Market-based health care reform

Ever heard the saying, "almost only counts in horseshoes?" It certainly doesn't count in health reform to "almost" do it, even though our federal leaders would like you to think so. Thank goodness Utah hasn't been sitting back twiddling our thumbs waiting for Washington to solve our health care problems!

Three years ago, Utah embarked on a bold mission to reform our health system. Our goals were threefold: 1) To give individuals, rather than employers, the choice of affordable health insurance plans that fit their family's needs; 2) to give individuals the choice of provider networks, costs, and risks they are willing to assume along with the accountability for healthy lifestyle and disease management; and, 3) to provide individuals the tools and incentives to ask about the benefits, risks, costs and quality of health care services.

In our several years of work on reform inside Utah, we have built a foundation for a new health system based on market solutions.¬ We have asked stakeholders to cooperate, participate, innovate and implement change. These groups have been diligently delving into problems and probing for solutions for the past few years. Several pieces of legislation have come out of this task force and are already having a positive impact on the lives of Utahns. Last year we implemented a groundbreaking reform measure establishing a defined contribution market. Employees could enjoy expanded choice and greater control over their health care dollars as they accessed this market through the Utah Health Exchange.

Among the first states engage in reform, Utah leads by adopting a market-based approach as the primary instrument for meaningful health system reform. Late last year, as a result of our limited launch, we discovered that the current methodologies and some of the existing laws governing health insurance in the traditional market did not work very well in the defined contribution market. Instead of throwing in the towel and declaring health reform a Sisyphean task too large to tackle, we instead spend the interim examining the problems and looking for solutions.

Included in our health system reform package this year is HB294, which aims to correct the problems we identified in the health exchange, designed to optimize choice for Utah businesses and their employees by equalizing markets. In addition to the changes being made to the health exchange there are several additional bills:

* HB20 amends the requirement that contractors with state contracts must provide qualified health insurance to their employees and the dependents of the employees who work or reside in the state.

* HB25 simplifies the coordination of health insurance benefits in divorce decrees and child support orders.

* HB52 amends the uniform electronic standards for health insurance claims processing, electronic insurance eligibility information, and electronic information regarding the coordination of benefits.

* HB408 facilitates the open and honest dialogue between care provider and patient regarding unexpected medical outcomes and timely and cost effective resolution of unexpected medical outcomes.

* HB459 will require additional accountability and transparency within our Medicaid program.

* HJR34 amends the Utah Rules of Evidence making expressions of apology, sympathy, condolences and the like inadmissible against the health care provider.

* HCR8, this resolution urges Congress and president to resist any legislation that imposes further restrictions on any state's ability to regulate the payment and delivery of health care, imposes additional financial burden related to health care on any state, or limits the ability of consumers and businesses to create innovative models for higher quality, lower cost health care.

Unfortunately, article space doesn't allow for a more detailed description of all the elements in this year's reform package, but more information can be found by visiting the legislative Web site www.le.utah.gov. We know there is still work to be done beyond 2010 on this issue.

Many families are still without insurance and the cost of care is too high. Once the legislative session ends, you will find our task force, once again, hard at work on the tough problems that just can't wait for an "almost" solution from Washington.

Rep. Dee is the majority whip in the Utah State House of Representatives. He represents House District 11, which covers portions of Davis and Weber counties.

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