Frequently Asked Questions

Why the Utah Health Policy Project, Why Do We Exist, & What is Our Ultimate Goal?

For more than a decade health care policy in Utah has languished under misguided principles.  The result: a decade of increasing costs, lagging quality, and rising numbers of uninsured.  Utahns are less able to receive needed health care.  Utah businesses are straining under the burden of double digit health benefit cost increases year after year.  Enough is enough…

The Utah Health Policy Project (UHPP) envisions a health care system that provides medically necessary care to all Utah residents in a timely, efficient, and culturally effective manner with sustainable financing.  We are known for our bold proposal for systemic health reform and for our leadership in sustaining vital health care resources like Medicaid and CHIP (Children’s Health Insurance Program). The UHPP is pleased to host USHARE (Utahns for Sustainable HeAlth REform),  a new coalition that has formed around health reform processes now underway to make sure reforms are meaningful and accessible to all.

What Has the UHPP Accomplished?

Real Results…
After two years of staffed operations, the UHPP is the state’s premier resource on health policy for community leaders, advocates, businesses, the media (see our Newsroom), providers, and policymakers.  We were instrumental in achieving the following policy milestones during the last 2 legislative sessions:

• Developed and passed Senate Bill 42 implementing a Preferred Drug List in Utah’s Medicaid Program. We successfully made the case to re-invest the savings in critical, under-funded areas of the Medicaid program, proving that our emphasis on cost management strategies is a prudent one;
• Worked with the leadership of the Utah Multicultural Health Network to develop and pass HB131  (Community-Based Self Sufficiency Mini-Grants), establishing a new line of grants for community-based organizations to facilitate outreach to high-risk populations and teach families how to make timely and effective use of coverage options and health care benefits.
• Restored Medicaid dental and vision services for adults for two years in a row;
• Developed and passed HB364 (Promotion of Health Coverage), providing funding to promote the underutilized Utah Premium Partnership program and the legislation and creating the framework to better promote UPP, CHIP, and Medicaid within Utah schools.
• Worked to amend and significantly improve upon HB133 (Health System Reforms); helped gain passage to launch multi-year health reform process in Utah.
• Mobilized communities to pass HB326 to permanently re-open the Children’s Health Insurance Program (CHIP) to serve up to 40,000 uninsured children;
• Helped to defeat HB141, an individual mandate that contained no mechanisms for affordability, imposed stiff fines on those who remain uninsured, and made being uninsured a criminal misdemeanor.

How Can We Make the Most of Today’s Unprecedented Interest in Systemic Health Reform?

As we know from past attempts to reform health care, Utah’s solution-seeking process can go terribly wrong, very fast.  At this moment the proposal ‘to watch’ is the Health Insurance Exchange, a mechanism for facilitating access to affordable insurance modeled loosely after the Massachusetts Connector.  If designed properly, the Connector may be a good model for Utah.

What is the Health Insurance Exchange?

Modeled after Massachusetts’ Connector, the Exchange will be the mechanism for facilitating access to quality, affordable health insurance coverage and controlling health care costs.  In the simplest terms, the Exchange is like a matchmaker – it links up eligible Utah residents with approved insurance plans and helps them pay for the plans.  We formed the USHARE coalition to make sure reforms meet the needs of individuals from all backgrounds.  By drawing small business owners, chambers and similar entities, and other stakeholders across the entire community into the health reform conversations, we can achieve this.  The word “Exchange” is always italicized because pretty soon everyone will need to be familiar with the Exchange. 

How is Our Interest in Systemic Health Reform Related to Our Interest in Medicaid?

The Utah Health Policy Project sees Medicaid advocacy and systemic health reform advocacy as interrelated.  We formed this organization to proactively articulate the right solution (systemic health reform with sustainable financing) and work on a strategy to achieve that solution that is relevant for the challenges of tomorrow and today.  Our Medicaid work is not a diversion from the broader mission of systemic health reform, but rather a choice to move toward a systemic solution in a way that is relevant, practical, and strategic.  

In fact, we see the two issues as dependent on one another – Comprehensive reform along the lines of our Guiding Principles isn’t possible (or at least is dramatically more difficult) if Medicaid isn’t protected.  Conversely, we think the most significant and fertile opportunity to advocate for systemic reform is within the Medicaid debate.  We have to reframe the Medicaid issue as a problem of the current health care delivery systems.

