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Doubling Down on Obstruction

By Dr R Scott Poppen

For those of us who have been champions of health care reform and advocates for the first step in the project, the Affordable Care Act (ACA), the progress we’ve made is most heartening.  But here in Utah our state political leadership is planning more obstruction with hopes that the ACA (also known as “Obamacare”) will eventually wither on the vine and go away.

Utah’s Governor Gary Herbert, a recently re-elected Republican, has been a consistent opponent of the ACA.  But more problematic for the hope of establishing a Utah-run exchange, that would allow thousands of Utah’s small businesses and citizens to purchase private insurance, is the widespread opposition to such a proposal by the state legislature.  Last month, Utah House Speaker Becky Lockhart, a nurse by vocation, announced that she would not touch a state run exchange for the ACA “with a ten foot poll.’  Other state legislative leaders have had even more negative reactions to the idea.  Nationally ACA opponents, still grasping at legal straws, hope federally run exchanges will be overturned in court challenges citing possible errors in the ACA’s legislative language.

Last week, Herbert asked for Utah’s current health insurance exchange, recently branded as ‘Avenue H’, to be approved as an ACA-compliant State-based exchange.

Utah’s political leadership has been very proud of their efforts to set up Avenue H despite evidence that it has largely been a failure in expanding access to health insurance.  Limited to small businesses, Avenue H has offered insurance products generally more expensive than those available through private insurance brokers.  Only a small fraction of Utah businesses have found it to be of any value in efforts to insure their employees leaving 400,000 Utahns still uninsured. Many observers feel the only hope to bring down exchange costs would be to open access to individuals as prescribed by the ACA.  Thus, Avenue H’s success may hinge on its ability to adopt the ACA exchange model—something Governor Herbert is opposed to.

Even more dismal than the prospect for a state-run insurance exchange is the chance that Utah will expand Medicaid next year.  Utah’s legislators, rather than insure thousands of uninsured Utahns, would rather cross their fingers and hope that funds for the Medicaid expansion eventually succumb to the ongoing federal budget wars or that the ACA is overturned. 

Such will be the tactics and strategy in many states in the coming years.  Only a successful implementation of state-run exchanges in other states and evidence that Medicaid expansion brings down costs will sway the bitter ACA opponents who, like unreconstructed confederates in post-1865, can’t believe their side lost and will continue to resist.        

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