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
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 HB16
0, especially for community-based navigators hoping to serve the estimated 76% of the uninsured with household income below 200% of poverty.
HB160 appears to prohibit navigators from assisting anyone who receives coverage on the SHOP or small business exchange (lines 327-329) and
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)
Location: Olmsted Room
at the Capitol- Senate Building (East Side)
Special Guest: Rep. Jim Dunnigan