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Scott G Winterton, Deseret News
FILE - Cecilia Figueroa, an enrollment specialist at Comunidades Utah, helps Gloria, one of her clients, sign up for insurance on Wednesday, July 12, 2017.

SALT LAKE CITY — The number of uninsured Utahns decreased from 2015 to 2016, continuing a steady reduction in that number, according to new health coverage data from the U.S. Census Bureau.

The bureau concluded in a report entitled Health Insurance Coverage in the United States, published Tuesday, that Utah's uninsured made up 8.8 percent of the state's population in 2016, compared to 10.5 percent a year earlier.

Previously collected data from the bureau found the state had a 14 percent uninsured rate in 2013, meaning about 402,000 were without medical coverage. Those numbers have declined each year since, with 265,000 Utahns estimated as uninsured in 2016.

Uninsured Utahns | Heather Tuttle

Rep. Jim Dunnigan, R-Taylorsville, who co-chairs the Utah Legislature's Health Reform Task Force, said the drop in the number of Utahns who are uninsured was "a little more than I anticipated."

"I think … part of that is the employers are offering benefits to attract and maintain employees" in a competitive hiring environment in the state, Dunnigan said. "I think at least one of the factors (is) a robust economy."

Jason Stevenson, spokesman for the Utah Health Policy Project, a think tank and nonprofit enrollment network that helps Utahns sign up for insurance, echoed Dunnigan, saying the number of uninsured was "surprising to me."

"It's actually much lower than I thought it was going to be," he said.

Stevenson said his optimism had been dampened by data published in June by the New York-based Commonwealth Fund think tank, indicating increasing uninsured rates among some demographics — for example, among households that make 400 percent or more of the federal poverty level and therefore don't qualify for subsidies for insurance bought on the Affordable Care Act exchange.

"Utah has made some incredible gains in expanding coverage and reducing our uninsured rate over the past three to four years," Stevenson said. "I think it will be challenging to keep that progress up in the face of efforts by the (Trump) administration to make it harder for people to find and keep insurance coverage. Our work is cut out for us."

He said his concerns about the exchange include President Donald Trump's declining to commit to paying cost-sharing reduction payments to participating insurers beginning in 2018, the federal government slashing funding for advertising promoting use of the exchange, reduced staffing at call centers that help people enroll, and an open enrollment period shortened to end on Dec. 15 instead of Jan. 31.

Dunnigan also believes "it's going to be difficult to get (the uninsured rate) a lot lower," but for different reasons.

"There's a certain percentage of the population that choose not to buy insurance for whatever reason," he said. "We have tens of thousands of Utah kids who are not enrolled in Medicaid or CHIP, even though it's virtually free to them."

Nationwide, Utah has the highest rate of eligible Hispanic children who aren't signed up for the Children's Health Insurance Program (CHIP), which is open to young people whose parents make too much to qualify them for Medicaid.

Jessie Mandle, senior health policy advocate for Voices for Utah's Children, said she is encouraged that "our child uninsured rate is at an historic low," but added that "compared to the rest of the nation, we are still falling behind."

About 6 percent of children in Utah were uninsured in 2016, according to the Census Bureau, down from 7.3 percent in 2015 and 9.9 percent in 2013. Still, Utah ranks 41st in the country in child uninsured rate, Mandle said.

The state also ranks 34th in the country in overall uninsured rate, according to the Census Bureau data. Utah closely mirrors the trajectory of the United States overall, which has seen a decrease in uninsured rates from 14.5 percent in 2013 to 8.6 percent in 2016. Utah is tied for the third largest overall uninsured rate decrease compared to last year and tied for 22nd in such a decrease when comparing 2016 to 2013.

More employed

Dunnigan believes Utah's "robust economy" is responsible for the current decline in the uninsured rate much more so than increasing numbers in the state signing up for insurance on the federal exchange. As the state's economy has improved, more and more people have received jobs with health insurance benefits, he said.

"The best way to help people to get insurance is to help them get jobs," he said.

