SALT LAKE CITY — The third year of decadelong overhaul of the state's health care system got officially under way with the announcement of landmark reform legislation that establishes a state risk adjuster board to ensure consumer health risks are spread evenly among private insurers as they increase access for 350,000 uninsured Utahns.

HB294 also permits businesses in Utah with more than 50 employees to be part of the Web-based exchange for medical insurance and information.

The exchange has been undergoing what Gov. Gary Herbert on Thursday called a "beta test" with small businesses. It has worked in fits and starts the past year, with about 400 people enrolling in plans through 13 businesses in the exchange.

More than 130 had originally enrolled to seek insurance plan options, but most gave up because the site was problematic and difficult to navigate.

Zions Bank is one of the four large businesses willing to give the exchange a chance.

"We were told about the problems, but we're convinced that most have been worked out or are well on their way to being worked out," said CEO Scott Anderson, noting his company will continue to offer a corporate medical plan and one offered through the exchange if any of the bank's 8,000 employees can find a more appropriate and perhaps cheaper insurance.

"Anything we can do offer more competition and more opportunity for employees and employers to save money on health care, we're going to at least give it a sincere try," he said.

Bill sponsor Rep. David Clark, R-Santa Clara and House Speaker, said any talk of health care reform "strikes a lot of fear in people. But what I can say is that the current system is not functioning. It's broken."

Clark said that lawmakers and the governor's office are committed to finding solutions that in the long run will reduce rampant spending, improve quality and increase access to care and insurance for hundreds of thousands of Utahns who don't have or can't get coverage now.

Providers have been put on notice to improve quality and consciously review tests and procedures rather than prescribe them out of habit or as a hedge against possible malpractice lawsuits.

Consumers will also be expected to be more accountable and healthy lifestyle oriented as well as more responsible for their own health.

Bugs are mostly worked out of the exchange, said John T. Nielsen, special health care advisor to the governor. "There will still be things to make it more user-friendly, but in the end it is a new marketplace for consumers, businesses and insurance companies."

The exchange begins to change the paradigm of the system and the insurance industry increasingly criticized for reducing covered benefits while raising premiums and co-pays.

Regardless of the fear and loathing federal reform proposals tend to induce in a growing number of states rights advocates, most Americans agree that insurers are much more interested in protecting profit streams than covering the health care bills for their clients.

Public opinion surveys, including Deseret News polls, show a majority believe U.S. insurers have a right to make money but they shouldn't be allowed to do so by dropping the sickest people, pushing people who can't pay their bills into bankruptcy and continually carving out benefits then charging higher premiums and co-pays.

"This is another step toward those solutions and a lot of others," Herbert said, "We're leading out on this, and we'll do everything we can to help insurers and providers and consumers reform the system through the free market," a reliable model across the economy, he added, that has never been allowed to operate at its potential in health care industry.