Along with being the world's focal point for winter sports, Utah is now the only state in the country that the federal government has ever allowed to alter Medicaid benefits for the poor.
By signing a special Medicaid waiver Saturday in Salt Lake City, U.S. Secretary of Health and Human Services Tommy Thompson, in town for the Olympics and the waiver signing ceremony, granted Utah's proposal to offer basic health-care coverage to poor Utahns who have none by reducing some of the coverage of those already under Medicaid.
A companion bill, passed by the Legislature last week in anticipation of the waiver and designed to permit private insurers to offer small employers the same limited benefit plan that the waiver creates, was also signed Saturday by Gov. Mike Leavitt. HB122, the first bill signed into law this session, is designed to help the state offer "basic care to many rather than unlimited care to a few," Leavitt said.
The waiver and the new law are "the first step toward providing everyone access to health care," Leavitt said, noting that it wouldn't have been possible without approval by Thompson, who Leavitt called the "father of welfare reform in this country."
Under the reduced plan, about 17,600 adults who have a complete package of benefits will now have limitations on some dental, vision and mental health benefits. Co-pays will also increase. A physician visit, for example, will increase to $3 from $2, and prescription co-pay will increase to $2 from $1.
But another 25,000 people who currently have no health care will have some coverage. HB122 allows the state to partner with insurers and employers to purchase the coverage through the private market rather than expanding enrollment in state programs.
The law would apply to any adult between the age of 19 and 64 who has not had health-care coverage for at least six months, whose employer pays less than half of their health-care benefit, and whose annual income is less than 150 percent of the federal poverty level ($8,590 a year for an individual).
Although the waiver will affect only 16 percent of the 152,000 uninsured Utahns, Thompson called the combination waiver and law "a giant step forward" for the state's working poor. He said access to health care is "the issue" in his department, which is the largest in the federal government with a $489 billion annual budget.
Still, advocates for the poor, as well as some doctors and local insurance providers, say the hope in the measures for expanding coverage for the poor is matched by the possible unknown side-effects.
The change limits access to specialty care while at the same time putting pressure on primary-care physicians, who might find themselves diagnosing problems that require treatment not paid for by the plan.
"This is a big unknown," said Val Bateman, deputy executive vice president of the Utah Medical Association. "On the other hand, primary-care physicians might catch a problem before it becomes acute and needs a specialist."
Those types of questions will be addressed over the next year by a network of health-care providers being developed as a result of the changes.
Some advocates for the poor claim the waiver is unlawful and violates the health-care protections established by Congress. They note that Washington state and Michigan plan to seek similar waivers and others will soon follow.
Judi Hilman, health policy analyst for the advocacy group Utah Issues, said she is "hopeful but very cautiously optimistic" about the changes. "There are a lot of questions about gaps in care it creates and whether a reduced program will ultimately prove to be adequate."
E-mail: jthalman@desnews.com