Down to Business 

Who knew the private sector would push a plan for mandatory health insurance in Utah?

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Earlier this summer Jon Huntsman Jr. linked arms with western Democrats pledging to combat greenhouse gasses. Now, Utah’s Republican governor is talking about health-care reform of the sort so far only seen in Massachusetts, Maine, Vermont and other left-leaning states.

Has the governor gone soft in the head? Maybe. More likely Huntsman is reading the political wind.

Utah business interests are piling on a plan Huntsman’s advisers are sketching for a state-administered fund that would make basic health insurance affordable for everyone, particularly small businesses squeezed out of the market by rising premiums.

Natalie Gochnour, vice president of the Salt Lake Chamber of Commerce, who serves on a health-care reform group sponsored by the chamber and the United Way of Salt Lake, says the stars are aligned for health-care reform in Utah, and soon. Her group began meeting in April with participation from the Utah Hospital Association, the Utah Medical Association and executives from several state insurance companies, hoping to have a health reform proposal ready by September.

“I’ve got business leaders asking for this to happen,” Gochnour says, noting area businesses last year saw their insurance premiums increase at double the rate of inflation.

The push from businesses is being hurried along by politicians who recognize time is running out on a Bush administration that has given wide leeway for states to tinker with health care. The chamber got into health reform following a January visit to Utah by U.S. Secretary of Health and Human Services Mike Leavitt, Utah’s former governor. “We have … an administration that is very open to state reform efforts,” Gochnour says.

Put another way, Utah’s leaders are frightened about what happens come a Democratic presidential victory, says Judi Hilman, executive director of the Utah Health Policy Project.

If Democrats control the executive and both houses of Congress, the betting is national health reform isn’t far behind. “Conservative states like Utah feel they better beat them to the punch. It’s a race to do it the Utah way before the heavy hand comes from the feds.”

Whatever the motivation, Hilman is excited that health care is suddenly fashionable in Utah. “You’ve got some of the most powerful business leaders in the state saying, ‘We’ve got to do this right.’ I’ve never heard that before,” she says. Hilman’s organization, which has been pushing a single-payer solution, is now cheerleading for the governor’s plan.

Called the Utah Health Insurance Exchange (UHIE), Huntsman’s proposal would be a state administered clearinghouse of approved insurance policies. Insurance companies would bid to provide the best coverage for employees of small businesses that don’t offer insurance as well as others who can’t afford health care.

Last month, Huntsman went further by suggesting Utah should mandate health coverage for residents.

States such as Mitt Romney’s Massachusetts require health coverage in an attempt to drive down insurance-policy costs. In theory, the greater the number of participants, the lower the costs of a policy. The goal of the UHIE is to make health insurance affordable for the 300,000 Utahns who don’t have it. Critics say without a mandate, only sick people will sign up, costs will balloon and the idea will tank.

When Huntsman’s economic development officers presented the Exchange idea to summer meetings of legislative health committees, they acknowledged the program would need large participation to work. Several alternatives were given, from requiring all Utahns buy health insurance to designating the UHIE as the only place polices could be offered for some employee groups.

Lawmakers on the health committees are interested in reform, but mandated insurance will be a hard sell. A proposal this spring from Rep. Brad Daw, R-Orem, to make it a crime for residents not to carry health insurance went nowhere. A similar fate met a 2006 proposal from Huntsman’s top health official to require health insurance for children up to age 18.

Sen. Chris Buttars, R-West Jordan, who sits on the health and health-appropriations committees, says he is interested in the UHIE idea but that mandatory health insurance is a nonstarter.

“I don’t know how you’d force somebody who says, ‘No.’ What are you going to do, lock ’em up?” he asks. Then, there is the question of who pays the premiums of those who can’t afford insurance.

“I’m not against the governor being involved in trying to come up with things, but he comes up with cryptic messages that just leave your head spinning,” Buttars says. “Who knows what he’s talking about? I don’t. If he’s talking about having Utah pick up some kind of catastrophic insurance for all Utahns, I think all my friends in the Senate will say, ‘No.’”

Rep. Paul Ray, R-Clearfield, chairman of the House Health and Human Service Committee, likes the Exchange idea. His committee is spending the summer studying potential health-care-reform options with a particular eye on whether or not coverage should be mandated, either for all Utahns or for certain groups.

The starting point for business groups, says Gochnour, is expanding the ranks of the insured. “There is a hidden tax that hits every employer who provides insurance,” she says, because business premiums are jacked up to help pay the medical bills of the uninsured.

Hilman says the Utah Health Policy Project will carefully watch health-reform discussions to make sure low-income residents aren’t left behind. With the health-care flexibility the Bush administration has given states comes risks, she says. Hilman’s group would campaign against any plan that pays for universal health coverage by cutting back benefits for the poor and disabled.

“If we all get involved in this, it can go in a good direction,” she says. “If not, it could go terribly.”

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