A few thoughts from Utah Health Policy Project

We all entered the 2013 legislative session anticipating (and perhaps hoping for) a pragmatic focus on implementing key provisions of the Affordable Care Act (ACA). After all, open enrollment begins on October 1st, and the law takes full affect three months later. We also hoped for some clarity on Utah’s future exchange model. But as of press time, Utah is still awaiting a decision from the federal government on its proposed split exchange model in which the state runs small business exchange, and the feds run individual exchange. [Ed. Note:  A decision is expected today or Friday—follow UHPP’s Facebook and Twitter pages for updates]. Even if we still lack clarity, Utah did become more prepared. That’s because legislators focused on several serious bills that readied Utah for the health care law.
Distractions did arise, of course. But for the most part they nipped at the heels of the ACA. For example, a bill attempting to nullify the ACA (HB391) was replaced during a committee hearing with a bill prohibiting the expansion of Medicaid. Other controversial bills attempted to limit the powers of the inspector general combatting Medicaid fraud. Medicaid, at least for this session, replaced the ACA as the most tempting target for conservative lawmakers.
Impact of HB160 The most important legislation to emerge in 2013 was, like it previous years, Rep. Jim Dunnigan’s (R-Taylorsville) Health System Reform Amendments—the omnibus HB160.  Each year Rep. Dunnigan, a broker by profession, updates Utah’s insurance code to accommodate new ACA regulations and state goals.  This year, HB160 made several important changes:

• Set licensing, liability, and operating restrictions for navigators on Utah’s ACA exchanges
• Assigned charity care as a study topic for the Health System Reform Task Force (HSRTF)
• Gave the Department of Insurance the authority to regulate stop-loss insurance

Navigator Progress A major breakthrough on HB160 was the change requested by advocates on the Real Exchange Utah (RXUtah) coalition to allow entities like schools and community health clinics to act as non-certified navigators on the state’s individual marketplace.  Navigators are people trained and certified to help others research insurance options on the state exchanges, and then enroll in their plan of choice. In the original version of HB160, these entities (acting as non-certified navigators) could only help people applying for public insurance programs like Medicaid and CHIP.   During the session advocates successfully changed the bill to let schools and clinics help people find their way into both public and subsidized private insurance on the state’s individual marketplace. Since many Utah families qualify for both public and private insurance options (ie. kids on CHIP, parents on subsidized private insurance), the change allows them to help an entire family at once.   But based on the final version of HB160, these agencies can only prepare clients for the individual marketplace options—they cannot finish the process by enrolling them. Only a certified navigator can complete the enrollment.  As a result, many schools and clinics will likely pursue navigator certification. In addition, the final version of HB160 included a change requested by the advocate community to allow quasi-governmental agencies to skip redundant background checks and liability coverage that they already have satisfied through other means.