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Utah health insurance

Lawmakers continue to fight for UT Medicaid expansion

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 compiled a wealth of information to help you get a clearer picture of the overall public health in Utah, as well as attitudes toward the Affordable Care Act and Medicaid expansion.

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 2014 edition of America’s Health Rankings gave Utah a significantly higher rating: 5th out of the 50 states – up a spot from 6th in 2013. The factors that increase Utah’s ranking include a low rate of smoking and preventable hospitalizations along with a low percentage of children in poverty. However, the state still has its challenges: a high rate of drug deaths, low immunization coverage among teens and limited availability of primary care physicians. Utah has seen a 16 percent increase in physical inactivity in the past year.

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 Sens. Robert Bennett and Orrin Hatch both voted against the ACA. In the U.S. House, Republican Reps. Jason Chaffetz and Rob Bishop voted no, while Democrat Jim Matheson 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.

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 Obamacare help Utah residents?

Prior to 2014, the uninsured rate in Utah was 15.96 percent. Post-ACA, at the end of 2014, Utah’s uninsured rate was 13.3 percent, according to a Gallup poll. A report by the U.S. Census Bureau showed a smaller drop – 14 percent in 2013 to 12.5 percent after 2014 open enrollment. A follow-up 2015 Gallup poll found the state’s uninsured rate had fallen slightly to 13.2 percent.

Utah’s relatively small reduction in its uninsured population since Obamacare took effect is mainly because the state has not yet expanded Medicaid.

Utah enrollment in qualified health plans

The Kaiser Family Foundation estimated in late 2013 that the potential market for Utah’s federally facilitated exchange 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 qualified health plans through the Utah exchange, and HHS reported that 86 percent of them received subsidies to lower their premiums.

During the second open enrollment period in 2015, a total of 140,612 Utahns enrolled in QHPs through the state’s exchange. However, by June 30, several had dropped coverage or failed to make their premium payments and enrollment stood at 126,784. Of those enrollees, 65.6 percent were receiving advanced premium tax credits and 62.1 percent were receiving cost-sharing reductions.

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.

As of early 2015, there were 22 CO-OPs operating in 23 states. By mid-October, nine had announced their closure, and but Arches Mutual remained. By the end of the month, however, Utah’s CO-OP delivered the news that it would cease operations at the end of the year. Two more Utah carriers decided to exit the exchange after 2015, as well: Altius Health Plans and BridgeSpan Health.

For plan year 2016, the following companies will offer individual plans through Utah’s federally facilitated exchange:

  • Humana Medical Plan of Utah
  • Molina Healthcare of Utah
  • Select Health
  • University of Utah Health Plans

Utah Medicaid/CHIP enrollment

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.

As such, Utah is one of 20 states that has not yet expanded Medicaid. If the state accepted expansion, 41,000 people who are now in the coverage gap would gain access to benefits.

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. Healthy Utah supporters estimate 126,000 Utahns would be newly eligible for Medicaid if the state were to expand coverage.

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

Utah is among the states with the smallest change in Medicaid enrollment since Obamacare took effect. With a 3 percent increase in monthly Medicaid/CHIP enrollment, Utah ties with South Dakota and Virginia and has a bigger increase than only Alaska, Wyoming and Nebraska.

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 are 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

Gov. Gary Herbert has been opposed to the ACA, but is looking for a way to expand Medicaid using private coverage and said, “Doing nothing is not an option.” The vast majority of Utah’s residents favor the governor’s approach over no expansion at all. On July 17, 2015, the state’s leadership announced it had reached an agreement on Medicaid expansion. However, in October, the bill failed to get enough House votes to advance to the Senate. Lawmakers will revisit expansion alternatives during the 2016 legislative session.

Medicare in the state of Utah

In 2009, Utah Medicare enrollment was about 10.6 percent of its total population, much lower than the total share of the U.S. population enrolled in Medicare, which is 16 percent. About 84 percent of Utah’s Medicare beneficiaries qualify based on age alone, and 16 percent are on Medicare as the result of a disability.

Medicare pays about $8,325 per Utah beneficiary each year. There are about 20 states that spend $10,000 or more per recipient. In terms of overall spending on Medicare, Utah ranks 39th with $2.3 billion per year.

Utahns eligible for Medicare can select a private Medicare Advantage plan instead of Original Medicare if they want additional benefits. In Utah, 34 percent of 2014 Medicare enrollees chose a Medicare Advantage plan.

Of all 2014 Utah Medicare enrollees, 46 percent had a Medicare Part D prescription drug plan. Nationwide, enrollment in a stand-alone Rx plan among Medicare enrollees is 47 percent.