Do you know who runs Avenue H? Don’t worry if you can’t recall their names. Until recently, Utah has kept the governance of its small business exchange under wraps. And since Avenue H serves only a tiny fraction of the state’s small businesses, Utah’s focus on secrecy was troubling, but not problematic. But with implementation of the Affordable Care Act less than a year away, Utah must get serious about building an exchange governance structure that is open and transparent to everyone, not just insurance executives and bankers.

Last week we witnessed a compelling reason for better governance when Avenue H’s steering committee released a 14-point statement that proclaimed half-hearted support for a state-run exchange. We call their statement “half-hearted” because the committee spent two-thirds of the document bashing the ACA before they concluded that Utah running the exchange was the best “less-than optimal” solution. But that’s not the most embarrassing aspect of the document.

Read the whole statement and you’ll notice that none of the 14 points suggest that the goal of health reform is to reduce the number of uninsured Utahns. Save employers money? Sure. Provide affordable healthcare to the 400,000 Utahns who lack it? Not a priority, according to this committee. In addition, the group is hostile to Medicaid and dismisses the notion that consumers will need help choosing the best insurance options on the new exchanges.

Perhaps their unawareness arises from the fact that none of the committee members—comprised mostly of insurance executives and government department heads (see list below)—actually deal with Utah’s uninsured on a daily basis. The ACA requires that exchange steering committees include representatives from the advocate community. But because Utah houses it’s Avenue H exchange in the executive branch (the Governor’s Office Economic Development), it is not required to follow those particular ACA guidelines. As a result, advocates will need to apply pressure to the governor, the legislature, and the insurance industry to expand the leadership of Avenue H.

We post this statement for two reasons. First, to illustrate the lingering ambivalence (or outright hostility) of state and insurance industry leaders toward Governor Herbert’s stated intention to operate ACA-compliant exchanges at the state level. Second, to showcase the need for a broader steering committee that includes more community representation for Utah’s future exchanges. See our related paper, Good Governance for Utah’s Exchange.

Avenue H Steering Committee:
Greg Bell (Co-Chair), Lt. Governor
Greg Poulsen (Co-Chair), Intermountain Healthcare
Richard Broadbent, Utah Association of Health Underwriters
Marc Bennett, HealthInsight
Rich McKeown, Salt Lake Chamber’s Health Committee & Leavitt Partners
Gordon Crabtree, University of Utah
Pam Gold, United HealthCare
Pat Richards, SelectHealth
Jennifer Cannaday, Regence BlueCross/BlueShield of Utah
David Patton, Department of Health
Spencer Eccles, Governor’s Office of Economic Development
Colleen Mellor, Strategic Employee Benefit Services
Mark VanOrden, Department of Technology Services
Todd Kiser, Department of Insurance
Howard Headlee, Utah Bankers Association
Greg Matis, SelectHealth
Vaughn Holbrook, Regence Blue Cross Blue Shield.
Ernie Sweat, Fringe Benefit Analysts
Patty Conner, Avenue H, Office of Consumer Health Services
Norm Thurston, Office of Consumer Health Services

For some of us summer was a time to kick back, visit family, or tend tomatoes—but not for Utah’s Exchange team! All summer they worked with Love Communications to rebrand the Utah Health Exchange. Utah’s new online marketplace for health insurance is…wait for it…Avenue H.

What we think

We rather like the look and main street feel of Avenue H—check it out for yourself here: http://www.avenueh.com/.  But what we don’t know is whether this new look and feel will translate into actual results on the issues that have to this point stumped Utah’s Exchange.  These include: governance, transparency, small business participation, and affordability measures. For details read our updated State of Utah Health Exchange here.

The clock is ticking on these issues. Utah has big decisions to make by HHS’ November 16, 2012 deadline…

• whether to operate exchanges that meet the robust standards of the ACA (SHOP for small businesses and AHBE for individuals)
• will Avenue H be the platform for these Exchanges or will it remain in place to compete with the ACA exchanges?
• If Utah is not ready to handle the requirements of state-operated exchanges (see the HHS CCIIO Blueprint document), does it want to form a Partnership Exchange (like training wheels in prep to operate state-based exchanges). Take a minute to read Families USA’s helpful articles framing these decisions (article 1 and article 2).

The Governor and legislative leaders will not say how they want to proceed on the Exchange decision until after the November election.  This gives them 9 days to decide a decision with far-reaching consequences for all of us, starting with the 377,000+ individuals who should be helped by the exchanges. In her presentation to the Health Reform Task Force Exchange Director Patty Conner said that Avenue H could evolve into the new exchange(s). This means now is the time to learn about it and how far it has to go to serve the low to moderate income individuals who need it most.

