Emphasizing its cautious and flexible approach, Gov. Mike Leavitt unveiled his "Utah Healthprint" for health-care reform Monday. The blueprint focuses on insurance reforms, expansion of Medicaid and increased market competition to allow Utahns access to affordable health insurance within the next few years.
An estimated 215,000 (11 percent) of Utahns have no insurance coverage. About the same number are considered "under-insured."The announcement ends weeks of speculation about what shape health-care reform will take in Utah.
Leavitt promises his plan would control health costs, maintain and enhance quality and increase access to care. The plan would phase in through the year 2000, beginning with two bills to be introduced to the Legislature this week. Ultimately, the plan promises insurance coverage to anyone who wants to buy it. And a "buying cooperative" would make insurance affordable for individuals and small businesses.
But he emphasized that the plan's success would depend on what form federal health reform takes, how flexible it is and whether Utah can get waivers to implement it.
The plan calls for creation of a Utah Health Policy Commission, with the governor as chairman. Members would include four legislators and six appointees. The group would study health-reform issues and provide updates and recommendations for lawmakers during each phase of enacting reform. Legislators are being asked for $450,000 to set up the commission.
Medicaid expansion is at the heart of Leavitt's proposal. He wants lawmakers to approve Medicaid expansion to cover all children who live below federal poverty guidelines immediately. That would provide health care for 32,000 more children. In the next two years, Medicaid would be expanded to cover all blind, elderly and disabled individuals and finally all Utahns up to the poverty line.
If Leavitt's plan passes, insurers will provide coverage for unmarried tax dependents to age 26, including those who attend college or serve missions. Small groups would enjoy a "community rating" with variations only for age, gender and geography. Pre-existing condition clauses would be phased out over two years, beginning immediately. Premiums could be discounted for healthful lifestyles. Insurance companies could not refuse to renew a policy unless the
policyholder failed to meet contract requirements such as paying premiums. In 1996, the plan calls for "guaranteed issue," meaning anyone who can afford insurance can have it.
Leavitt said his plan has no employer mandate but rather makes the individual responsible for providing health insurance coverage, while making it easier and more affordable to do so. "That doesn't mean employers don't have a role in providing insurance," he said.
To make that possible, Utah will ask the federal government to change tax laws so that individuals can get the same tax break when they buy insurance that employers now enjoy.
The Legislature will also be asked to increase funding for the uninsurable risk pool by $1.5 million. The pool allows people who are considered uninsurable to access health insurance at affordable rates.
Over the next three years, all Medicaid recipients would be placed in "capitated" health programs, where the providers are paid a flat fee to provide care. They would be paid the same amount for healthy and ill Medicaid clients and provide whatever care is needed.
The governor believes many private insurers will move into capitated care systems in the future.
Future changes would include a ban on physician self-referral, such as for laboratory tests in facilities they own, portability of insurance so people can change jobs, a rural health plan, alcohol and drug treatment plan and mental health plan.
"We want to move cautiously, slowly and methodically," Leavitt said. "We have to depend on a competitive marketplace to make sure we don't jump too radically."