J. David Ake, AP
SALT LAKE CITY — Tens of thousands of Utahns soon will be browsing health insurance options in preparation for individual mandates imposed at the start of next year.
State lawmakers are doing what they can — and calling on industry leaders and the public to help — to make the upcoming transition go smoothly for individuals, families and small-business employees who don't otherwise have access to health care.
Utahns needing health insurance will have access during open enrollment in October to one of two marketplaces, formerly called exchanges, including Utah's already functioning Avenue H, intended for small-business use, and a new individual marketplace that was recently decided to be managed by the federal government going forward.
Utah is the only state with an approved "bifurcated model," with the state running one marketplace and the feds running the other. And as such, it is serving as somewhat of an example to many others still working through the process of health care reform, said Rep. Jim Dunnigan, R-Taylorsville, chairman of Utah's Health Reform Task Force.
The group has already begun digesting hundreds of pages of federal legislation, known as the Patient Protection and Affordable Care Act, as well as thousands more containing supplemental regulations.
"This is my eighth or ninth summer working on this issue. It is sometimes hard to not get overwhelmed by how much is going on," said Cathy Dupont, associate general counsel for the legislative task force.
Dupont told lawmakers that while some parts of the Affordable Care Act have already been implemented, "it gets very real this year for your constituents."
Choices people will have include obtaining insurance through an employer, if offered; taking advantage of federally required Medicaid eligibility expansion; purchasing a plan through the marketplace options; or paying a penalty tax for choosing to not be insured.
Dunnigan joked during Thursday's meeting that the federal application for insurance is at least a dozen pages long, but a portion of that is meant to weed out individuals and families who might qualify for health plan premium subsidies or federally partnered Medicaid services.
It is estimated that up to 53,000 Utahns already qualify for Medicaid coverage, but for one reason or another don't apply. The state has yet to make a decision on optional Medicaid expansion, which could envelop another 100,000 or so individuals. Approximately 377,000 Utahns are currently uninsured.
The task force on Thursday received updates from the state's Insurance Department, which will likely bear the brunt of the work for upcoming changes to the insurance market, the Utah Department of Health and the Office of Consumer Health Services, which operates Avenue H.
The small-business insurance marketplace opened in 2010 and was rebranded last year. It works with 344 employer groups to insure 2,800 employees and their dependents throughout the state. It faces numerous changes as the new year rolls around.
Larger employers offering insurance plans to employees will also likely face significant rate hikes going into 2014, as several federal tax increases will be implemented throughout the health care industry as a result of the Affordable Care Act, Dupont said.
Although the task force is keeping an eye on Medicaid, a governor-appointed work group is separately discussing optional expansion. The group's recommendation to the governor is expected by summer's end, and legislation passed during the recently expired session requires lawmaker input for any movement on the issue.
Dunnigan said he welcomes public assistance as the task force now delves into studying locally provided charity care, risk adjustment and reinsurance, Avenue H improvements and mental health reimbursement options. Contact information, meeting times and background information are available online at www.le.utah.gov.
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