Utah health insurance exchange
Utah moves forward with dual-model exchange, seeks state-specific health care reform
By Louise Norris
November 1, 2013
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 for small businesses 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. According to an article in The Salt Lake Tribune, about 350 businesses provided health insurance to about 7,800 people through Avenue H.
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, and Utah moved forward with two separate exchanges – small business run by the state and individual run by HHS – when open enrollment began for individual policies in October. New Mexico has also adopted a hybrid approach, but the specifics are different.
Utah has been politically divided on the ACA, with some lawmakers championing HCR10, a non-binding resolution detailing the “devastating impacts of the ACA” that was signed by Governer Herbert in April 2013. As of the beginning of November, Governor Herbert had not yet decided whether to move forward with Medicaid expansion in Utah, but is simultaneously pushing for expanded charity care for low income residents and a state-based, Utah-specific solution to health care reform.
Six health insurance carriers are offering a total of 99 policies through Utah’s federally-run individual exchange: Altius Health Plans, Arches Mutual Insurance, BridgeSpan Health, Humana Medical Plan of Utah, Molina and SelectHealth. Rates in Utah are lower than the national average. Across all age groups, the average lowest cost bronze plan in Utah is $201/month before subsidies, compared with a national average of $249.
Three companies — Arches Mutual Insurance, SelectHealth and UnitedHealthcare of Utah — are selling small group policies through Avenue H in 2014.
According to Kaiser’s State Health Facts, about 14 percent of Utah’s population is uninsured.
Contact the exchange
Use the federal marketplace to enroll in individual or family coverage beginning Oct. 1, 2013
More Utah health insurance exchange links
Utah’s exchange for small businesses (Small Business Health Options Program, or SHOP)
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.
State Exchange Profile: Utah
The Henry J. Kaiser Family Foundation overview of Utah’s progress toward creating a state health insurance exchange.