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Utah health insurance

Utah lawmakers oppose health law, but ACA still broadens coverage

  • By
  • contributor
  • August 7, 2014

If you’re a current or future resident of Utah, or if your loved ones live there, you may be interested in learning more about the health of the state’s residents and how the state’s political leaders are approaching healthcare reform. We’ve put together a list of resources to help you get a clearer picture of the overall public health and attitudes towards reform in Utah.

Utah health ratings

The Commonwealth Fund’s Scorecard on State Health System Performance 2014 rated Utah 19th out of the 50 states and District of Columbia – a gain of one spot from 20th in 2009. Utah’s Scorecard includes rankings for a variety of specific factors and explains how the overall ranking is determined.

But the 2013 edition of America’s Health Rankings gave Utah a significantly higher rating: 6th out of the 50 states. The factors that increase Utah’s ranking include a low rate of smoking and binge drinking, a low rate of obesity, physical inactivity and diabetes, and low prevalence of preventable hospitalizations. But the state still has its challenges: relatively few primary care physicians, and high rates of drug deaths and pertussis infections..

Trust for America’s Health has also summarized Key Health Data About Utah, which includes information about specific disease prevalence and a variety of factors that influence health outcomes. And you can also see how the counties in Utah compare with one another using this interactive map created by the Robert Wood Johnson Foundation.

Utah and the Affordable Care Act

In 2010, Utah’s U.S. Senators, Robert Bennett and Orrin Hatch, both voted against the ACA. In the U.S. House, two of Utah’s Representatives – both Republicans, Jason Chaffetz and Rob Bishop – voted no, while Jim Matheson, a Democrat, voted yes. Mike Lee, a Tea Party Republican, has replaced Bennett in the Senate, and is a very vocal opponent of the ACA. In the House, Chris Stewart took office in 2013, and has since voted to repeal and defund Obamacare. The current U.S. congressional delegation from Utah is mostly opposed to the ACA, with Matheson as its lone supporter.

Governor Gary Herbert is also opposed to the ACA, but is looking for a way to expand Medicaid using private coverage, saying that “doing nothing is not an option.” The vast majority of Utah’s residents favor the governor’s approach over no expansion at all, but the legislature failed to support his proposal in 2014, and he has yet to receive approval from HHS for his proposed modifications.

Utah has taken a unique approach to running the exchange. In a compromise with HHS, the state is running its own “Avenue H” small business (SHOP) exchange, which pre-dates the ACA, while HHS is running the individual exchange.

How did the ACA help Utah residents?

Prior to 2014, the uninsured rate in Utah was 15.96 percent. Mainly because the state has not yet expanded Medicaid, the reduction in that number is projected to be relatively small – only about 2.38 percentage points. That translates to a post-ACA uninsured rate of 13.57 percent, putting Utah right the in the middle of the ranking of states (23rd) for overall uninsured rate after ACA implementation.

Utah enrollment in QHPs

The ACA contained a provision that provided funding for the creation of Consumer Oriented and Operated Plans (CO-OPs), and more than $2 billion was awarded for CO-OP creation in 22 states. Utah’s Arches Mutual Insurance Company received $89.6 million.

In addition to Arches Mutual, five other carriers are offering individual health insurance through the Utah exchange: Altius Health Plans, BridgeSpan Health Company, Humana, Moilina, and SelectHealth.

The Kaiser Family Foundation estimated in late 2013 that the potential market for the exchange in Utah was 331,000 residents, and that 206,000 of them would qualify for premium subsidies to offset the cost of their plans. By mid-April 2014, when the first open enrollment period ended, 84,601 people had completed their enrollment in private plans through the Utah exchange, and HHS reported that 86 percent of them received subsidies to lower their premiums.

Utah Medicaid/CHIP enrollment

Although Governor Herbert is considering ways that Utah could expand Medicaid using private coverage (as opposed to a straight expansion of Medicaid as called for in the ACA), the process has been slow and no agreement has been reached. As of August, Utah is one of 22 states that will have no Medicaid expansion in 2014. As a result, the state has 77,127 people in the coverage gap, with no access to financial assistance with their health insurance.

Another 25,997 residents have incomes between poverty level and 138 percent of the federal poverty level (FPL); they would be eligible for Medicaid if Utah were to accept federal funds to expand coverage under the ACA. For now, they are eligible for subsidies to purchase insurance through the exchange, but they would benefit from Medicaid expansion as well.

Since the state has not yet expanded coverage, Medicaid is not available in Utah for non-disabled adults without dependent children, and parents of dependent children are only eligible if their household income is under 51 percent of poverty.

The ACA would have provided Medicaid for all Utah residents with incomes up to 138 percent of poverty, but a Supreme Court ruling in 2012 allowed states to opt out of Medicaid expansion, and Utah has so far chosen that path. 50,268 Utah residents had enrolled in Medicaid through the exchange by mid-April, qualifying under the existing guidelines.

Does Utah have a high-risk pool?

Before the ACA, individual health insurance was underwritten in nearly every state, including Utah. This meant that pre-existing conditions could prevent an applicant from obtaining a policy, or could result in higher premiums or pre-existing condition exclusions. The Utah Comprehensive Health Insurance Pool (HIPUtah) was created to give people an alternative if they couldn’t get private individual health insurance because of their medical history.

Now that all health insurance plans are guaranteed issue, high risk pools largely obsolete. HIPUtah coverage ended on December 31, 2013, and members were able to transition to guaranteed issue coverage through the exchange instead.

State-based health reform legislation

Here’s a summary of recent Utah bills related to healthcare reform: