SALT LAKE CITY — Apparently tired of being told he can’t get the health insurance fix he’s been hoping for from private carriers, Utah House Speaker Rep. David Clark said Wednesday he will introduce a bill that would establish the state’s first and one of the country’s few statewide health insurance risk pools for small businesses.
After hearing at least a half dozen times and 12 different ways the past several months that the state’s pilot health care insurance exchange is too complicated to right with current market methods, Clark said he sees no other way to make a Web-based insurance market viable in the coming new and improved health care system.
The exchange is a centerpiece to the redesigned health care system that Clark, R-Santa Clara, and fellow members of a special task force envision. The exchange is key to the state’s overall reform effort to reduce health care costs, make health care providers more accountable, get consumers more engaged and information technology up to speed with the rest of the world.
After being told that the exchange was faltering on all fronts, from burdening users with tedious questionnaires to posting premium prices 30 percent to 40 percent higher on plans identical outside the exchange, Clark said he has no choice but to merge the risk pools.
Moving to a “modified community rating” under Clark’s proposal is a landmark decision given that reformers basic tenet is to let the free market, i.e., private insurers, find solutions.
Many reform advocates and observers have said for two years that a community rating approach is fairer, cheaper and the only workable way to run the exchange. The proposal would prohibit insurance companies with plans in the risk pool from jacking up premiums for those with pre-existing medical conditions and instead base premiums on age, geographic area and general wellness practices of a group.
It’s a decision Clark said was two years in the making, and one he is willing to reconsider if the insurance industry manages to figure something else out,
He said the whole process keeps coming down to some missing variable no one can put a finger on. “Pretty soon we’ve got to figure out maybe that is the right answer.”
Of the 136 small employers who initially signed up for the exchange, 13 remain. There are dozens of others interested, exchange managers said Tuesday, but those who dropped out said expense and hassle were prohibitive and the process was aggravating.
Utah Association of Health Underwriters President Ernie Sweat said the exchange is a new market, and higher costs and paperwork problems should be expected but not deemed insurmountable.
“It’s a matter of getting to the point of being able to look at an apples-to-apples plans,” Sweat said. “There’s a lot of flexibility and a number of options that aren’t available any other regular market. But things can be worked out.”
e-mail: jthalman@desnews.com
