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A recent article in The Salt Lake Tribune outlining the Utah Hospital Association's position on possible expansion of the Medicaid program in the State of Utah ("Utah hospital lobby says 'no' to Medicaid expansion, for now," Nov. 8) does not do justice to a complex issue and potentially leaves readers with confusion about why UHA does not support a seemingly no-cost approach to expanding Medicaid.

To be clear, UHA supports expansion conditioned on exploring use of the private insurance market as an option for people newly eligible for Medicaid.

Our private health care market is strong and delivers great quality at the lowest cost in the country. Why then would we pursue Medicaid expansion without giving these new eligibles the option of the private market system?

We have time to do this right. UHA has called for a measured approach to the issue of expanding Medicaid to adults under 133 percent of the poverty level in Utah. As any new or expanded Medicaid coverage will not "kick in" until January 2014, this is not a decision that needs to be made this week, next week or next month. Rather, it is an issue where we have considerable time to work through the details with our elected officials, the business community, advocates and other key stakeholders.

The recent article, however, fails to clarify the time element, thus leaving the impression that the train is leaving the station and there will be no time to board it down the track before it gets to its destination. That simply is not the case.

UHA's position is not one of anti-Medicaid expansion, but rather a call for connecting the new Medicaid dollars to help new Medicaid clients use the non-public insurance market to obtain their coverage wherever possible. Simply requiring all 110,000 estimated new eligibles to enroll in the publicly offered Medicaid program does not give these individuals the choice of using a Medicaid subsidy to purchase insurance through their employer or through Avenue H, Utah's health exchange.

Additionally, expanding coverage to 110,000 new eligible Medicaid recipients, without addressing the shortages in access to Medicaid primary care providers, can only worsen the access situation for all Medicaid clients. This is another argument for giving these new Medicaid eligibles access to non-public insurance products so the primary care burden can be spread across all primary care providers, not just those enrolled in Medicaid.

UHA believes that the state needs to connect all components of Utah's health reform strategy (decisions relative to the exchange, essential benefit package, etc.) to include how to best expand coverage to persons up to 133 percent of poverty. These are all connected elements that bear on making sure this expansion is done as much as possible through the employer market or the exchange, as many, if not most, of these Utahns are employed at least part time. It makes no sense to address just one leg of the stool while not looking at the whole picture.

The state took a similar approach when Congress first passed the Children's Health Insurance Program (CHIP). Utah took the lead in that situation to press Congress for the option of expanding Medicaid using a commercial product based on the average employer benefit rather than simply expanding the Medicaid product. As a result, Utah's CHIP program is very healthy financially and more cost-effective compared to what would've been the case if we had simply expanded Medicaid. This approach garnered state political support that would not have been there otherwise.

To develop this "Utah Solution" for Medicaid expansion, the UHA Board has asked Gov. Gary Herbert to form a medicaid advisory group to include hospital representatives as well as other appropriate health care, business, citizen, advocacy groups and elected officials.

UHA will push for all Utahns having access to affordable health care as Medicaid expansion talks continue.

Rod L. Betit is president/CEO of the Utah Hospital Association.