SALT LAKE CITY — As one of just two states with an existing health insurance exchange, Utah is in a unique position in regard to the nationwide implementation of the federal government’s health care overhaul.
Whereas most states are creating or gearing up to roll out exchanges, Utah’s program has been up and running since 2009 to allow small businesses to select health care plans in an online marketplace that lists several options and prices, similar to websites that sell airline tickets.
State officials are still deciding if they’ll expand the exchange to individuals, as required by the federal plan. Here’s a closer look at how the plan works and what is ahead:
• How many people are uninsured in Utah, and how many of those are projected to get insurance under the exchange?
An estimated 300,000 people are uninsured in Utah, about 10 percent of the state’s population. State officials say the exchange is designed to get more uninsured covered, but they have no way of knowing how many are, or will be, insured under the exchange. They do know, however, that 73 percent of the small businesses using the exchange previously did not offer health insurance to their employees.
• How many people in Utah are served by Medicaid, and how many more will be served if Utah chooses the Medicaid expansion?
An estimated 225,000 to 250,000 people are on Medicaid in Utah, but Gov. Gary Herbert has said Utah will not administer Medicaid through its exchange.
The state is completing a cost-benefit analysis of what it would take for the state to run Medicaid expansion. It plans to use this to make a careful, rational decision but is in no hurry, said Robert Spendlove, the state’s deputy chief of staff for federal relations. It will be months, if not years, before a decision is made, he said.
• How many small businesses are likely to take advantage of the health insurance offered in the Utah exchange?
Currently, 335 small businesses are using the exchange, covering 8,000 employees and their families, said Patty Connor, director of Utah’s health insurance exchange.
Utah’s exchange has been adding about 20 businesses a month since its 2009 launch, and growth has picked up since the October launch of the first-ever marketing campaign. There are 67,000 small businesses in Utah with two to 50 employees that would qualify for the exchange.
• How is Utah’s exchange set up, and which agency will be responsible for overseeing it?
The exchange, called Avenue H, is run by the state’s Consumer Services department within the Office of Economic Development. The exchange was placed there by design, state officials said, because they believe the exchange is helping businesses grow by attracting and retaining employees.
• Will Utah’s exchange serve individuals and families, or just small businesses?
The state is still deciding if it wants to expand the exchange to offer plans to individuals, Spendlove said.
An individual option is required by the Affordable Care Act. In getting conditional approval, the state submitted a plan that provides for that change. If it does opt to go that route, officials said they’ll have no problems getting that running by October.
• How much money has Utah received from the federal government to do the initial work in setting up an exchange?
The state took $1 million from a federal planning grant in 2010, but the exchange now operates on a state budget of $600,000 a year, Connor said. The state charges an administration fee of $8 per employee, per month, to help take care of costs.
• How will residents in Utah access the exchange, and what kind of customer support will be offered?
The plan has an automated 1-800 number and 800 licensed brokers who help people choose the health insurance plans that fit them best. There are rules to prevent brokers from steering people toward certain companies.
Utah charges a broker fee of $37 per employee, per month, for the service. That’s comparable to what insurance companies charge within costs on traditional plans, officials said.
• How many people will Utah’s exchange employ?
Utah’s exchange employs just five people. It may add a few employees as the exchange grows, but not many. The small size is by design to keep administrative costs down.
“Our goal,” Connor said, “is to facilitate, rather than to administer, the exchange.”