Most say opt out of health reform
Poll » Many say states would do better job than federal government.
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If a federal health reform bill passes, a majority of Utahns say the state should have the choice to opt out, no matter what the consequences, a new Salt Lake Tribune poll shows.

Rep. Carl Wimmer, R-Herriman, is carrying a bill that would make it illegal for state agencies to implement any part of a new federal law without first reporting to the Legislature. House Speaker David Clark and Fruit Heights Republican Julie Fisher are sponsoring resolutions that urge Congress and the federal government to respect states' 10th Amendment rights.

"We want to get to the top of the same hill," Clark said. "Our pathways are as different as the politics."

Opting out could jeopardize the flow of federal dollars for programs like Medicaid. No matter, Utahns say.

Salt Lake City resident Mark Evans, who supports a state opt out, said federal health reform will financially cripple states by piling on unfunded mandates.

"The government has never been able to solve problems or manage anything," said Evans, 57. "I think that [health reform] is best done by the private sector. I think the level of health care that is basically available to most people throughout the nation is good."

Small-business owner Dell Clement thinks states are smaller, more nimble and thus better able to tackle the health care conundrum.

"I just think if it [reform] were on the state level, we would have a little more control than if it were on the federal level," the 50-year-old Lehi resident said.

Clark, along with Senate President Michael Waddoups, wants Utah to be able to use any federal dollars it receives for its own state-specific solution. The two lawmakers argue the merit of their idea in an editorial they expect to be published soon in The Washington Post .

"Take the challenge. Give us a chance. Rather than risk an entire national system, let's allow a state or two to try to demonstrate what may work," said Clark, one of the Utah Legislature's lead architects of reform that focuses on private insurers.

He and others, including Republican U.S. Sen. Orrin Hatch, think Utah is on the right path. Hatch cites Utah's efforts to help businesses give a contribution to employees, who shop for their own policy on a state exchange.

"You could learn from all 50 states what to do and what not to do," Hatch said recently on the Senate floor. "Utah has taken important and aggressive steps toward sustainable health care reform. The current efforts to introduce a defined contribution health benefits system and implement the Utah Health Exchange are laudable accomplishments."

Norman Thurston, the state's health policy and reform initiative coordinator, said Utah is indeed on the cutting edge.

"What makes it happen is the willingness of such a broad coalition of people to tackle the hard problems and move forward the legislation," he said. "Both parties have been involved, the business community, the health care provider community -- and that has allowed Utah to move forward on some very ... difficult questions."

In both Utah and Massachusetts, two states that have made some of the biggest strides in reform, "it was very much a collaborative and consultative process, far more so than what you're seeing in Washington [D.C.]," said Ed Haislmaier, an expert in health care policy and markets at The Heritage Foundation. "I would say the bipartisanship at the end of the process is a product of that as much as it's an instigator of it."

This kind of collaboration "was present at the beginning in Washington, but it very quickly got lost," he said.

Not everyone thinks Utah can, or should, reform its health system on its own, however.

"I don't know why they say our health care system is so great," said Deanna MacDonald, 50, of Cottonwood Heights. "I don't think they have ever made a trip to the ER."

MacDonald, whose husband is a health care provider, said too many people are uninsured and are not getting the health care they need. "If we opt out [of federal health reform], who is going to take care of the people who still need coverage?"

Janice Houston, coverage initiatives director for the Utah Health Policy Project, said it's a matter of resources. "I think it's becoming more and more apparent that Utah has been great at being a leader," she said, "but there are some places where we're never going to have the economies of scale to effect change."

The state's budget, for instance, isn't big enough to subsidize the cost of health coverage for all of its lowest income residents, she said.

And Utah is finding some of the tenets of national reform -- requiring all small groups to shop through the exchange and making it more difficult for insurers to reject applicants, for instance -- are what works best here after all.

It was a lesson Clark and his colleagues at the Legislature learned after the first round of pricing for the exchange revealed flaws in how it was designed.

But that, the House speaker said, proves his point exactly: the state Legislature rolled out the exchange as part of a limited launch in order to identify and fix any glitches. The employer-contribution system will be retooled until it functions as planned, he said.

If federal health reform has the same problems that state reform has, it would be much more costly and difficult to change.

"We think we have the ability to craft solutions that make a lot of sense for Utahns," said Clark, pointing to a number of pilot projects. "Let us incubate."

lrosetta@sltrib.com

Tribune reporter Matt Canham contributed to this story.