Commerce generally has its way in Utah's Republican-controlled Legislature.
But amid the tax breaks and other pro-business legislation wending its way through the 1998 general session is a packet of health-care proposals seen by insurance companies and the employers they serve as downright hostile."The Republican philosophy of let the free market rule goes out the window when it comes to health care," huffs one industry lobbyist, speaking privately.
And no wonder. The nationwide backlash against managed health-care plans hasn't bypassed Utah, and every election-year politician in the Beehive State knows it.
At last count, 15 proposed laws have been filed by Republicans and Democrats alike, mandating that health insurers provide more benefits ranging from unrestricted access to a dermatologist to including certain drugs under prescription plans.
Health insurers and business owners are scrambling under the onslaught, sounding warnings that legislating benefits will backfire by jacking up premiums for consumers.
The governor's Health Policy Commission, created in 1994 as a clearing house for health care-related legislation, hasn't helped industry. Commission member Rep. Peter Knudson, a Brigham City Republican and orthodontist, bypassed the panel in introducing two bills mandating coverage of facial bone surgery and childhood immunizations.
Even lawmakers with ties to the industry can't be relied on by the business lobby.
"My industry is madder than hell at me," said Rep. Brian Allen, R-Salt Lake, an insurance executive who is sponsoring a bill that would force health plans to cover treatment for depression and other biologically based mental illnesses.
Gov. Mike Leavitt, a former insurance executive, said through a spokeswoman the administration will reserve comment until it has carefully reviewed the proposed mandates.
Utah lawmakers are following a trend by other state Legislatures and Congress, experts say.
Patients and physicians are fed up with the limited access to certain doctors, treatments, medications and other services that managed health-care proponents claim is necessary to keep costs in check.
The complaints are falling on sympathetic ears in the 52nd Legislature. On Tuesday, the House voted 64-1 for legislation that would allow women to use their obstetrician-gynecologist as their primary-care physician.
"I got the idea by listening to my daughters," said sponsoring Rep. Judy Buffmire, D-Salt Lake.
She said the requirement by some insurers that a general practitioner must approve any visits to a specialist is impractical, considering most women rarely see anyone but an obstetrician-gynecologist during childbearing years.
The bill likely will become law, as will measures requiring coverage of childhood immunizations and of dietary products for treating metabolic diseases in infants.
Insurance and business lobbyists don't argue that the proposals have merit. But they contend lawmakers don't seem to understand how the health-care market evolved into today's strict, cost-conscious managed care system.
House Assistant Majority Whip John Valentine, who voted against the metabolic diseases bill, agrees.
"People don't want to be perceived as being against children or women, so they don't make a conscious, intellectual decision about whether this is good policy," he said.
Complaints by employers of spiraling health insurance premiums in the early 1980s forced insurers to clamp down and micro-manage doctors, hospitals and other providers. They capped prices, eliminated procedures and created rigid protocols for providers and patients.
The result was more affordable plans under "health management organizations" or "preferred provider" networks that employers could offer their workers. But the bottom-line approach isn't always consumer-friendly.
"Some plans cause people to react, like going too far in restricting access and contracting with only certain doctors," said Michael Stapley, president and chief executive officer of Deseret Mutual Benefit Association, which manages insurance benefits for Mormon Church-owned enterprises. "It doesn't take too many of those things before the public says, `Now wait a minute.' "
That's what Sen. Mike Dmitrich, D-Price, heard from his dermatologist, complaining that managed care plans threaten the livelihood of specialists who have to rely on a "gatekeeper" physician for referrals.
The veteran lawmaker said the committee room was empty until his bill came up for hearing recently. "Then the room filled up with insurance people," he said, and the proposal was voted down.
Industry lobbyists also ganged up on legislation requiring coverage of dental anesthesia, which was stalled in committee with a tie vote.
Health insurance and business lobbyists said they are simply telling lawmakers that the well-meaning legislation will backfire as premiums go up to pay for the expanded coverage.
"The Legislature said it wants to increase benefits, but when the costs hit, coverage will actually decrease because it will be too expensive," said Larry Bunkall, president of the Utah Manufacturers Association.
He said the slate of bills considered this session is expected to send rates up another 20 percent. Bunkall said the sector hardest hit will be small and medium-sized businesses.
Large companies and state government are self-insured and under federal law are exempt from state mandates. And most of the large health insurers already offer some of the benefits being proposed, such as childhood immunizations and open access to an obstetrician-gynecologist.
"These bills only impact about one-third of the market," said Frank Pignanelli, representing Blue Cross and Blue Shield of Utah. "They (lawmakers) just like to tell us what to do."
But some lawmakers believe the industry inflates the cost of mandates and ignores the long-term cost savings of treating childhood diseases or mental illness.
Allen, a manager at Zions Insurance Agency, said if insurers and business leaders don't come to the table with some alternatives, the trend to legislate insurance won't end anytime soon.
"I gave them three years to come up with a plan (to cover mental illness) and the phone never rang," said Allen, whose bill is stalled in the rules committee. "In reality, if they don't do something, other states will mandate it and the federal government will step in and force them all to offer the coverage."