What you can do

• Play around on the new Avenue H interface—and let us know what you think.  Don’t get your hopes up if you’re looking for insurance for yourself as an individual. For that you will have to wait until 2014 when the ACA brings affordable options to uninsured individuals. Avenue H is still only for small businesses and their employees. Now bounce around the Massachusetts Connector to see what exchanges should look like for individuals.
• Mark your calendar for Avenue H’s open forum call-in sessions. These meetings (attended by 25-100 individuals, including small business owners) are always held on the 2nd Wednesday of each month beginning at noon.  The call-in number is 605-477-3000, pass-code: 256947.
• Mark your calendar for UHPP Post-Election Forum on the Future of Health Reform. When: Thursday, November 15^th  4:00-5:30 PM

Where: Location given with RSVP to volunteer@healthpolicyproject.org

The Essential Health Benefit (EHB) will be the package of benefits that must be offered by all insurance policies sold in the small group and individual markets beginning in 2014.  People who work for small businesses will be assured this package of benefits when they buy insurance.  People who buy their own insurance will also be assured this essential health benefits package.  The essential health benefit will be required both in and out of the new insurance market places, called “exchanges.”  In addition, the Medicaid program and the Basic Health Programs will have to cover, at a minimum, these essential health benefits.

The essential health benefits must not discriminate based on age, disability, or expected length of life, and must consider the health needs of diverse segments of the population.   EHB must cover the following 10 categories:

(1) ambulatory patient services
(2) emergency services
(3) hospitalization
(4) maternity and newborn care
(5) mental health and substance use disorder services, including behavioral health treatment
(6) prescription drugs
(7) rehabilitative and habilitative services (defined in the Social Security Act as “services designed to assist individuals in acquiring, retaining, and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community based settings.”) and devices
(8) laboratory services
(9) preventive and wellness services and chronic disease management
(10) pediatric services, including oral and vision care.

Rep. Dunnigan, the co-chair of the Health System Reform Task Force, is proposing that the PEHP Basic plan be used as the EHB benchmark plan.  This means that Utah will build their EHB based on what is offered in the PEHP Basic plan.

What we think:

Three of the 10 required categories (listed above) are deficient in the PEHP Basic plan. These three categories are: mental health and substance use disorder services, including behavioral health treatment; pediatric services, including oral and vision care; and rehabilitative and habilitative services and devices. Utah will have to substitute benefits from a different plan to make the benchmark complete.  Specifically, Utah would have to supplement the deficient category from another of the possible benchmarks approved by Federal Health and Human Services.

Center for Consumer Information and Insurance Oversight (CCIIO) explains it like this:

“For example, if a benchmark plan covers newborn care but not maternity services, the State must supplement the benchmark to ensure coverage for maternity services.  The default benchmark plan would be supplemented by looking first to the second largest small group market benchmark plan, then to the third, and then, if neither of those small group market benchmark plans offers benefits in a missing category, to the FEHBP benchmark plan with the highest enrollment.” (http://cciio.cms.gov/resources/files/Files2/02172012/ehb-faq-508.pdf)

In addition, the EHB will have to comply with the Mental Health Parity and Addiction Equity Act (MHPAEA).  This means that mental health services have to be covered at the same level as physical health services.

What you can do:

You can read more about the EHB by visiting these websites:

http://101.communitycatalyst.org/aca_provisions/essential_benefit_package

http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf

Also see the background materials posted on the Task Force’s website here: http://le.utah.gov/asp/interim/Commit.asp?Year=2012&Com=TSKHSR

Please attend the Health System Reform Task Force meeting on Thursday, August 16, 9AM, Room 30 House Bldg.

NOTE: there will be time for public comment about the EHB. To comment, raise your hand high! If time is limited, please allow National Alliance on Mentally Illness (NAMI) and other knowledgeable consumer-friendly mental health groups to go first.

For the schedule of health policy-related interim committee meetings, click on Health Action Calendar below.

One of the “good for consumers” things federal health reform law (the ACA) does is create an “essential health benefit” package.  This benefits package will set the standard for what will be included in health insurance plans sold in the individual and small business markets—inside and outside of the new “exchanges.”  Each state has to choose a “benchmark” package from some of the best-selling plans on the market, including federal, public employees, and small group market plans.  (You can read Health + Human Services Bulletin on UHPP’s webpage: click here.)  Then, the benchmark plan has to be “tweaked” to make sure it offers benefits in each of 10 categories:

• ambulatory patient services
• emergency services
• hospitalization
• maternity and newborn care
• mental health and substance use disorder services, including behavioral health treatment
• prescription drugs
• rehabilitative and habilitative services and devices
• laboratory services
• preventive and wellness services and chronic disease management
• pediatric services, including oral and vision care

To learn more about how the Essential Health Benefits will be formed and what it will do for you read Community Catalyst’s “EHB 101.”

