Utah has over 60,000 small businesses employing over 50% of our workforce—but the majority of Utah’s small businesses don’t offer health insurance to their employees because it costs too much! (See our brief Health Reform is Key to Economic Recovery). The Utah Health Exchange was designed to “decrease the ranks of the uninsured” but it’s off to a slow start. Use our scorecard to track our Exchange’s progress. Also, check out Utah’s Application for Certification of State-based Exchange (Utah’s version) WITH UHPP ANALYSIS AND SAMPLE COMPARISONS WITH OTHER STATES.
UHPP submitted our own detailed comments regarding the proposed regulations for health insurance exchanges along with the final sign-on letter endorsed by 37 Utah leaders, small businesses, organizations to Secretary Sebelius at HHS on October 31, 2011. Thank you for your help on the sign-on campaign!
For more information: Click here to see the HHS document. Click here to see UHPP’s table of proposed exchange rules for comment. You will find more regulations as they are released by HHS and CMS at www.healthcare.gov. For regulations related to health insurance exchanges, click here.
UTAH EXCHANGE WATCH SCORECARD
| ITEM | WISH LIST | STATUS | NEED | GRADE* |
| Transparency | Clear, accurate, easy to use information for consumer decision making | Exchange includes a filtering mechanism to help consumers choose and compare plans. | Tiered benefit plan comparison tool, like the ACA bronze, silver, gold, platinum scheme. | C |
| Transparency | Apples-to-apples comparison of insurance plans based on actuarial value | This is included in 2011’s HB128 (Health Reform Amendments) sponsored by Rep. Dunnigan and being addressed by UHE staff.Without access to the UHE it is impossible to assess the progress made toward this goal. | Apples-to-apples comparison of insurance plans based on actuarial value | ? |
| Transparency | Public Utah Health Exchange Advisory Board meetings | The UHE Advisory Board was dissolved in July 2011 and replaced with 4 separate groups (see our “advisory board” page for more information). The promised ad hoc consumer advocate group was not convened, however GOED did convene a “Open Forum on Reform Community Group” under Norm Thurston’s direction. Meets once a month (contact UHPP if you would like more information).This group has no formal link to Utah’s Health Exchange. | A governing board with strong, real consumer representation, including the uninsured, the underinsured, small business owners, employees of small businesses. | D |
| Enrollment | A consumer-friendly, simple, application process | Uniform application in place and seems to be functioning well. However, only 33% of groups who are underwritten actually join the exchange. | Robust, well-funded, comprehensive Navigator program. | C |
| Enrollment | Adequate, timely broker training about using the Exchange | Exchange training for brokers are underway and well attended. | A | |
| Enrollment | Broker training for cultural and language competency | This was initially in 2011’s HB128 but did not make into the final legislation. | Cultural and language competency training for Navigators and brokers. | F |
| Enrollment | Include the individual market in the exchange | Individuals are at this point NOT included in Exchange future plans | Individual Market Exchange, known as the “American Health Benefits Exchange” in the national health reform law (ACA). | F |
| Subsidies | Seamless integration of subsidy (Utah Premium Partnership/UPP) and public (Medicaid + CHIP) programs | Brokers are offered training about UPP as of June 2011, but there is no seamless integration in to the enrollment process. | “One Stop Shopping” Exchange application should funnel applicants into appropriate benefits, private or public, depending upon their eligibility. | F |
| Subsidies | Broker training about premium subsidies, like Utah Premium Partnership (UPP) | This training is being offered to brokers who sell in the Exchange as of June 2011. | B | |
| Subsidies | Trigger to premium subsidies (UPP) | A link to UPP is required by HB128 | Integration of subsidy eligibility into the enrollment process | C |
| Insurance Products | Plans offered on Exchange have counterparts outside the Exchange | Exchange staff have identified a lack of in and out of Exchange concordance as a barrier to enrollment. DOI must address this issue. | C | |
| Affordability | Plans inside the Exchange are priced in concordance with plans outside the Exchange | Exchange staff have identified that premium quotes inside Exchange are sometimes higher than those outside. This was remedied in part by requiring insurers to quote premiums as renewals for businesses coming into the Exchange that already offer insurance to their employees. | An active purchasing strategy (i.e. the Exchange could negotiate for lower prices with insurers in the Exchange) would help lower costs. | C |
| Affordability | Affordability standards that limit how much of a family’s income can be spent on health care costs. | None. | Utah needs affordability standards to bring more low- and mid- income families into the private health insurance market; these are required by the ACA. | F |
| Affordability | Insurance premium rate review (a formal process whereby insurers must justify and obtain approval for premium hikes | As of September 2011 the Department of Insurance is required to review all proposed rate increases of 10% or more and has hired staff to review 100% of rate submissions. | C | |
| Governance | Governance of the Utah Health Exchange should be free of conflicts of interest | Currently the Utah Health Exchange does not have a strong governance structure. | The Utah Health Exchange needs good governance now! Exchange should be accountable to consumers, not to industry. | F |
| Governance | A governing board with strong, real consumer representation, including the uninsured, the underinsured, small business owners, employees of small businesses balanced with health care expertise free from conflict of interests. | The UHE Advisory Board was dissolved in July 2011 and replaced with 4 separate groups (see our “advisory board” page for more information). The promised ad hoc consumer advocate group has not yet been convened, however GOED did convene a “Open Forum on Reform Community Group” under Norm Thurston’s direction. Meets once a month (contact UHPP if you would like more information).This group has no formal link to Utah’s Health Exchange. | A governing board with strong, real consumer representation, including the uninsured, the underinsured, small business owners, employees of small businesses balanced with health care expertise free from conflict of interests. | F |
*GRADES:
A: in place and working well.
B: in process, no data yet OR in place and needs some improvement
C: proposed OR in place and needs substantial improvement
D: identified but rejected OR in place and has failed miserably
F: not in the works, not being considered