Governor Gary Herbert presented his Healthy Utah plan on Dec. 3. He has proposed Healthy Utah as Utah’s approach to Medicaid expansion. You can read the plan at healthy.utah.gov/healthyutahplan.pdf.
Under the Affordable Care Act (ACA), Utahns will pay an estimated $700-800 million over 10 years in new ACA-related taxes to Washington D.C., yet by not expanding Medicaid, we would forgo the benefit of these taxes. Healthy Utah can bring nearly $1.8 billion of federal tax dollars to Utahns for unmet healthcare needs for roughly $100 million in state funds over three years.
More than 60,000 Utahns living below the poverty level have no real access to health insurance or coverage because they can’t get it through healthcare.gov, nor do they qualify for Utah Medicaid. Notably, a majority of these people are gainfully employed. Healthy Utah provides coverage to approximately 95,000 Utahns who earn less than $15,521 per year (for one person) to purchase private insurance. Look at your neighbors or your own household. You will probably find one or more people who are working full-time or as much as possible, but don’t have health insurance because their employer doesn’t offer it or they can’t afford it.
Absent medical insurance, families can’t afford doctors and pharmaceuticals, so they defer dealing with health issues until they become serious. Typically, people who defer care of serious conditions finally end up in the emergency room — the most expensive and least efficient place to deal with many health issues, such as chronic conditions like diabetes, asthma and heart disease, and mental health issues like depression, anxiety and substance abuse.
Federal law requires hospitals to treat every patient, whether they can pay for their care or not. This results in much uncompensated care. The costs for uncompensated care have to be absorbed by the hospital, but after a point, the hospital has to allocate costs to those who do pay for their care. So every insured person is paying a “tax” in the form of increased health insurance premiums and hospital charges to offset the costs of treating the uninsured. It’s an inefficient, awkward way to finance health care for the indigent. We’re all paying for this cost anyway, so let’s do so in a more rational way. Making less affluent people get medical care on a catch-as-catch-can basis does not make sense for them or for society at large. Utah can do better than this, much better.
Utah is the first state in the nation to negotiate permission to charge higher co-pays for non-emergency use of emergency rooms. Healthy Utah dis-incentivizes people from visiting the Emergency Room for non-emergency care by raising their ER co-payment from $8-$50. Utah recipients will share in the cost of their plan through co-payments for all adults and premiums for those above the poverty level.
Healthy Utah offers incentives for healthy behaviors – as healthier recipients cost less to cover than those in poor health. For example, members who want to quit smoking can get free services to help them quit. In future years, the plan will offer financial incentives to members who control their weight, diabetes, cholesterol, blood pressure, etc.
Able-bodied adults who are not employed will be automatically enrolled in a work program designed to get them back into the workforce and off public assistance. The ultimate goal is not only to help people in need, but to help them no longer need assistance.
Rather than expanding the one-size-fits-all federal Medicaid program, Healthy Utah recipients will choose from a variety of private insurance companies through Avenue H, the state health insurance exchange. Healthy Utah participants will therefore have commercial insurance, and medical providers will be paid at regular commercial rates rather than steeply discounted Medicaid rates.
Chambers of commerce, businesses and community and religious groups strongly support the governor’s plan. The business community grasps the fact that current and prospective employees need health insurance to work. It’s also a question of social equity. Can we ignore the poorest among us when most everyone else looks upon our health insurance as one of the most important benefits provided by our employers? It’s sad that from top to bottom, everyone in Utah can either afford health insurance, obtain it through their employer, get a subsidized policy, or enjoy Medicaid benefits—except for a small group of about 65,000 Utahns who earn less than the poverty level.
It’s time to extend medical care to all Utahns who can’t afford it themselves, do not receive it at work, or don’t qualify for government subsidized care.
Greg Bell is a former lieutenant governor of Utah and the current President/CEO of the Utah Hospital Association. Robb Austin is the CEO of Moab Regional Hospital and a resident of Moab.