What we think:

It’s important that consumers speak up about what the Essential Health Benefit plan should look like.  It should include the right balance of good benefits that promote health and help manage chronic disease with a price that people can afford.  Utah’s Health System Reform Task Force will be taking public comment on Tuesday June 19 from 4:30-7:00 PM.

What you can do:

Attend tomorrow’s (Tuesday June 19 from 4:30-7:00 PM) listening session hosted by Rep. Dunnigan.  You can attend in person at 10 locations in Utah or listen on the web.  Click here for more information about locations.  Visit www.healthpolicyproject.org for information sent out by the Utah Health System Reform Task Force about the essential health benefits (look in the right column under “What’s New”).

HB144 3rd Sub (Health System Reform Amendments, Rep. Dunnigan) sets the table for the Health System Reform Task Force.  One thing the task force will study this summer is which benefits will be included in Utah’s Essential Health Benefits (EHB) package.  These essential benefits will be required to be included in plans sold on health insurance exchanges.  Utah already has a small business insurance exchange up and running—the Utah Health Exchange.  This is a web-based market place where Utah businesses with between 2 and 50 employees can purchase insurance.  A new exchange, called an “American Health Benefits Exchange” in federal health reform law, is coming in 2014 for Utahns who buy insurance in the individual market.

Utah’s leaders must choose a “benchmark” plan upon which to base the EHB package.  There are 10 types of plans to choose from, and there are 10 categories of benefits that must be included in the EHB package.  (You can read more about the federal guidelines about Essential Health Benefits here.)  Health + Human Services also recently published answers to frequently asked questions about EHB federal guidelines.

What about benefits already mandated in Utah’s small business insurance market, like catastrophic coverage of mental health conditions and diabetes coverage? (For a list of all of Utah’s benefit mandates see the Dept. of Insurance’s 2010 Health Insurance Market Report.) How will state mandated benefits fit in with the new Essential Health Benefits?

• Any benefits that are mandated in Utah’s small business market before December 31, 2011 will be part of Utah’s EHB package if applicable to the benchmark plan Utah chooses.  This means that if Utah chooses to base the EHB plan on, say, the largest small group plan in Utah, those state mandates will automatically be included.  These benefits—as part of the EHB—will qualify for coverage under the premium tax subsidies that will be available to individuals who buy insurance through the AHBE (the coming individual insurance exchange).  However, any mandates that have been put into place after December 31, 2011 are not automatically part of the EHB and Utah would have to defray their cost.
• If the benchmark plan Utah chooses is missing coverage in one or more of the 10 categories of federally required benefits, Utah will have to add that benefit in to the chosen plan.

These and many other issues will be considered during the 2012 interim session by Utah’s leaders and they need to hear from you!  Your voice as a consumer is going to be very important in keeping this discussion not only about cost, but also about promoting health and managing chronic disease.

If you are interested in lending your voice or serving on a monthly consumer group contact Shelly at (801) 433-2299 or shelly@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.

Health and Human Services released a flurry of proposed regulations over the last month for health insurance exchanges (see our article about HHS’s listening session held last week).   You can read about (and get a copy of) the regulations at  http://www.healthcare.gov/news/factsheets/index.html.

The Utah Health Exchange has one of only 2 exchanges in the country (the Massachusetts’ Connector is the other) and is often viewed as a model for other states.  Because of this Utah has unique insight into the proposed regulations for HHS.  Comments about the regs are due Sep. 28, 2011.  Stay tuned for an opportunity to join your voice with UHPP as we prepare our comments.

As the mechanism for facilitating access to quality, affordable, private health insurance, Exchanges are a core element of the federal health reform law, the Affordable Care Act (ACA). The federal government is asking for comments on the proposed regulations for Exchanges by September 28, 2011 (see UHPP’s table indicating what HHS is looking for comments about). To help stakeholders prepare their comments, the Department of Health and Human Services (HHS) is holding invitation-only Listening Sessions around the country.  The session for Regions 7 and 8 was held Wednesday, Aug 24 in Denver. In attendance at the morning session for state officials were Dave Patton, Executive Director of the Utah Department of Health; State Senators Gene Davis and Wayne Niederhauser, Rep. Rebecca Chavez-Houck; and Dave Jackson of First West Benefit Solutions, head of the
Utah Risk Adjuster Board. Two advocates attended the afternoon session for community stakeholders: UHPP’s Hilman and Voices for Utah Children’s Nehring.

