5 Things Utah: 5th Circuit, Rep. Brad Daw, Convening Panel

I’m a little late getting this out, but I’m really late on getting my holiday shopping done! Hopefully, you’ve gotten all of yours squared away and you’re stress-free heading into the weekend! We should all be so lucky..!

Merry Christmas to you, and happy holidays! Thank you for your support and engagement as we’ve built State of Reform over this last year! I look forward to seeing you in 2020!





1. What the 5th Circuit decision means

The news that the 5th Circuit struck down the individual mandate belied a more nuanced reporting of the decision. I detail four things I think are worth noting in my post this morning. Here are a couple of thoughts that mainstream reporting might not share.

First, this isn’t a broad decision. It’s a careful one, pointing to a more conservative approach to jurisprudence than to politics. Moreover, it creates an interesting question for the Supreme Court, on when is a tax a tax. But, overall, I think it sets up more modest questions for the Supreme Court, which may create an opportunity to strongly re-affirm the court’s precedent in NFIB (2012) that upholds the constitutionality of the ACA. It may be an unintended consequence of the legal strategy by the “Red States” that brought the case, but I think it’s where we’re headed.

2. Video: Rep. Brad Daw

Representative Brad Daw represents Utah’s 60th House District and is the Chair of the House Health and Human Services Committee. He is also a member of the Health Reform Task force. He joins us in this edition of “What They’re Watching” to discuss transparency in pricing.

“We need to get the person engaged back in the process of how much things cost, and get the consumer more attached to their insurance policy. Right now, you’re completely isolated from it. For example, most people get their policies through their employer. They have no idea what the premiums are; they don’t really have any great incentive to save any money because they don’t see it one way or the other. And so, if we can get the consumer a little bit more connected with paying that money out, I think we’ll see some really positive differences.”


3. Convening Panel to meet in early January

We are getting the band back together. Our Convening Panel is the group we look to for guidance on topics and speakers as we build our agenda for the 2020 Utah State of Reform Health Policy Conference. That event is coming up on April 2nd this next year, and we’d be thrilled to have you with us. “Early Bird” rates are in effect through January 24th, so you can focus your spending on Christmas instead of conferences…!

If you have ideas for content, now is a good time to share those. I’ll incorporate the feedback into the Discussion Guide that we share with our Convening Panel to support their conversation. What topics should we tee up for next April? Who should we curate to speak? In our crowd-sourced model for content development, your input is really helpful to us. So, let us know!

4. Legislature passes supplemental appropriations bill for behavioral health

A supplemental appropriations bill for behavioral health passed the state legislature this week. The bill, S.B. 2002, appropriates $3.9 million in operating and capital funding for fiscal year 2020, all of which is from the General Fund. Lawmakers said the bill was needed to backfill a budget shortfall due to lower than expected Medicaid enrollment. The legislation underscores both the challenge of predicting Medicaid, particularly in the behavioral health space.

Directed to the Department of Human Services, $3.5 million will be allocated for local substance abuse services while the remaining $398,000 will be reserved for state substance abuse services in order to restore funding to Washington County Court Support Services. The bill will take effect immediately upon the governor’s approval.


5. Surveying DOH reports to the legislature

December is a time of reports by state agencies to the legislature to inform policy in the next session.

According to a new report from the Dept. of Health, Utah’s expansion population averaged 35,188 beneficiaries per month through the first six months of the year. Noteworthy, at the end of the report, it states “The Department recommends that the State not implement the first five provisions bulleted above unless state budget pressures require additional action to reduce Medicaid expansion expenditures.” The five provisions include “suspend housing supports” in Medicaid or “Enroll expansion adults with income over 100% FPL in (Medicaid) the month after their approval.”

DOH also noted savings of $1,197,597 since May 1, 2019, by moving more than 300 low-cost medications to a 90-day supply when dispensed rather than a 30-day supply. This cuts down on admin fees, and was made mandatory on May 1 after modest uptake by pharmacists. Participation is still only 26%, meaning more admin overhead can be wrung from the system. Another report lists four policy options to increase compensation of “legally responsible” caregivers.