Tom Smart, Deseret News archives
Governor Gary R. Herbert is shown in this file photo from Jan. 25, 2012, in Salt Lake City, Utah. Herbert sent a list of questions Nov. 19, 2012, to Health and Human Services Secretary Kathleen Sebelius that he wants answered before considering whether Utah would join the federal health insurance exchange.

SALT LAKE CITY — Gov. Gary Herbert is moving forward with Utah's version of a health care exchange, with or without the blessing of the federal government.

The federal government has not yet approved the state-based system for insurance reform, but says it will work with Utah to make the existing exchange comply with federal rules.

In a letter addressed to U.S. Department of Health and Human Services Secretary Kathleen Sebelius, Herbert said he remains concerned about the level of flexibility that will be afforded to states under either a state or federal approach.

"It is becoming increasingly clear that there are many potentially detrimental federal exchange features," he wrote. "Generally, I would prefer a state-based approach if I were to have the flexibility to stay true to Utah principles."

Herbert again asked federal officials to certify Utah's version of an exchange as compliant with the Affordable Care Act.

On Monday, Herbert issued a similar request in a letter addressed to the president, which was met with collaboration from Sebelius, who responded Thursday, saying her office would work with Utah's on the existing plan.

Avenue H does not currently offer individual insurance plans, but caters primarily to small businesses, which is something that must change to make the plan compliant with federal law.

Judi Hilman, director of the Utah Health Policy Project, said it appears Herbert is "trying to push the envelope" on what is expected of a working health care exchange.

"It's going to be up to us as consumers to really make sure that the feds hold Utah accountable to the highest standards that are set forth in the Affordable Care Act," Hilman said. "We have our work cut out for us."

Utah's exchange, which Herbert explains in Friday's letter as "a working, consumer-focused, free market-based plan for health reform," was in place prior to the passage of the Affordable Care Act, making it unique. It was fully implemented in 2011. Herbert said it remains "in its infancy."

All states were required to inform the federal government of their intent to offer a state-based plan or go with a federal option by the end of day Friday. The exchanges are expected to be in full swing by 2014.

The Centers for Medicare and Medicaid Services reported Friday that the District of Columbia, Kentucky and New York were approved for state-based plans. Conditional approvals for similar plans were granted earlier this week for Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington. Each is expected to begin open enrollment with the plans in 10 months.

At least 20 states were either expected to reject the federal plan or peddle their own versions, hoping for leniency in making insurance available to the uninsured throughout America.

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