Hilman shares a few observations geared toward UHPP and partners’ quest for a robust health insurance exchange…

I can be faulted for looking too much on the bright side, but I found the session worthwhile—if only to learn what these immense operational challenges for Exchanges and flexibility questions feel like in our region. HHS really wanted to hear from us—blackberries were down—each and every comment was responded to by someone from the HHS/CMS panel.  

By design, they gave a very brief introduction to the given topic (exchanges, plan standards, eligibility & enrollment; Medicaid eligibility and enrollment; tax credits and small business options) and then opened up to any and all input. Key decision makers were there taking notes: Joel Ario (over the Office of Health Insurance Exchanges at HHS, though he
is exiting that position soon) and Vikki Wachino (the ACA Medicaid expansion lead at CMS).

The regional team was well represented, including the OMH (Office of Minority Health) and OCR (Office of Civil Rights) leads, who were there all day.

 Just a few eye-opening remarks from the HHS/CMS panel (keep in mind that I’ve likely captured what speaks to Utah in our situation):  

• Ario: we will grant flexibility wherever we can, but not where it doesn’t make sense, for example on standards for
  data collection or, of course, the big ACA changes (such as a mandate as the mechanism to bring in young people,   which is necessary for community rating in both marketplaces; affordability standards and the subsidies as
  tool for this; and other changes that are awkward for states like Utah).
• Wachino: we are studying best practices in eligibility systems pretty heavily now. Utah’s MyCase (consumer’s
  interface with E-REP, our electronic eligibility system) is under the microscope as a possible model.  Some states (like Utah) are preparing to  operate the SHOP exchanges but maybe not the AHBE (American Health Benefit
  Exchanges for the individual market). HHS is strongly considering a partnership with such states to accommodate such a separation. 

New ACA Medicaid Eligibility RulesReleased for Public Comment

The new rules, released for the 75-day comment period starting August 12, will build on existing momentum toward Exchange development in states by…

• Simplifying eligibility standards for Medicaid and CHIP programs
• Simplifying the enrollment process
• Creating care coordination standards
• Increasing the Federal Medical Assistance Percentage (FMAP) for newly eligible individuals
• Minimizing the administrative burden on states as they establish separate eligibility processes for current Medicaid target population and expansion groups in 2014 (great news: states will be able to do statistical sampling)

Utah’s E-Find system gets a shout-out in the overview as a best practice – big kudos to DWS!

Click here for directions on how to submit comments to CMS.

HB2003 Health Insurance Amendments (formerly known as SB294 2^nd substitute, Patient Access Reform), sponsored by Rep. Jim Dunnigan, was heard on the House floor on July 20^th in the 2001 2^nd special session—and passed 46 to 23.  This is the “last minute” bill re-purposed by Rep. Dunnigan on the last day of the 2011 legislative session, later vetoed by the Governor, reworked and renamed for the special session.

The bill still contains a provision that allows insurance companies to increase the standard slope ratio range for age band rating and for family tiers to 6:1 (the standard is 4:1, and ACA guidelines, coming online
in 2014, restrict the ratio to 3:1) in an effort to bring in the “young immortals” by allowing carriers to lower rates for the young immortals—but at greater cost to the older and sicker insureds.

New to the current bill is that insurers outside of the Utah Health Exchange can offer 4, 5, or 6 family
tiers (the standard in the Exchange is 4; new tiers proposed include one-employee-one-child tier and an employee-spouse-and-one-child tier). This will lower costs for small families but raise them for larger families and, more worrisome perhaps, create two insurance markets in Utah—one in and one out
of the Exchange.

Rep. Dave Clark testified against the bill, noting that it undoes carefully crafted legislation from the 2010 session and that, having two markets has proven to create more problems than it solves in the past.  Rep. Dunnigan countered that it is not a mandate, and most insurers who play in the Exchange will use the same tiers and rate band for their products both in and out of the Exchange because it is too expensive for them to do differently.

UHPP Analysis
This raises the question of why change it at all?  Will it indeed “let the market be the market” as Rep. Dunnigan argues, possibly producing an innovative new way to do things that the others can then copy?
Or is it just tinkering with Utah’s insurance code to no lasting effect? Does it serve Utah consumers to move these tiers and rate band ratios back and forth every year in legislation?

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.