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Utah health insurance

Medicaid expansion might be on Utah's ballot in 2018, bypassing legislative resistance to full expansion

Utah 2018 enrollment update

Utah overview

Utah uses the federally-run exchange (HealthCare.gov) for individuals, and as of 2018, for small businesses as well; before 2018, the state used its own Avenue H small group exchange).

The state has not expanded Medicaid under the ACA, despite Governor Gary Herbert’s years-long push to do so. In 2018, the state will submit a waiver proposal to CSM, requesting federal approval to expand Medicaid (with the federal funding called for in the ACA), but only to people earning up to 100 percent of the poverty level, as opposed to 138 percent. It’s doubtful that CMS, even under the Trump Administration, will approve that, however, given that they rejected a similar proposal from Arkansas in early 2018.

But Medicaid expansion might be on the Utah ballot in November 2018, taking the issue to voters instead of relying on reluctant lawmakers. Nearly two-thirds of Utah voters support Medicaid expansion, so a ballot initiative might be more successful than legislation. Supporters have to gather more than 113,000 signatures by April 15, 2018 in order to get the initiative on the ballot.

194,118 people purchased individual market plans through the Utah exchange during the open enrollment period for 2018 coverage. That was about 1.6 percent lower than the 197,187 people who signed up the year before, but it was still much higher than enrollment in 2016, when 175,637 people bought coverage through the exchange.

Utah uses the federal exchange, so the state was limited to the much shorter open enrollment period that the federal government implemented in the fall of 2018, and enrollment was hampered by the federal funding cuts for exchange marketing and enrollment assistance in the weeks leading up to the open enrollment period. But Take Care Utah, a navigator organization, was able to obtain local funding to offset the federal funding cuts (which had reduced the organization’s annual funding by 60 percent), and remained available to help people enroll for 2018. The Utah Health Policy Project is also available to consumers, providing public outreach and education and also working toward “advancing sustainable health care solutions for underserved Utahns through better access, education, and public policy.”

2018 health insurance rates and carriers

Utah’s exchange includes 2018 plans from two carriers, after Molina exited at the end of 2017. But both of the remaining carriers are offering coverage statewide, after University of Utah Health Plans expanded their coverage area for 2018. Average rate increases for 2018 included the cost of cost-sharing reductions added to silver plan premiums. The following average rate increases (before premium subsidies were applied) were implemented for 2018:

  • SelectHealth (HMO): 44 percent
  • University of Utah Health Plans (PPO): 30.8 percent

Open enrollment for 2018 coverage ended on December 15, 2018. Open enrollment for 2019 coverage will run from November 1, 2018 to December 15, 2018. Outside of open enrollment, coverage is available year-round to Native Americans, people eligible for Medicaid or CHIP, and to people who experience certain qualifying events.

Utah health ratings

The Commonwealth Fund’s Scorecard on State Health System Performance 2015 rated Utah 18th out of the 50 states and District of Columbia – a one-spot improvement from 2014. And in the 2017 Scorecard, Utah climbed again, to 15th.

Utah’s score was based on indicators in five categories, in which the state ranked as follows:

  • Access – 40th
  • Prevention & Treatment – 29th
  • Avoidable Hospital Use & Costs – 3rd
  • Healthy Lives – 4th
  • Equity – 18th

The state ranked No. 1 for having lower than average rates of overweight or obese children; adults ages 18 to 64 who have lost six or more teeth because of tooth decay, infection, or gum disease; and adults who smoke. The state had the third-lowest incidence of colorectal cancer deaths per 100,000 population. But the state’s percentages of uninsured adults and children and individuals were above average, as was the percentage of at-risk adults who went without a routine doctor visit in the past two years.

See the state’s scorecard for more specific factors and an explanation on how the overall ranking is determined.

The 2015 edition of America’s Health Rankings gave Utah a significantly better rating: 7th out of the 50 states (down two spots from 5th in 2014), In 2016, Utah dropped to 8th place, but the state’s ranking jumped to 4th place in the 2017 edition of the Rankings. Florida and Utah were the two states that made the biggest improvements (four spots) in that year’s rankings.

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.

Has Obamacare helped Utah residents?

Utah has not exactly embraced Obamacare, but the state’s uninsured rate has still fallen significantly since the law was enacted.

According to US Census data, 14 percent of Utah residents were uninsured in 2013, and that dropped to 8.8 percent by 2016.

Were Utah to expand Medicaid under the Affordable Care Act, it is likely more significant improvements would be seen. The state obtained federal approval in 2017 to implement a very limited version of Medicaid expansion for people with no income who are homeless and/or in need of substance abuse treatment. But the bulk of the people who would be eligible for Medicaid under full expansion continue to be ineligible.

