Forbes guest column misses the mark on Healthy Utah criticism

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On October 16, 2014 Forbes.com posted an opinion piece by Jonathan Ingram, Nic Horton and Josh Archambault critical of Gov. Gary Herbert’s Healthy Utah Plan. While the governor can respect differing opinions on important issues such as this, the administration cannot allow the half-truths and blatant misrepresentations presented in the piece to go unchecked.

The Healthy Utah Plan is an alternative to Medicaid expansion under Obamacare that will provide 92,000 low-income Utahns with access to health insurance through the private market. Along with supporting private markets, the plan will promote individual responsibility, provide maximum flexibility and respect the taxpayers of our state. The Healthy Utah Plan enjoys wide-scale support in Utah, as evidenced through numerous public opinion polls.

Those are the facts.

These are the mistruths put forward by the authors of the opinion piece, and the administration’s response to them:

“Most of the details of the plan remain a mystery.”
If this were true, the Healthy Utah Plan would be the worst guarded secret in history. We have provided the Legislature regular monthly updates at the Health Reform Task Force and at the Health and Human Services Appropriations Subcommittee throughout the year. We have held community information sessions in Provo, St. George, Logan, Ogden, Clearfield and Taylorsville, which the public, including legislators have attended. We have presented the plan to chambers of commerce and business associations and have kept the Senate leadership and key members of the House well informed.

“Replace Utah’s compassionate ‘neighbors helping neighbors mentality,’ and weaken the family values that have been strong in the state for so long.”
The authors are unable to substantiate this baseless attack.  The Healthy Utah Plan is keenly focused on helping the most vulnerable in our community, neighbors helping neighbors if you will.  The majority of Healthy Utah recipients are working poor, nearly two-thirds are employed, and more than 85 percent live in a household where at least one adult is working. Many are “medically frail” with serious health and intellectual disabilities that won’t allow them to work. Others are single parents or parents who do not earn enough to receive a federal subsidy for health insurance, but too much to qualify for Medicaid.

The governor’s plan strengthens these families by allowing them to find their own commercial health plan and allowing their children on Medicaid to move off that federal program and onto their family’s private insurance subsidized by the Healthy Utah Plan.

“Speaker of the House Becky Lockhart, for example, has called Herbert’s plan ‘straight-up expansion of Obamacare.’”
First, nobody is suggesting we expand Obamacare. The Healthy Utah Plan is different and better than Medicaid expansion. It is based on private insurance, meaning doctors and hospitals can expect better reimbursement rates than they receive from Medicaid, and clients can expect better access to care. Health care providers will likely never know that a patient has private insurance supported by the Healthy Utah Plan. In addition, cost sharing is different and better than traditional Medicaid expansion, the linkage to work programs is different and better, and the incentives for healthy behaviors and appropriate use of emergency departments is different and better than traditional Medicaid expansion.

In fairness, the Healthy Utah Plan is similar to Medicaid expansion in that it recovers the Obamacare taxes paid by Utah residents and returns them to the Utah economy to pay for health coverage for needy Utahns.

“Legislators willing to stand up to governors… look no further than the silence of the majority of Republicans in Iowa, Pennsylvania and Indiana.”
The Legislatures in each of these states and others (i.e. Arkansas) supported their governors and passed legislation authorizing health plans in those states. This certainly does not constitute silence.

“Currently, nearly 2,500 seniors and individuals with intellectual or developmental disabilities are sitting on Medicaid waiting lists in Utah.”
There is no waiting list for seniors eligible for Medicaid. Any eligible senior who applies for Medicaid will be enrolled and receive services.

There is a waiting list for intellectual or developmentally disabled people in the Division of Services for People with Disabilities (DSPD).  Some of the individuals waiting for services on the DSPD waiting list would receive assistance under the Healthy Utah Plan, depending on their family income level.

“His plan would move 100,000 to 150,000 able-bodied adults to the front of the line, pushing those on waiting lists even further back.”
This statement is a bold-faced falsehood, and the authors and their supporters know it. Many of those eligible for the Healthy Utah Plan are medically frail, suffering from physical and intellectual disabilities. The only connection between waiting lists for services and the Healthy Utah Plan is that some of those on waiting list will likely qualify for assistance under Healthy Utah, pushing them off a waiting list and into a health care plan.

To argue the Healthy Utah Plan will push the needy further behind is inflammatory and misleading.

“These newly-eligible adults are in their prime working years, largely have no dependent children and have no disabilities keeping them from gainful employment.”
Again, this statement is blatantly false and insulting to those trying to support their families. The intent of this statement appears to be simply to characterize the newly-eligible as lazy. The exact opposite is typically true. Most potential recipients are employed in low-income jobs and are trying to support dependent children or parents.

Further, any able-bodied adult who is not employed will be automatically enrolled in a work program designed to get them back into the workforce and off of public assistance programs.

