When federal health reform (Affordable Care Act or ACA) goes into full effect in 2014, people who don’t get insurance through their job will be able to buy it in a new one-stop shop, the “American Health Benefit Exchange.” Small businesses will be able to shop for
insurance on the new Small Business Health Option Program (SHOP) Exchanges. But
what exactly will they be buying? People will likely find plans they can afford, but will those plans meet their needs—not just now, but later, if they get sick? How will they know? The ACA has an answer to these questions: Essential Health Benefits (EHB), the basic benefit package that all plans must offer in order to be sold on the new Exchanges.
The decision about what to include in the Essential Health Benefits package is not a slam
dunk! If the package is extra fancy, the cost will be too high; but if the benefit package has a lot of holes in it, people may miss out on care they need or delay care until it becomes more
expensive—or too late. To find the sweet spot, Health and Human Services (HHS) held hearings across the country. Utah leaders, like Rep. Jim Dunnigan, argued for a minimal, less costly benefit package so as not to disrupt the new insurance exchange markets (details at Different Takes, Kaiser Health News). UHPP argued that the EHB package should include the things that promote health and good management of chronic conditions because over the long run, healthier people cost less. The bottom line when it comes to cost and quality: evidence-based benefit design.
Last month HHS Secretary Kathleen Sebelius released new guidelines for the Essential Health Benefits Standards. States will have flexibility about what to include in the EHB
package—within limits. Learn how this will work and what comes next at Stateline
Next steps for Utah: Most state insurance commissioners are pleased with the new guidance, but what about Utah’s Commissioner Neal Gooch? UHPP will be meeting with him before deciding on the best course of action for Utah. Stay tuned.
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 firstname.lastname@example.org or (en Español) email@example.com.
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.
Tuesday, Nov. 15th 2011
11:30-1:00 in the Olmsted Room at the Capitol- Senate Building
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 firstname.lastname@example.org
(No meeting in November)
Remember that Monthly Meeting happens every other month, according to this
- 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: email@example.com; health topics to Jason Cooke at Utah Health Policy Project firstname.lastname@example.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.
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)
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 email@example.com or 801 433 2299 if you have any questions.
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Salt Lake City’s Economic Development Division & Local First Utah sponsored the 2nd annual Neighborhood Business Conference on Friday, May 6, hosted by Westminster College. The keynote speakers from the Austin Independent Business Alliance spoke to an audience of over 150 Utah small business owners about leveraging their businesses by working together. Utah’s small businesses struggle to provide health insurance for their employees. In 2009, UHPP partnered with the Small Business Majority to find out just what Utah’s small businesses thought about health care coverage (© 2009 Small Business Majority www.smallbusinessmajority.org; see the full report here):
- The number one concern for Utah small businesses in healthcare reform is controlling costs, followed by having coverage that is guaranteed and covers everybody.
- 88% of Utah small businesses not offering health insurance say they can’t afford to, while 79% of those who do offer it say they are really struggling to do so.
- 80% of small businesses support establishing a health insurance pool to create a marketplace where small businesses and individuals choose their coverage. Only 12% oppose this proposal.
- 79% of small businesses want to eliminate preexisting condition rules, and 74% see these rules as a barrier to starting a business.
- 77% support a proposal to establish a minimum standard of coverage for health insurance benefit packages in order to facilitate comparison shopping in the marketplace, ensure access to medical care, and protect people from financial risk.
- 69% prefer having the choice of a private or public health insurance plan, with 20% preferring private only and 7% preferring only a public health insurance plan.
- 67% say it is important for individuals, employers, insurers, the government and healthcare providers to share the responsibility for making healthcare more affordable.
- 64% say healthcare reform is important to getting the economy back on track.
- 57% say their company has a responsibility to provide health coverage for its employees.
- 46% believe that businesses that don’t offer health insurance should be required to pay something to cover their employees, although 40% say no contribution should be required. Of those who agree a contribution should be required, more than half believe it should be less than 5% of payroll.
See UHPP’s brief on how federal reform affects Utah’s small businesses: The Nuts and Bolts of Federal Health Reform: the Impact on Utah Small Businesses.
Stay informed and get involved:
- visit UHPP’s website http://www.healthpolicyproject.org/Business.html
- sign up for UHPP’s Business Group on Health newsletter here
- join U-SHARE, a coalition of people in Utah who are interested in sustainable health reform (also on UHPP’s webpage)
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
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.
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 firstname.lastname@example.org
For more information about how health reforms will help small businesses, check out this report from Small Business Majority
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