(Al Hartmann | The Salt Lake Tribune) Governor Gary Herbert on Dec. 12, 2012 as he releases his budget recommendations at Granite Technical Institute in Salt Lake City.
Utah expected its federal high-risk pool ? subsidized health coverage for the sick and uninsurable ? to be an easy sell.
But it proved easier than state officials ever imagined.
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Examining exchange plans
In letters to the U.S. Department of Health and Human Services last week, several advocacy groups complained about the lack of clarity and transparency surrounding Utah?s plans for Avenue H. Among them: a physicians group, federally certified community health clinics, AARP Utah, Voices for Utah Children and the Utah Health Policy Project.
The Salt Lake Tribune obtained parts of Utah?s exchange blueprint through a records request. They make promises, say advocates, but don?t say how the state will live up to them.
?There?s so much in there that?s theoretical,? said Judi Hilman, executive director of the Utah Health Policy Project. ?If I were the feds, I would agree to a federally facilitated exchange or give Utah conditional approval subject to our meeting certain requirements and deadlines.?
See the embedded documents for details of Utah?s blueprint.
Links to other states? plans:
New York
New Mexico
Washington state
Minnesota
That?s because hospitals, looking to get paid for treating uninsured patients, did the heavy lifting. They filled out and submitted papers on behalf of patients and, in some cases, paid their monthly premiums, no strings attached.
"People who have a financial interest in making things work will find a way to do it, and do it quickly," said Utah Gov. Gary Herbert?s health adviser, Norm Thurston, citing the experience as proof that Utah?s hands-off, private-market approach to another Affordable Care Act (ACA) requirement ? health exchanges ? will work.
Exchanges, online insurance marketplaces, are designed to be a "no wrong door" portal to health coverage where consumers can compare plans, see if they?re eligible for federal subsidies to purchase them, or enroll in low-income programs such as Medicaid.
"The idea is you can enter this door and walk out with coverage," said Lincoln Nehring, a health policy analyst at Voices for Utah Children.
Utah already has a "shop" exchange for small businesses, Avenue H, which the governor has asked the U.S. Department of Health and Human Services (HHS) to declare as good enough for Obamacare.
Herbert promises to open it to individuals and larger employers and to enforce new insurance price controls and consumer protections. But he argues the customer outreach and hand-holding required to help people navigate insurance options are a waste of money and unrealistic.
His proposal is being viewed as a test case of just how much leeway the Obama administration is willing to give states in running their own exchanges.
HHS will not comment on the negotiations, but Thurston said sticking points are mostly on small, technical issues.
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It?s the details that worry consumer advocates, who are pushing for greater clarity on Utah?s plan and fear Herbert?s vision for Avenue H falls woefully short.
Of top concern, they say, is Utah?s poor track record in linking eligible Utahns with health safety nets.
The state ranked 50th in enrolling eligible children in Medicaid and the Children?s Health Insurance Program (CHIP) in 2010, said Nehring, noting that 80 percent of the state?s 102,400 children are eligible for these programs.
"Utah families are in particular need," he said, "of the ACA?s vision of an exchange that will connect [them] with all their health coverage options."
Under the ACA, those shopping on an exchange must first be screened to see if they?re entitled to Medicaid or CHIP. They are also screened for federal tax credits to apply toward the purchase of their coverage.
States are supposed to hire navigators to help people pick plans best suited to their needs. The rules say they have to provide interpretive services, aides for people with disabilities, and publish "culturally and linguistically appropriate outreach" materials.
But Herbert?s advisers argue these services are widely available in the community.
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Source: http://www.sltrib.com/sltrib/news/55504856-78/utah-health-exchange-font.html.csp
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