The one size fits all approach combined with lack of consumers knowing — or caring — what services cost is not working, Clark said, noting that more options other than catastrophic care and high deductibles must be developed in order for the uninsured to be willing to get insured.

Incentives must also be developed for insurance providers to be willing to take on more clients, and not just more of the healthiest segment of the population.

Insurance coverage has become a money-making operation, not a pool providing access to care for everyone, Steve White, political director of the Utah State AFL-CIO, told the caucus.

Most of the business revenue to the state comes from small businesses, many of whom are telling state officials they have reached a point of having to chose between offering a health plan and closing up.

"That's how expensive coverage has become," said Natalie Gochnaur, chief operating officer of the Salt Lake Chamber of Commerce, adding that the price of insurance premiums has doubled in Utah the past nine years. The number of Utahns without insurance, including those who can't afford it through work or with Medicaid or the state subsidy would fill Cougar Stadium at BYU five times.

Data in several studies show that a little heads-up attitude about treatment could save millions of dollars: between 40 to 50 percent of all procedures prescribed by doctors duplicate earlier diagnoses. For example, an MRI often only confirms what is found on an X-ray.

Lawmakers are already firmly supporting an "open enrollment" funding for the Children Health Insurance Plan next year.

For example, part of the package will be House Speaker Greg Curtis' CHIP proposal for working parents who don't have health insurance for themselves or their children. If they make only 200 percent of the federal poverty level, their children automatically qualify for CHIP.

In the past, there were more Utah children qualified than state matching money to give them health insurance. But in 2008, all qualifying children have been allowed into the program, and Curtis wants to allocate $2.8 million next year to keep that "open enrollment" going. If he makes funding non-lapsing, then any unused funds can just carry over into the next year.

Clark said he approached his complicated bill with two goals in mind: individual accountability and private market solutions.

Clark's bill does not yet have a fiscal note — or how much it will cost in state dollars.

But another bill, part of the overall reform goal, is to give an income tax cut to self-employed individuals so they spend pre-tax dollars on their health care, just like company-employed individuals have now. That will cost about $15 million, House Republicans were told.

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E-mail: jthalman@desnews.com; bbjr@desnews.com