The Affordable Care Act has again survived a potentially crippling legal challenge. The question now becomes: What is the path forward in Utah? Hopes were high during the last legislative session that lawmakers would act to reduce the number of Utahns without equitable access to health care. While public opinion in poll after poll showed overwhelming support for the governor's Healthy Utah initiative, the Utah House of Representatives chose to ignore this reality, and the bill was never even brought to the floor for a vote after it was passed by the Senate.
Over a 30-year career, I have chaired many health reform task initiatives, both within Utah and at the national level. One thing became clear in any discussion of the issue; nearly everyone who has health care coverage is dependent on someone else to pay for it.
Historically the majority of all people with health care coverage fall into one of three groups: (1) those covered by Medicare, (2) those covered by Medicaid or other public programs and (3) those who have benefits through an employer.
Medicare covers the elderly and some disabled persons. This insurance is sponsored and primarily paid for by the federal government. In 2013 there were 54 million people enrolled in Medicare who paid, on average, 13 percent of covered care. The balance was paid by someone else, primarily the government.
Medicaid and similar public programs have an enrollment of about 56.2 million nationally, about 18 percent of the total U.S. population. The numbers are smaller in Utah, but still significant. About 318,000 people (11 percent of the population) are enrolled in public programs. These people are the neediest in our society and are totally dependent on government for the cost of their health care.
According to the Kaiser Family Foundation, 56 percent of people in the U.S. under age 65 (about 150 million people) receive health insurance coverage as an employer-sponsored benefit. Employers typically pay a significant portion of the cost: 82 percent for single coverage and 71 percent for family. (For example, the state of Utah pays 90 percent of the cost of health insurance for members of the Legislature.) A major reason employers offer health insurance is the exclusion of employer-provided health insurance from income and payroll taxes. In 2012, this resulted in lost tax revenues of $286 billion. Economists generally agree that the tax exclusion should be eliminated or curtailed, but in today’s environment, it is a reality and a major reason the majority of Americans under age 65 have health insurance. These people are dependent on their employers and the government for their coverage.
Those who remain uninsured are people under age 65 who are not eligible for Medicare; they are working but do not qualify for or receive employer-sponsored coverage, and they are poor but not poor enough to qualify for Medicaid. They are just like the rest of us who are dependent on someone else but unfortunately do not have a third party willing to help them pay for their health insurance. These people are as important as anyone else. History will not judge kindly an affluent society that ignores these people.
The moral character of any society is defined by how well it takes care of its poor. The real heroes in our world are those who do something for others. I believe the citizens of Utah want to help. Hopefully there will be a few real heroes in the Legislature who will be motivated by compassion and choose to act in a manner that truly represents the moral character of our great state.
Michael Stapley is a former president and chief executive officer of Deseret Mutual, as well as a former executive director of the Utah Department of Health, where he chaired health reform task forces for two governors.