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In this week's Health Matters: HB160 | Week #5 Bill Tracker | Medicaid Expansion Cost Matrix | Essential Health Benefits | Luis Arnoldo Rios

HB160 Raises Concerns

The updated text of HB160 Health System Reform Amendments (Rep. Jim Dunnigan) was released on Monday night even as we await a final decision from the Dept. of Health and Human Services (HHS) on Gov. Herbert’s request for a “bifurcated partnership” exchange for Utah.
 
In the unique arrangement proposed by Gov. Herbert earlier this month, the federal government would handle the individual market exchange and the state would operate the SHOP (Small Business Health Options Program) exchange, building on the state’s current Avenue H. No other state is asking for such an arrangement, and this may be because it won't serve consumers well.
 
As introduced, HB160 presupposes that HHS will grant Utah all the flexibility it’s asking for, including special permission to bypass many of the Affordable Care Act (ACA) standards for SHOP exchanges. The challenges started with Gov. Herbert’s statement that only the federal government should oversee navigators (people trained to help people learn about their options and acquire health insurance through their state exchange), and that navigators will not be involved in the SHOP exchange. As we better understand how SHOP exchanges are expected to operate, Utah’s plan appears to be outside the bounds of ACA.
 
Remember that if a small business employee pays more than 9.5% of their income for their employer’s lowest-price plan on the SHOP exchange, they are automatically eligible to purchase coverage on the individual market with premium subsidies. But without navigators available to help them recognize this trigger-point, or to help them find their way into the right exchange, these employees could easily get lost in the shuffle.
 
Aside from the “good fences make good neighbors” approach to the relationship between Utah’s bifurcated exchanges, UHPP sees mostly red flags in HB160, especially for community-based navigators hoping to serve the estimated 76% of the uninsured with household income below 200% of poverty.
 
1) HB160 appears to prohibit navigators from assisting anyone who receives coverage on the SHOP or small business exchange (lines 327-329) and
2) HB160 seems to make it easy for brokers to get around conflicts of interest prohibitions in the ACA (see in particular lines 248-253 but see how contradicted in lines 486-7?).
 
And the problems continue from there.
 
Here’s the rub: While navigators are designated and funded by HHS in a federally facilitated individual market exchange, the standards and policies for navigators may be dictated and overseen by the state (lines 156-159). HB160 takes this unfortunate design flaw of the ACA as far as it can go, making it very difficult for community-based navigators to serve the populations who need them.
 
Please watch our website and future issues of Health Matters for detailed analysis and recommended changes for HB160. In the meantime and before you panic, please note that HHS’s decision on Utah’s request for a partnership exchange should have significant bearing on the content of HB160, in particular for the navigator provisions.
 
Take Action Today
HB160’s sponsor, Rep. Jim Dunnigan will answer questions about the legislation during today’s meeting of the Real Exchange Utah (RxUtah) coalition at 1:15pm in the Olmsted Room at the State Capitol. Bring your concerns about HB160 to the meeting.
 
Real Exchange Utah (RxUtah)
Wednesdays, 1:00-2:00pm
Location: Olmsted Room at the Capitol- Senate Building (East Side)
Special Guest: Rep. Jim Dunnigan discusses HB160 (1:15pm-2pm)

Bill Tracker

Big movement on UHPP’s Bill Tracker during  week #5. Rep. Dunnigan’s HB160, ER diversions amendments, competing Medicaid Inspector General bills, and more. Be better informed on the Hill with our Bill Tracker.

Read more here.

Medicaid Expansion at Slow Boil

Without the twice-delayed PCG study on Medicaid expansion, Utah legislators won't have the same economic data that other states are using to make informed budget decisions.

Read more here.

Senate Health and Human Services Standing Committee
Wednesday, February 27, 2013
Time: 8:00am
Location: 250 State Capitol
Agenda: here
Notes: 
HB0013 - Protection of Children Riding in Motor Vehicles (P. Arent)
SB0227 - Patient Information Protection Amendments (S. Urquhart)
 
House Health and Human Services Standing Committee
Wednesday, February 27, 2013
Time: 2:00pm
Location: 25 State Capitol
Agenda: here
Notes: 
HB141 - Medicaid Emergency Room and Primary Care Amendments (M. Kennedy)
 
House Business and Labor Committee
Wednesday, February 27, 2013
Time: 2:00pm
Location: 445 State Capitol
Agenda: here
Notes: HR3 - Resolution Requesting Repeal of the Patient Protection and Affordable Care Act (J. Anderegg) – please help oppose
 
Bills we are interested in:
SB42 - Medical School Admissions (J. Valentine)
  Last Location: House Rules Committee
HB153 - Medicaid Amendments (R. Chavez-Houck)
  Last Location: House Rules Committee
HB160 - Health System Reform Amendments (J. Dunnigan)
  Last Location: House Rules Committee
 
Visit the legislature’s website to see the legislative schedule, and find bills and representatives and senators. Check out UHPP’s Bill Tracker for the latest details on over 20 pieces of health care legislation.        
 
Join us at the Capitol every Wednesday afternoon for these three strategy meetings in the Capitol Senate Building (East Side)
 
Tell UHPP What Better (and Worse) Care Means to You
UHPP is looking for people who have either had good or bad experiences with Utah’s health care system to find out how to improve it.
Read more here
 

Utahns for Medicaid Expansion (U4ME)
Wednesdays, 11:00-12:00pm
Location: Olmsted Room at the Capitol- Senate Building (East Side)
 

UHPP Coalition Meetings (U4ME)
Family Investment Coalition
Wednesdays, 12:00-1:00pm
Location: Olmsted Room at the Capitol- Senate Building (East Side)
 

Real Exchange Utah (RxUtah)
Wednesdays, 1:00-2:00pm
Location: Olmsted Room at the Capitol- Senate Building (East Side)
Special Guest: Rep. Jim Dunnigan discusses HB160 (1:15pm-2pm)
 

Everything you wanted to know about health care reform in Utah -- but were afraid to ask.
Health Reform Facts-at-a-Glance (Kaiser Family Foundation)
Medicaid Expansion (state by state) (The Advisory Board)
How Medicaid expansion impacts Utah (Kaiser / The Urban Institute)

Benefits Rules Released

Last Wednesday HHS released rules on Essential Health Benefits (EHB) like hospitalization, maternity care, and mental health services. How did Utah's standards change?

Read more here.

New Brakes on Insurers

After 2014, can insurers charge a person higher premiums if they have a pre-existing condition? Not after the final market reform regulations released last Friday.

Read more here.

Luis Arnoldo Rios

UHPP’s is pleased to welcome the newest member of our staff: Luis Arnoldo Rios, an AmeriCorps member working with the Take Care Utah to enroll eligible Utahns in health care programs

Read more here.

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