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Utah Health Exchange


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The Utah Health Exchange is a Web site where individuals and businesses can compare and buy health plans. For more service, visit

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Utah Health Exchange

  1. 1. Expanding Health Insurance Coverage for Utah’s Uninsured Citizens The Utah Health Insurance Exchange 8/15/2007
  2. 2. Who are the 11.9%? iCurrently Uninsured (11.9%) 306,500 By Age: -Children, Under 19 years old 89,500 -Young Adults, 19 to 34 years old 140,200 -Adults, 35 years old or older 76,800 -Note: Figures in these categories do not sum to the total because of missing values on the grouping variable. By Employment Status: -Adults, 19-64 with Full-time jobs (35%) 107,600 -Adults, 19-64 with Part-time jobs (13%) 39,300 -Adults, 19-64 who are Self-employed (12%) 36,200 8/15/2007
  3. 3. Key Factors – The Young Immortals i75% of the 11% (229,000) are under age 34 i68% of uninsured adults (147,000) have jobs iAround 70% of uninsured workers work for small business iThere are also many uninsured who are dependents of people with jobs iThere are around 25,000 uninsured full-time college students iThe Young Immortals are the primary group of free riders in the health care system 8/15/2007
  4. 4. Organizing Principles for Insuring Everyone iGive needed attention to the small group market iReverse the trend of businesses discontinuing insurance benefits iIntroduce competition and individual choice iInsure people while they are young and healthy iCreate an Exchange to facilitate the purchase of insurance with pre-tax dollars where possible iFacilitate purchase of insurance by part-time workers and workers with more than one job iCreate a social attitude of insurance and personal responsibility 8/15/2007
  5. 5. Goals iMake it easier and more appealing for Utah’s individuals and families to purchase health insurance iGive employers another tool to provide valuable benefits to Utah’s workers iIncreased the number of insured Utahns & decrease the uninsured population iPromote a culture of insurance and personal responsibility 8/15/2007
  6. 6. Description of the Exchange iIt is a mechanism to facilitate purchase iLegal structure to coordinate -Workers using pre-tax income -Employer contributions -Federal and state subsidies iThe Exchange is a state-chartered not-for- profit corporation iThe Exchange is not government-sponsored insurance iThe Exchange is not a risk pool iThe Exchange is not a regulator 8/15/2007
  7. 7. Stock Exchange vs. Insurance Exchange Individual Individual Investor Consumer Investment Broker/Agent Firm Securities Utah Exchange Department Commission of Insurance New York Utah Stock Health Insurance Exchange Exchange Publicly Traded Insurance Companies Carriers 8/15/2007
  8. 8. Insuring Individuals and Employees of Small Business Utah Health Insurance Exchange Choice of Private The Utah Insurance Exchange is a Health Plan clearinghouse for private health plans. Working • Employers offer a pre-tax health plan to Families all employees Pre-tax Premiums • Allows employers to use a defined contribution system Private • Working families choose plans to meet Health their needs Defined contribution Employers • Health insurance premiums are tax free Plans (pre-tax) • Health insurance becomes portable and flexible Subsidy for UPP qualifying families 8/15/2007
  9. 9. The Functions of the Exchange iApprove private health insurance products for inclusion iFacilitate enrollment and choice iCollect and consolidate payments iSend funds to insurance companies 8/15/2007
  10. 10. Benefits for Employees iEmployees elect to participate iCan select any offered plan for themselves and their family iInformation on cost and coverage comparisons iPre-tax withholding iPortable and flexible coverage 8/15/2007
  11. 11. Benefits for Employers iChoose to designate the Exchange as their group health plan – simplifies administration iNo need to research, negotiate, or designate one option for all workers iVoluntary contribution amounts iContributions from multiple employers can be pooled 8/15/2007
  12. 12. Public Subsidies iQualifying workers can apply for subsidies iThe Utah Premium Partnership for Health Insurance (UPP) iPublic dollars reduce employees’ share of premiums 8/15/2007
  13. 13. Employer Obligations iEmployers might still offer current group plans iAt a minimum, employers must make the Exchange available by: -Setting up a Section 125 plan -Collecting premiums -Submitting premiums to the Exchange iContribution requirement? 8/15/2007
  14. 14. Insurance Market Impact iThe Exchange would be the only marketplace for individual and family policies iThe Exchange could become the sole marketplace for small group plans iInsurers compete for business by offering appealing policies iExchange requirements would prevent niche products and cherry-picking – all insurers would have to offer an “essential benefit” plan 8/15/2007
  15. 15. Risk Sharing in the Exchange iSome mechanism is needed to address uninsurable individuals iVarious options will be explored: -Community rating -Rating bands -Rate regulation -Reinsurance -HIP Utah 8/15/2007
  16. 16. The Role of Brokers/Agents in the Exchange iLicensed and trained producers provide a valuable service iAdvice and counseling on plan selection iEnrollment of individuals and groups iReceive a commission for services rendered iAdjust services provided in a changing marketplace 8/15/2007
  17. 17. Advantages of the Exchange Model iAffordability (Tax Savings) iCombining Resources iSimplified Process iPrivate Solution iFlexibility and Choice iPortability iPromotes Shift to Defined Contribution iMechanism for Reaching Non-Traditional Workers 8/15/2007
  18. 18. Individual Responsibility iRequiring everyone to be insured iPros -Eliminates cost-shifting of the uninsured -Eliminates risk-selection issues iCons -How do you enforce an individual mandate? -How do you ensure an affordable product is available? 8/15/2007