Experts from UHPP break down Utah health policy

Utah had the highest increase in Medicaid enrollment in the entire country last year, according to Courtney Bullard, the education and collaborations director for the Utah Health Policy Project (UHPP). Stacey Stanford, UHPP’s health policy analyst, joined Bullard on a panel at UHPP’s annual Health Care Solutions for Utahns conference to discuss Utah’s evolving health policy and its response to COVID-19.

 

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Stanford said there are 207,371 Utahns enrolled through the open marketplace in 2021 — a number that’s been steadily increasing over the past three years. This signifies an increased need for health care because the state initially anticipated a decrease in open enrollment with the expansion of Medicaid in 2020, according to Stanford. It turns out the opposite was true.

“So instead of seeing that shift, where there was a decline, we actually saw an increase in both healthcare.gov and Medicaid [enrollment],” she said. “So that reflects the pandemic and the economic crisis that we’re living in.”

According to Bullard, 44 percent of Utahns get self-funded health insurance through their employer. Twenty-four percent are insured through government-sponsored programs like Medicaid, and 22 percent are insured through commercial plans, including plans from the individual marketplace. Ten percent of Utahns are uninsured, she said.

She noted that Utah’s uninsured rate has declined since 2005, with the steepest decline occurring after the passage of the Affordable Care Act in 2010. However, she explains the rate has recently begun increasing again.

“Utah was a state that chose not to expand Medicaid until this year, so that’s a policy that has a significant impact on the uninsured rate,” she said. “So in the coming years, because that policy has been implemented, we should start to see the data represent Medicaid expansion’s effect on the uninsured rate.”

She added that Utah has one of the highest rates of uninsured Hispanic children in the country, which has been a key contributor to the overall uninsured rate. She also said federal tactics like the Public Charge Rule were designed to prevent immigrants from utilizing public benefits like affordable health care, and have had “chilling effects” on insurance rates in Utah and across the entire country.

In 2021, 90 percent of Utahns were eligible for a premium subsidy, and 50 percent were eligible for some form of cost-sharing deduction, according to Stanford. Eighty-six percent of Utahns could find a plan for $50 per month. In 2020, marketplace subsidies lowered the average premium from $424 to $104, she said.

According to Stanford, there are up to 67 plans from six different carriers on the individual exchange this year. The plans with the highest enrollment are SelectHealth, University of Utah Health Insurance Plans and Cigna.

Stanford said over 200,000 Utahns are currently covered by the Affordable Care Act Marketplace, and 75,000 are covered by Medicaid expansion. There are 19,000 essential workers covered by Medicaid, and 176,000 Utahns receive subsidies to help pay for Marketplace plans. Between 438,000 and 1.2 million Utahns have pre-existing conditions, and over 225,000 Utahns have COVID-19.

Bullard said almost 375,000 Utahns are enrolled in Medicaid, including nearly 200,000 children. Approximately 16,000 Utah children are currently enrolled in CHIP.

According to Stanford, the simultaneity of Medicaid expansion and COVID-19 in early 2020 was fortuitous.

“We had our brand new full Medicaid expansion open in January, and as you know, that’s right when COVID became a thing around the world,” she said. “Utah had that expansion in place as a safety net as the need grew, and we can see that reflected in the dramatic increase in Medicaid enrollment.”

Utah’s Medicaid expansion is based off of enrollment projections and is funded by a nonfood sales tax that Utahns voted on in 2018. In FY 2020, Utah’s budget had approximately $125.8 million in revenue for Medicaid expansion, according to Bullard. Medicaid expansion expenses for FY 2020 were approximately $79.2 million, even considering the enrollment increase brought on by the pandemic, she said.

“That’s actually really great when you consider that the money comes from a sales tax, and that includes several months of significant recession, where we expected a lot of decline from our taxes,” Bullard said.

According to this data, FY 2021 is starting at a balance of $109.3 million for Medicaid expansion — a “great place to be,” Bullard said. She added that Utah’s Medicaid Budget Stabilization Restricted Account has $74.8 million. This budget can only be used if Medicaid expenses increase over 8 percent in one fiscal year, and since Utah has not yet tapped into it, the state’s Medicaid funding is in a good place, she explained. 

“The first place I’m going to look is this budget if I’m ever worried about the Medicaid account, because the legislature will draw from this account in times of crisis in the Medicaid budget,” Bullard said.

Bullard said the top health care concern for Utahns is insurance costs. This is largely due to prescription drug prices, she said. According to a report from the Utah Foundation, 30 percent of Utahns reported skipping a recommended medical test or treatment, 24 percent refused to fill a prescription and 19 percent said they cut pills in half or skipped doses — all due to worries about cost.

According to the report, 58 percent of uninsured adults said they did not have coverage because it was too expensive.

“It’s a little bit counterintuitive, just because we usually see insurers as the protector against high health care costs,” she said. “But now, we’re really in a situation where pretty much every area of health care is unaffordable for many people.”

Stanford highlighted successful legislation UHPP supported in the past year, including HB 207, which increased insulin access in the state. The organization worked to increase telehealth access through support for HB 313, which expanded telehealth parity. It also supported HB 38, which added substance use and health care amendments that expanded access to Medicaid for inmates.

She also spoke about UHPP’s COVID-19 response efforts, which included suspending work reporting requirements. The Utah Health Policy Project also worked to increase federal Medicaid funding and expand Medicaid coverage and COVID-19 testing for uninsured Utahns.

Stanford presented UHPP’s goals for 2021, citing health equity and health care affordability as key priorities. The Utah Health Policy Project wants to promote enrollment as a tool to reduce racial disparities in health care and maximize Medicaid to address COVID-19 and reduce inequities.