This is an archived article that was published on sltrib.com in 2007, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
Imagine a Utah where everyone has health insurance.
Coverage would be purchased from the private market, but at affordable prices. Benefits would encourage consumers to adopt healthier lifestyles without skimping on medical care. No one, not even the poorest families, would be denied basic care.
Such are the promises delivered in a blueprint for health-care reform quietly authored by a think tank of 130 Utah business leaders and backed by economic and health advisers to Gov. Jon Huntsman Jr.
The framework will be released today by the United Way of Salt Lake, which organized the group and now will seek public input. A draft copy obtained by The Salt Lake Tribune provides glimpses of what one business leader called "Utah's health care future."
This isn't "nibble around the edges" reform, said Zions Bank president Scott Anderson last week, urging support from lawmakers.
The alternative, he said, is a "financial doom cycle" in which more businesses withdraw benefits to compete on the global market, the ranks of uninsured swell and people grow sicker, driving premiums even higher.
Over the past decade, median household incomes in Utah grew by 15 percent, while family health care premiums increased 109 percent, said Anderson. "If we don't address the trend, premiums will consume half of median incomes by 2010. In 20 years, premiums will exceed the average family income. Think of that."
There are, by conservative estimates, 360,000 uninsured Utahns. Most have jobs or are the children of uninsured workers.
"This is a problem of the middle class," said Anderson, speaking to growing consensus for change.
At the crux of the proposal is a basic benefits package for purchase by all Utahns through an exchange - sort of like a stock exchange - using pretax dollars and employer premiums.
The exchange would be a nonprofit entity, not a government regulator, said Natalie Gochnour, a think tank member and policy vice president at the Salt Lake City Chamber of Commerce. "We must resist the temptation to substitute government judgments for that of markets."
Coverage would be portable and follow an employee from job to job. Competition among insurers would drive down prices. And businesses would be relieved of the burden of administering their own plans.
Benefits would be comprehensive, covering preventative and specialized care, but not elective procedures, such as plastic surgery.
There would be no deductible or ceiling on coverage. Instead, beneficiaries will pay for varying portions of their care based on need.
They might, for example, pay a $5 co-pay for immunizations but pay 25 percent of the cost of so-called "comfort" care, such as shoulder surgery to alleviate arthritis pain.
The idea is to encourage patients to seek preventative care, pre-empting costlier treatments later on.
An independent commission would decide what is covered, choosing the most medically appropriate, lowest-cost treatments. There would be financial incentives to encourage patients to lose weight or stop smoking.
The commission also would handle patient appeals, to be weighed by an administrative law judge. Beneficiaries would have no recourse to sue providers or insurers for denial of coverage or care.
Poor families would qualify for financial help to pay their premiums.
The proposal is still a work in progress and raises more questions than answers, such as how much will it cost and who will pay?
One estimate pegs the price at $200 million, said Joseph Krella, director of the Utah Hospital Association. But, Krella said, the hope is much of that would be offset by a decrease in expensive charity care and unnecessary trips to the emergency room.
Anderson stressed that Utah's uninsured already cost taxpayers, businesses, consumers and others $900 million annually.
Other funding options in the plan include federal and state dollars, tax deductions for businesses that purchase coverage and penalties for those that don't, a hospital tax and tobacco tax.
Also unknown: how to guarantee coverage for the uninsurable, those too sick to be able to find coverage on the open market. And how do you make benefits robust enough to entice buyers, especially the young and healthy, without bankrupting insurers?
"I hope you don't come back with more state mandates," remarked Rep. Jim Dunnigan last week. The Taylorsville Republican is an insurance broker.
Huntsman has hired an independent actuary and lawyers who specialize in insurance law to help answer those questions, said Anderson. The goal, he said, is to have legislation drafted by November, though full reform could take two to three years.
Powerful forces are lining up behind the idea: big business, the Salt Lake Chamber, the state insurance commissioner, the Utah Hospital Association, Utah Medical Association, advocates for low-income families and even some legislative leaders.
In opposition are the equally formidable insurance companies, underwriters and brokers.
Kelly Atkinson, Utah Health Insurance Association director, calls the plan "a quasi-socialized system."
Scott Ideson, president of Regence Blue Cross Blue Shield of Utah, is more measured, acknowledging, "The insurance industry is part of the problem."
But, Ideson said, if reform doesn't address underlying causes of inflation, such as consumer appetite for new drugs and technologies, costs will continue to grow.
Proponents, however, pitch the plan as the antithesis to socialized medicine - the thing that will prevent socialized medicine.
"Our health system is far too expensive, at times has dubious outcomes and leaves hundreds of thousands without the peace of mind that comes from health insurance coverage," said Gochnour. "We absolutely would not be doing it if it would not contain costs."