Utah Legislature: Utah health reform bills moving forward

SALT LAKE CITY — Two bills that in effect change the game in the middle of the rules governing how medical care is paid for by most working Utahns are a step away from becoming law following a committee approval Monday.

HB294 easily the most complex bill introduced this session, is now in the Senate's hands. SB39, probably the shortest bill this session, requires insurers who require preauthorization to provide a statement that a medical procedure covered under the plan if a plan member in good standing requests it.

The statement is not a commitment that the insurer pay for the procedure in question, only that it is a covered benefit of the plan, said SB39 House sponsor Rep. Merlynn Newbold, R-South Jordan.

The bill, which passed 28-1 in the Senate last week, is barely 41 lines long, is the runt of the litter of health care reform proposals that average 400 times that size.

But bills that do the most good are the often the shortest, Newbold told members of the House Health and Human Services Committee.

It addresses an issue that adds big knots in the medical billing process, proponents of the measure said.

The bill isn't an attempt to gang up on insurance companies, which an industry lobbyist said Monday are becoming the scapegoat of the health care cost crisis, but a bill to help "people become a partner in their own health care," said committee member Rep. Trisha Beck, D-Sandy.

SB294 isn't either, said sponsor and House Speaker Rep. David Clark, R-Santa Clara, "but it does level the playing field" for companies who want to be part of the new online health care exchange, now in its second trial run. The exchange is to eventually offer an alternative marketplace for privately insured Utahns to review alternative insurance plans other than the one offered through their workplace, where more than 70 percent of working Utahns get insurance.

HB294, which received passed the House 62-13 last week, adds oversight to the industry that will prevent them "gaming" the system by in effect skewing risks in their favor instead of sharing as equally as possible.

Adding the risk adjuster is common in the business and monitors actual risk so that one company isn't benefitting from taking more low-risk members at the cost of another who is accepting higher-risk individuals or those with chronic or known serious health problems.