“More than a third of them have checkered criminal histories.”
This is completely unsubstantiated, undoubtedly false and another attempt to label the newly-eligible group as criminal and undeserving.

“His plan borrows heavily from Arkansas’ failed ‘Private Option’ experiment.”
The primary similarity between the Healthy Utah Plan and the Arkansas plan is that they both use private insurance instead of traditional Medicaid. The Arkansas plan had some flaws, and the health care environment in Utah is much different than the environment in Arkansas. We have learned from the Arkansas experience as well as that of other states. Having an existing managed care environment and state-operated small business exchange significantly improves our ability to implement health reforms.

“The Medicaid director who spearheaded the program abruptly resigned to ‘pursue other opportunities.’” And, “The program’s chief legislative architect… lost his primary.”
These are non-sequiturs having no connection to the point attempting to be made other than by suggestion and innuendo. A tool intended to intentionally deceive and mislead.

“Arkansas legislators have even warned their colleagues in Utah of the state’s growing buyer’s remorse.”
One legislator from Arkansas wrote an editorial that was published in a Utah newspaper, which was quickly rebutted by two of his colleagues in the same newspaper. Arkansas legislative leadership has denounced that legislator and his opinion and has demonstrated support of the Arkansas plan by reauthorizing it through legislation.

“It’s likely the governor’s negotiations will be just as unsuccessful [as Pennsylvania on the work requirement],” and, “signaling that the ‘requirement’ will disappear altogether.”
The concurrent work program enrollment is an integral part of the Healthy Utah Plan and will not disappear. Consequences that include loss of state benefits for not engaging in work programs are being considered, but the federal government has agreed in principle to integrating work programs into the Healthy Utah Plan.

“The plan will create a massive new tax cliff, where earning a single extra dollar could cost enrollees moving off the program hundreds or even thousands of dollars in higher out-of-pocket costs and premiums.”
The Healthy Utah Plan is designed to seamlessly transition individuals from private health plans supported by the State under Healthy Utah to the same or similar plan supported by federal subsidies if their income exceeds the plan’s limits.  Limits imposed by the ACA on premiums and out-of-pocket maximums apply to health plans qualifying for either Healthy Utah or the federal marketplace.

“Eighty-two percent of these possible enrollees do not work at all or only work seasonally or part-time.”
Although used to disparage the newly eligible group as lazy and fully capable, the authors inadvertently acknowledge that a large majority of those who are eligible for the Healthy Utah Plan are unable to work due to medical or intellectual conditions or are the working poor.

“Economist J. Scott Moody finds that the Obamacare expansion would reduce Utah’s long-run economic growth by up to $749 million.”
Moody’s analysis has been publicly refuted by economists from BYU, and the University of Utah.  Dr. Sven Wilson (Policy Economist and Chair of the Department of Political Science at BYU) said, “J. Scott Moody tries to muddle this clear choice by making the nonsensical argument that the Governor’s plan will actually hurt the state economy. Moody misapplies the basic economic concept of ‘crowding out.’

“Imagine someone saying that when tourists spend their money in our state, their purchases end up costing us jobs and hurting our economy.  Who would believe that? But that is exactly the argument Moody is making about Healthy Utah.

Let me explain to Mr. Moody a very basic principle of economic policy: don’t throw money away.”

“Because these private plans reimburse doctors and hospitals at higher rates than Utah’s traditional Medicaid program, providers will have large financial incentives to treat the new able-bodied adults comprising the Medicaid expansion rather than the truly needy already enrolled in Medicaid.”
Is the argument that we should not pay private plans better reimbursement rates?

The plan is to incentivize providers to offer services to Healthy Utah patients unlike the low reimbursement rates for traditional Medicaid recipients that dis-incentivize access to care.

Unlike Arkansas and most other states, this argument might have some credibility if Utah did not cover most of its current Medicaid recipients with managed care through Accountable Care Organizations (ACO).  In ACOs, recipients enroll in a private health plan.  Utah Medicaid pays a per capita reimbursement rate (capitated rate) to the health plan but individual providers within the plan negotiate their own rates with the health plan much like private insurance arrangements.

“Legislators are being left in the dark.”
We have involved legislators from the very beginning on the development, concepts, and many details of the Healthy Utah Plan.

  • Legislators were disproportionately represented on the workgroup organized by the Health Department last year (eight legislators were invited to participate).
  • Monthly updates have been given to the Health Reform Task Force for the past several months, and to the Health and Human Services Appropriations Subcommittee.
  • Community presentations have been given at six locations across the state with legislators invited and attending.
  • Presentations on the Healthy Utah Plan have been given to chambers of commerce and business associations with legislators invited and attending.
  • Key legislators have been briefed individually on the details of the Healthy Utah Plan.
  • Key legislators have been invited to participate in meetings with the White House and Secretary of Health and Human Services.
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