Utah enacted legislation in 2018 to partially expand Medicaid, but only to those earning less than the poverty level (the ACA calls for expansion to those earning up to 138 percent of the poverty level). The state will submit a waiver proposal to CMS for this program, but it’s unlikely to garner federal approval, even under the Trump Administration (Arkansas requested something similar and CMS rejected it in early 2018).

But proponents of Medicaid expansion are working to get an initiative on the ballot in 2018 to expand Medicaid by vote, bypassing the legislature altogether. Nearly two-thirds of Utah voters support Medicaid expansion, so this could be a means of implementing full Medicaid expansion, despite lawmakers’ resistance to the idea.

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 2016 open enrollment, 175,637 people enrolled. 86 percent of Utah exchange enrollees qualified for premium subsidies that year. The average pre-subsidy premium was $271 per month, and the average after-subsidy premium was $84 per month; both are the lowest of all 38 states using HealthCare.gov.

Private plan enrollment for 2016 was more than double 2014 enrollment. By the end of March, effectuated enrollment stood at 164,415.

For 2018 coverage, 194,118 people purchased individual market plans through the Utah exchange during open enrollment. That was about 1.6 percent lower than the 197,187 people who had enrolled for 2017, but it was still considerably higher than 2016’s enrollment. Nationwide, the trend in HealthCare.gov states has been reduced enrollment in both 2017 and 2018 (ie, with 2016 being the highwater mark). But in Utah, enrollment in 2017 was the high point so far, and 2018 enrollment is only slightly lower.

Arches Mutual Insurance Company – Utah’s CO-OP

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 the end of October 2015, however, Utah’s CO-OP delivered the news that it would cease operations at the end of the year. As of 2018, all but four of the original ACA CO-OPs have closed.

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. Chaffetz resigned in 2017, and was replaced by John Curtis, also a Republican. Mia Love rounds out the House delegation from Utah, which is comprised entirely of Republicans, all of whom are opposed to the ACA.

Utah initially took a unique approach to running the exchange. In a compromise with HHS, the state ran its own “Avenue H” small business (SHOP) exchange, which pre-dates the ACA, while HHS ran the individual exchange. But the state eventually decided that it would be more cost-efficient to switch to the federally-run SHOP exchange (which is now functioning in more of a direct-to-carrier fashion), and that transition was made as of 2018.

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 19 states that has not yet expanded Medicaid. If the state accepted expansion, at least 41,000 people who are now in the coverage gap would gain access to benefits.

Tens of thousands of other Utah 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 2 percent increase in monthly Medicaid/CHIP enrollment from 2013 to December 2017, Utah is among only 11 states where Medicaid/CHIP enrollment has increased by single-digit percentages (or decreased slightly, as has been the case in a few states).

Utah enacted legislation in 2018 to partially expand Medicaid, but only to residents earning less than 100 percent of the poverty level, as opposed to full expansion to everyone earning up to 138 percent of the poverty level. But the state will need to obtain approval from the federal government to implement this plan, and it’s unlikely that CMS will grant approval, even under the Trump Administration’s more lenient approach (Arkansas requested something similar and CMS rejected it in early 2018).

Medicaid expansion proponents are working to get an initiative on the ballot in 2018 to expand Medicaid by vote, bypassing the legislature altogether. More than 60 percent of Utah voters support Medicaid expansion.

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.

Medicare in the state of Utah

In 2015, Utah Medicare enrollment reached 345,340, which is 12 percent of the state’s population and lower than the U.S. average of 17 percent. About 85 percent of Utah’s Medicare beneficiaries qualify based on age alone, and 15 percent are on Medicare as the result of a disability.

Medicare spends about $8,016 per Utah beneficiary each year. In terms of overall spending on Medicare, as of 2009, Utah ranked 39th with $2.3 billion per year.

Utah residents eligible for Medicare can select a private Medicare Advantage plan instead of Original Medicare if they want additional benefits. In Utah, 36 percent of 2017 Medicare enrollees chose a Medicare Advantage plan compared with 33 percent nationwide.

Of all 2017 Utah Medicare enrollees, 35 percent had a Medicare Part D prescription drug plan. Nationwide, enrollment in a stand-alone Rx plan among Medicare enrollees is 44 percent. As enrollment in Medicare Advantage plans trends generally upwards, enrollment in stand-alone Part D plans will tend to decrease, since the Part D plans are designed to work with Original Medicare, while most Medicare Advantage plans have their own built-in Part D coverage.

State-based health reform legislation

Gov. Gary Herbert has been generally opposed to the ACA, but has been looking for a way to expand Medicaid for several years, noting that “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.

HB472 was enacted in Utah in March 2018, and calls for the state to expand Medicaid, but only to people earning up to the poverty level (instead of up to 138 percent of the poverty level, as called for in the ACA. The legislation directs the state to submit a waiver proposal to CMS by January 1, 2019, although it’s doubtful that CMS, even under the Trump Administration, will approve the state’s plan.

Scroll to the bottom of this page for a summary of more state-level health reform bills in Utah.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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