Utah health insurance exchange

Utah wins approval for dual-model exchange

By Carla Anderson
healthinsurance.org^TM contributor

Along with Massachusetts, Utah has a health insurance exchange that predates the Affordable Care Act. However, unlike the exchanges called for by the Affordable Care Act, Utah’s exchange is not open to individual consumers to purchase health insurance. That fact has led to a series of discussions and negotiations between the state and the U.S. Department of Health and Humans Services (HHS) — and ultimately, a unique approach that is attracting interest from other states.

The Utah Health Exchange was established in 2009 and rebranded as Avenue H in October 2012. Avenue H offers a “fixed contribution” approach for small employers. An employer contributes a fixed amount toward each employee’s health insurance. An employee then uses the exchange website to pick an insurer and policy to fit his or her individual or family needs. By late 2012 about 320 small businesses provided health insurance to about 7,600 people through the exchange.

Gov. Gary Herbert asked President Obama to direct the U.S. Department of Health and Human Services (HHS) to approve Utah’s exchange and to consider it a “minimum standard” for an ACA-compliant state-based exchange. In January 2013, HHS granted conditional approval for Utah’s exchange while maintaining that it must be expanded to serve individual consumers. Herbert continued to lobby for HHS to accept the Avenue H “as is” and proposed in February that the state continue running its small business exchange and that the federal government operate the individual exchange. In May, HHS and Utah reached an agreement for this dual-model approach. Once HHS officially changes its rules governing exchanges, other states could also pursue the dual-model approach.

According to Kaiser’s State Health Facts, about 14 percent of Utah’s population is uninsured.

Updated May 14, 2013

More Utah health insurance exchange links

Avenue H

Health Insurance Division Consumer Service
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Utah.
(801) 538-3077

Office of Consumer Health Assistance (OCHA)
Serves residents with health care complaints.
(801) 538-9674 / Toll-Free: 1-800-439-3805 / health.uid@utah.gov

State Exchange Profile: Utah
The Henry J. Kaiser Family Foundation overview of Utah’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Utah