Greg Bell, CEO of the Utah Hospital Association and former lieutenant governor, said he believes more Utahns are insured because of more filled jobs, hospitals' improved ability to quickly screen a patient to see whether they can be signed up for Medicaid, and increasing awareness of Medicaid eligibility generally across the state.

"Various mechanisms have just raised the instantaneous ability to catch eligibles in Medicaid," Bell said. "Every hospital who is dealing with a person without insurance will check for their eligibility. … You can bet there's somebody following up on that person.

"It makes a big difference."

Utah Insurance Department spokesman Steve Gooch said officials there are gratified by the new data.

"The decreasing uninsured rate is encouraging," Gooch said. "The department is in favor of funding Cost-Sharing Reduction payments as a way to help stabilize Utah's market."

Those payments are intended to reimburse insurers who offer plans on the federal exchange, making it possible for them to lower their premiums and deductibles. Utah Insurance Department officials have said that because the future of those funds continuing next year are in doubt, insurers offering plans in the state for 2018 have been met with uncertainty as they try to finalize health plan prices and conditions this fall.

State Sen. Brian Shiozawa, R-Cottonwood Heights, agreed with Dunnigan's and Bell's assessments that an abundance of good jobs has been critical to insuring as many Utahns as possible.

"Assuming the (Affordable Care Act) stays in pace with no changes and assuming the Utah economy stays robust like it is, we're going to continue to have low levels of uninsured," he said.

Rate concerns

On the federal exchange specifically, there are concerns about whether Utahns signed up there will have "meaningful, effective health insurance," said Shiozawa, who serves on both the Legislature's Health Reform Task Force and the Senate Health and Human Services Committee.

"We're losing choice in the individual marketplace. So there will be insurance, (but) there's concerns about what those rates and what types of coverages those will be," he said.

Many Republicans in Utah and across the country have criticized the use of uninsured rate figures to promote the virtues of the Affordable Care Act, claiming that while the number of uninsured Americans has in fact steadily gone down, many health plans on the federal exchange have been rendered useless thanks to exorbitant monthly premiums and unsustainably high deductibles.

Sen. Orrin Hatch, R-Utah, a vocal critic of the Affordable Care Act, told the Senate Finance Committee on Tuesday that increasing "coverage numbers … warrant a closer look."

"Enrollment in the individual market may be reaching a tipping point where those who previously had insurance are being priced out of the market and actually becoming uninsured since the enactment of Obamacare," Hatch told that committee, which he chairs.

Stevenson pushed back against claims that plans on the federal exchange are unaffordable, telling the Deseret News that 86 percent of Utahns who buy insurance there get large federal subsidies toward their premiums, amounting to 72 percent of those monthly costs on average.

The federal exchange is also popular in the state, Stevenson said. More than 197,000 Utahns currently have plans through the federal exchange. Compared to the year before, Utah added the most enrollees in the latest sign up period out of any of the 39 states that use the federal exchange, and also recorded the third highest jump in enrollees as a percentage of the state population.

Among those 39 states, Utah's enrollees also had the second highest proportion of people between the ages of 18 and 34 in the latest sign up period, Stevenson said. That demographic is thought to be relatively healthy and therefore important to keeping costs under control for insurers, he said.

But most Americans who have gained coverage nationwide have not done so through the exchange, Hatch told the Senate Finance Committee.

"True enough, from 2014 to 2016 insurance coverage in the U.S. increased by about 15.7 million people," the senator said. "However, the vast majority of these newly insured people — around 14 million — were added through either Medicaid or CHIP."

As of 2016, Utah had seen a jump in Medicaid enrollment of approximately 35,000 since 2013, according to an annual report from the Utah Department of Health. The Children's Health Insurance Program has about 22,000 fewer enrollees than it did in 2013 in Utah, largely because of migration of many of its recipients to the Medicaid program, according to the same report.

In all, about 137,000 fewer Utahns were uninsured in 2016 compared to 2013, according to the newly released Census Bureau data.