Utah once again finds itself on the cutting edge of health care reform.
During the national debate over health care reform, Utah-based Intermountain Healthcare was often cited as a model of efficiency and cost control. And years before the federal government took action, Utah legislators looked at a number of ways to both expand health care coverage and decrease health care costs, even without leadership on the issue from Washington, D.C.
That's why, two years prior to the passage of the Affordable Care Act (ACA), Gov. Jon Huntsman Jr. signed legislation creating Utah's Health Care Exchange, now known as Avenue H. The program differs substantially from the exchanges authorized by the ACA, and it operates with a minimum of bureaucracy and maximum application of free-market principles. Gov. Gary Herbert has called it a "private-sector approach to solving health care costs," and he has long insisted that it is the approach that Utah will continue to take, regardless of any federal mandates.
Now, in the words of the Washington Post, the White House has "(called) Utah's Obamacare bluff." Contrary to expectations of most health policy observers, the Obama administration has approved Utah's application to continue this innovative approach in its health care exchange.
We consider that to be good news.
Of course, as is usually the case in the legislative arena, "good" is not the same thing as "perfect." Avenue H will have to adjust in order to become more compliant with the ACA. Most notably, Utah will have to expand Avenue H's coverage beyond small business and enter the individual market. But plans to take that critical step were already in the works before the Obama administration gave its stamp of approval.
Avenue H will likely be required to grow well beyond the handful of employees it currently has on its payroll, and a certain measure of new bureaucracy is probably inevitable. But the Legislature has indicated that, at least initially, this won't require any additional money from Utah's state government.
Even more promising is the flexibility the Obama administration is showing to accommodate Utah's unique approach. By approving Avenue H, the White House sends a message to other states that they don't have to feel shackled by a one-size-fits-all approach to creating health care exchanges. This will encourage other states to follow Utah's lead.
Of course, the approval is provisional, and there is still much that can go wrong. But this is a step in the right direction.