Utah health insurance

In 1st month, 2017 signups surpass last year's November numbers

In the first month of 2017 open enrollment, more Utah consumers enrolled in 2017 health insurance through the state’s exchange than during the first month of 2016 open enrollment. Federal officials reported that 46,652 Utahns signed up for exchange-based health plans from November 1 through 30—by comparison, a total of 37,816 signed up in November 2016.

There could be any number of reasons for Utah’s enrollment surge. Though the state participates in the federal exchange, its residents have access to local support through nonprofit organizations such as Take Care Utah, which consists of about 90 navigators and enrollment specialists statewide, and the Utah Health Policy Project, which provides public outreach and education and also works toward “advancing sustainable health care solutions for underserved Utahns through better access, education, and public policy.”

2017 health insurance rates and carriers

Utah’s exchange includes 2017 plans from three carriers with a weighted average rate increase of 31.1 percent. The carriers and their rate increases are as follows:

  • Molina (HMO): 37.2 percent
  • SelectHealth (HMO): 30.1 percent
  • University of Utah Health Plans (PPO): 4.47 percent

2017 open enrollment runs through January 31. To obtain coverage that starts January 1, consumers must enroll by December 15, 2016.

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.

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

  • Access – 36th
  • Prevention & Treatment – 28th
  • Avoidable Hospital Use & Costs – 5th
  • Healthy Lives – 4th
  • Equity – 24th

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; adults who smoke; and colorectal cancer deaths per 100,000 population. 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.

But 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. Within the past year, Utah’s number of children in poverty increased 30 percent. And while the state ranked within the top five for several health measures, it was near the bottom for certain immunizations and access to primary care physicians.

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, which may be why the state’s reduction in uninsured rate since the ACA took effect is among the smallest.

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 12.4 percent – a total of 3.2 percentage points since 2013 and the nation’s seventh smallest reduction. As of late-2015, the national uninsured rate was to 11.7 percent.

Were Utah to expand Medicaid under the Affordable Care Act, it is likely more significant improvements would be seen.

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, 86 percent of Utah exchange enrollees qualified for premium subsidies. 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.

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. All but seven of the original ACA CO-OPs have closed or announced their closure.

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.

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, 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 5 percent increase in monthly Medicaid/CHIP enrollment from 2013 to July 2016, Utah is among the 10 states whose Medicaid enrollment has shrunk the least.

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, 35 percent of 2015 Medicare enrollees chose a Medicare Advantage plan compared with 31 percent overall.

Of all 2015 Utah Medicare enrollees, 36 percent had a Medicare Part D prescription drug plan. Nationwide, enrollment in a stand-alone Rx plan among Medicare enrollees is 45 percent.

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.

Here’s a list of Utah’s state-level health reform bills:

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