Medical patients would have more access to the doctor of their choice under a Senate bill that could either reduce or increase insurance costs.

While there was little debate during Thursday's Senate Business and Labor Committee meeting about whether access to doctors who are not part of a health management organization's plan would improve if SB34 passes the Legislature — even opponents of the bill called it a "freedom of choice" bill — there was plenty of ammunition from both sides about how the law would affect costs.

What there was not, however, was a fiscal note on the bill from legislative analysts, a problem for at least some of the committee members who asked that it be held until a note is prepared. Should the bill have a significant fiscal impact, either on the state or on individuals and businesses, even supporters conceded it would have a hard time passing the Senate.

"The fiscal note will tell us the story about whether costs are going up or down," Sen. Bill Hickman, R-St. George, said. "Personally, I believe it's going to increase costs. It may give more access, but costs will rise."

Despite the lack of a fiscal note, the committee still passed the bill on a 5-3 vote, primarily because of assurances from sponsoring Sen. Chris Buttars, R-West Valley, that the note would be finished before floor debate.

SB34 would allow patients to go to a doctor outside of the insurance provider or health management organization by requiring that the outside doctor be reimbursed at 95 percent of what a plan doctor would have been paid. Buttars said that would have the dual benefit of giving patients the freedom to choose their medical provider without costing the insurance provider any additional money.

Buttars also said that it only makes sense for rates to drop if patients have their choice of doctors.

"If you believe that competition will raise prices, then vote against this," he said.

Opponents of the bill, which included insurance companies, small business representatives and advocates for low-income families, told a different story, however. If patients are allowed to go outside of the plan, then doctors in the plan will have to charge more because they will have fewer patients, which would raise insurance rates and potentially force smaller HMOs out of the state, they said.

"If we can't drive membership to hospitals, we can't offer discounted rates," said Kirk Olsen, the chief executive officer of Molina Health Care of Utah. "That will hurt all of us . . . it will not increase competition, it will decrease competition."

Throughout the almost two hours of public testimony and committee debate Thursday, both sides — the approximately 150 people packed into the committee room seemed almost evenly split between those for and against the bill — presented a slew of statistics, cited studies and told personal stories to support their position. By the end of the meeting, even those who voted in favor of the bill were hedging their support.

"This issue needs further debate," Sen. Ed Mayne, D-West Valley, said. "I'm supporting it so it can get to the Senate floor for that debate, but there are some things that concern me."

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