Our task is to keep the broader reform goal very specifically tied to our Medicaid and other work – both by assuring that we focus on issues that are “on the road” to the real solution, and by making sure that our specific strategies are working to advance proposals for systemic health reform.  It is important to recognize that we are not engaging in Medicaid advocacy in the same way or providing the same “service” as other groups working on Medicaid.  

Why is Utah Medicaid So Vulnerable to Attack?

Medicaid is under attack because it is the one area of health care spending that is within the control of policymakers.  Yet, health care costs and inefficiencies are much worse in the rest of the health care system. The demand for Medicaid is growing because middle class health care is a broken system.  Illness and injury are bankrupting families (even if insured) and forcing them to spend down assets into Medicaid eligibility.  Any Medicaid advocate who focuses only on the Medicaid program itself, demanding more resources, but failing to see the larger picture, can never succeed.  Their task is fast becoming impossible.

Employment based health insurance is failing because high overhead and cost shifting (from Medicaid and the uninsured) cause premium costs to skyrocket beyond the means of small businesses.  A restricted benefit package merely makes the middle class more apt to suffer medical bankruptcy, leading to Medicaid eligibility, and the cycle starts all over again.  Any advocate for preserving employment based-benefits who fails to see the impact of Medicaid policy (and Medicare and many other programs) cannot succeed.

Why do We Emphasize Cost Containment in Medicaid and Financially Sustainable Approaches to Covering the Uninsured?

It’s not that increasing health spending to cover more people is bad in and of itself. But building more coverage on top of the system we have just isn’t sustainable over the long-term—at the state level or at the national level.  It doesn’t seem to us that you can take a system whose costs are already double that of other countries and are crippling to households, businesses, state governments, and the federal government – and add significant new spending with no mechanism to slow the growth of health costs over time. Thus what is unique about our approach to Medicaid is the emphasis on maximizing efficiencies and economies of scale so that we can pay for all medically necessary care—including the so-called ‘optional’ services.

Why does the Utah Health Policy Project Plan to Launch a “Quality Watch” as One of Our Four Initiative Areas (or, why do we care about quality in health care)?

The Utah Health Policy Project’s Quality Watch is dedicated to the promotion of “best practices” in the delivery of quality, cost effective and culturally appropriate healthcare.  Our approach to the quality conundrum revolves around the issues of cost, price and variation with a resolution in reforms that meet our “Guiding Principles for Health Reform in Utah”).

While there are many ways of looking at quality, high performing health care systems have low rates of:

• Underuse: Failing to provide a service that would produce a favorable outcome;
• Overuse: Providing a health service whose risk of harm exceeds its potential benefit or that is not cost-effective;
• Misuse: Avoidable complication of appropriate healthcare; and
• Variation:  Wide deviation in care of similar diagnosis across the country or within communities www.ncsl.org/programs/health/forum/FAQ_Quality.html

Based on these four quality criteria, published by the National Conference of State Legislators, it is apparent that our current system is deeply troubled. Within the literature on quality, there is general consensus that high-quality health care systems bring down health care costs. There is less agreement on how they do this and to what degree. 

It is in the discussion of quality that the market driven health care argument begins to unravel, and this is because the prerogatives of market-driven health care (satisfying investors and stockholders first) are inherently in conflict with quality.  Some for-profit health plans may derive cost efficiencies through quality initiatives, but too often savings are found by cherry picking or denying care (the opposite of quality). In fact, a good portion of administrative overhead costs are directly related to the staffing that is required to systematically review or deny claims.

These dynamics look very different in not-for-profit or government health plans, again with some exceptions.  Nonprofit health plans are generally established to meet the growing demand for quality, cost-effective health care. As not-for-profit corporations they are exempt from tax as long as they meet their own mission-related obligations to the communities in which they operate. 

Nowhere is the relationship between quality and cost stronger than in Medicaid-sponsored quality initiatives (disease management, care and case management, health education, Pay for Performance).  Measurable quality is of paramount importance to state governments in relationship to Medicaid, because administrators and policymakers must be, first and foremost, accountable to taxpayers.  To this end, Medicaid agencies require health plans that contract with the state to submit performance data. Cost efficiencies can be directly or indirectly (but always imperfectly) inferred from these data. 

Budget realities further contribute to the surfacing of the cost, price and quality discussion. Budget constraints raise the demand for objective evidence that public funds are being spent wisely. Quality measures and performance data create transparency in the system which leads to informed decision making and reform.

For 2007 our work in the quality arena will be limited to collaborative efforts to reduce health disparities and to efforts to monitor and improve quality of care in Utah’s Medicaid program.