”
Specifically, state agencies are presumed to be subject to the following laws, unless otherwise exempted in statute, while independent public corporations and independent quasi-public corporations are not (for more information see Cathy Dupont’s materials by clicking the “related materials” for October’s Task Force meeting here):
• Funds Consolidation Act
(Title 51, Chapter 5) (Accounting)
• State Money Management
Act (Title 51, Chapter 7) (Investing)
• Utah Administrative
Services Code (Title 63A) (Purchasing and Accounting)
• Utah Administrative
Rulemaking Act (Title 63G, Chapter 3) (Rulemaking)
• Administrative
Procedures Act (Title 63G, Chapter 4) (Adjudications)
• Utah Procurement Code
(Title 63G, Chapter 6) (Purchasing)
• Budgetary Procedures
Act (Title 63J, Chapter 1) (Expending Appropriations)
• Revenue Procedures and
Control Act (Title 63J, Chapter 2) (Accounting)
• Utah Personnel
Management Act (Title 67, Chapter 19) (Personnel)
• Open and Public
Meetings (Title 52, Chapter 4) (Meetings)
• Government Records
Access and Management Act (GRAMA) (Title 63G, Chapter 2) (Records Management)
• Risk Management (Title
63A, Chapter 4) (Insurance)
• Governmental Immunity
Act of Utah (Title 63G, Chapter 7) (Liability)
Independent public corporations and
independent quasi-public corporations are subject to the Open and Public Meetings (Title 52, Chapter
4) (Meetings) and GRAMA (Title 63G, Chapter 2) (Records Management).
Governance: getting a consumer voice into the decision-making process
It is time to get the consumer voice back into the process of decision making around Utah’s health exchange (see our October HealthMatters article on the recent change to the Utah Health Exchange Advisory structure). Come to the first “UHE Consumer Roundtable” hosted by Patty Conner, UHE Director, Friday, November 18, from 8:30-10:00 at the State Capitol, Multi-Purpose room, located just inside the north entrance of Capitol (click here for a map).
If you own or work for a small business, if you buy health insurance in the individual market or forgo health insurance altogether because it is too expensive (or you’ve been turned down!) this roundtable is for you! This is your chance to be a vital part of the ongoing process of holding Utah’s Health Exchange to the stated goal of decreasing the rate of uninsured in Utah and making sure decisions about the future of health insurance in Utah reflect input from consumers.
For this first meeting, Patty Conner will take attendees through a virtual tour of the Utah Health Exchange, bringing everyone up to speed on the UHE, and discuss Utah’s next steps with Exchange 2.0. This will be followed with time to discuss issues and concerns to consumers in the small business and individual market. No RSVP is necessary, but you can contact Shelly Braun at shelly@healthpolicyproject.org or 801 433 2299 if you have any questions.
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