Facebook Twitter

Gov. Herbert must decide if state will pay for high-risk insurance pool

SHARE Gov. Herbert must decide if state will pay for high-risk insurance pool

The scale of the federal health care reform package is enough to wilt even the most ardent advocate: 2,700 pages, 200-plus change orders already added and more than 2,000 still to come.

Sorting out the exact ways that reform will affect Utahns will take some time, but for now, Utah Gov. Gary Herbert and his advisers have an immediate task at hand: to decide if they will continue to fund a high-risk insurance pool or opt into the federal plan instead. They must decide by next week, and if they opt for the state-funded plan, they have until July 1 to make it operational.

What concerns some state lawmakers is that if they opt for the federal plan, there's little chance they'll get out of it. And that could leave the state responsible for paying for high-risk insurance that federal funds don't cover.

The state already has a high-risk pool that provides insurance coverage for about 4,000 Utahns who are disabled or have chronic illnesses that otherwise make them uninsurable as far as private companies' actuarial standards. The annual cost to taxpayers is $8.5 million.

Under the federal reform plan, insuring this group of people isn't Utah's problem.

"Oh, yes it is," said Rep. David Clark, House speaker and point man for both the federal plans and Utah's own reform effort. "Everything in the federal plan is the state's and every state's problem."

As the package stands, states that opt into the federal plan will receive $40 million over the next three years but will have to come up with any additional money that's required to insure the high-risk pool. There are an estimated 11,000 more uninsurable Utahns the state would have to cover. Another 110,000 are expected to be added to the 200,000 Utahns on Medicaid.

The state's Medicaid enrollment choke point — eligibility requirements — would also be lifted and within a few years, and a person's assets could no longer be used to filter people out under the federal reform. Utah has to lift those restrictions, no matter what it does with the high-risk pool.

Legislative analysts estimate that totally implementing federal reforms could cost $1 billion and run about nearly $150 million a year by 2020, when reforms are to be completed.

As a buffer against reforms, the Legislature in its last session approved a bill that prohibits any state agency or department from implementing provisions of the federal health care reform without first reporting to the Legislature. The measure also requires the state to opt out of federal reform if doing so is in the best interest of Utahns.

"There's been a lot of doom-saying and negativity about reforms, but they are flexible and ultimately contain a lot of changes that coincide with Utahns' and legislators' own values, such as endorsing private-market reforms that are core to the state reform effort, such as private-market solutions," Clark said.

e-mail: jthalman@desnews.com