Health Highlights: July 13, 2009

State vs. Federal health care reform

Insurance reform + medical provider reform = health care reform, right? Utah health insurance reform has been center focus for the state, UAHU and private insurance carriers over the past 24 months. Mike Oliphant (UAHU board webmaster) runs a small Utah based health insurance website http://www.BenefitsManager.net as well as http://www.DentalInsuranceUtah.net. Mike’s viewpoint provides a unique analysis which comes from being a “fly on the wall” observer in countless state session and insurance meetings. “Utah has been thrust into a state insurance reform pressure cooker which isn’t necessarily negative where I am an insurer, insured and patient”. Several interesting changes took place with H.B. 188 passage earlier this year which seems all too familiar to the ongoing federal health care reform attempt under Obama’s administration. The spirit of the bill allows private Utah market place remedies. It essentially guarantees a Utah health insurance carrier a "no loss" or "no gain" premise over competing carriers that operate within the “Utah Insurance Exchange portal”. On the surface it would seem unattractive to a carrier’s consideration (voluntary at this point). But you have to understand the carriers’ goal is to cover their administration fees and maintain a 3% profit. The Utah health insurance reform model claims this can be accomplished now by legislation and the watchful eye of the state’s risk adjuster board. The medical claim risks are essentially shared equally among the participating carriers. Therefore, the carriers can focus on administration efficiencies more so than competition over a fluctuating market share.