Top health policymakers in Utah convened in Salt Lake City on Wednesday to share their experiences with the 2023 legislative session, which adjourned on March 3rd.
Members of the House and Senate Health and Humans Services Committees led a panel discussion during the 2023 Utah State of Reform Health Policy Conference, highlighting some of the measures that passed and failed.
Senate Health and Human Services Committee Co-Chair Sen. Jacob Anderegg (R-Lehi) said his focus this session was raising awareness among his legislative colleagues and members of the Executive Appropriations Committee of the big issue items in healthcare.
“We did some good things,” Anderegg said. “I think that a lot of people got help who needed it critically. Did everyone get help who needed it? No. We can parse out project by project, issue by issue.
I do think [the] proper role of government is to help those who are just not able to help themselves first, within certain limitations and constraints. We cannot be all things to all people. I don’t think it was ever designed … to be that way.”
He added that he views both this year’s and last year’s sessions as successes from a social services standpoint.
Earlier this year, the legislature approved a record $29.4 billion budget for FY 2024, appropriating more than $10 billion to social services.
The Utah Department of Health and Human Services (DHHS) had its budget set at $8.3 billion, an increase of $1 billion from last session. This session, lawmakers expanded Medicaid coverage to include a 12-month extension of postpartum coverage, family planning services, dental benefits for adults, treatments for autism, and recreational therapy.
The Division of Services for People with Disabilities (DSPD) will spend more than $8 million in the coming years to increase caregiver compensation and address the growing number of people on the waiting list for services. DSPD has been experiencing a caregiver shortage, which resulted in more than 4,300 individuals being on the waiting list last year.
“So the last couple of years, especially this year, there was really an increased focus on caregiver compensation,” said Paul Ray, former state representative and assistant director of legislative affairs at DHHS. “Let’s pay people—it’s a hard job.
And to think that you can make more at McDonald’s than you can providing personal services for somebody who’s disabled, that’s why we have such a high turnover. And we have almost a 90% turnover rate. One of the areas actually had a 105% turnover rate when I was chairing, so it’s nice to see money going into the compensation to help with that. And that was about a $4.5 million increase.”
The budget also included some $200 million for various housing supports, work that Rep. Rosemary Lesser (D-Ogden) recognized as far from finished.
“Social services appropriations was such a big budget item because [of] social determinants of health,” Lesser said. “So we recognized that issues of housing impact health in a much broader way. So [housing] was one of the biggest ticket items in this past session—trying to … chip away at the deficits that we have in housing, because all of us in this room who are concerned about healthcare policy know that things like food security and housing impact our ability to access healthcare.”
Among the bills that failed were Lesser’s bill to extend Medicaid coverage eligibility for pregnant women and a bill that would have required both insurers and pharmacy benefit managers (PBM) to count prescription drug discount coupons towards patient deductibles.
Critics of the latter legislation said the measure would have ultimately increased healthcare costs through higher insurance premiums.
Speaking on an earlier panel about legislative insights, Stephen Foxley, director of public affairs and government relations at Regence Blue Cross Blue Shield of Utah, said the state needed to come up with alternative solutions for individuals who have sustained high out-of-pocket costs for specialty drugs that do not steer them to charities and patient assistance programs.
“Less than 2% of our prescription claims on the medical and RX side drive more than 50% of our spending,” Foxley said. “So if we don’t find a way to control how we spend on prescription drug costs, we are not going to be able to sustain the coverage that we have. Last year, the average launch price for drugs was $220,000. That’s up from $8,000 just 10 years ago.
You can see that it doesn’t take a large number of people getting on these really life-changing drugs to have a huge impact [from] the premium perspective, which ultimately [means health plans] don’t absorb those costs. We are a reflection of them and they get passed on to everybody in this room.”
According to the Utah Hospital Association, the signing of Senate Bill 126 into law this year will essentially double the amount of the current hospital Medicaid rate structure. Changes to federal law will also offer hospitals access to an increased federal funding match for both inpatient and outpatient services.
Brian Shiozawa, MD, former state senator and associate vice president of health policy at University of Utah Health, said SB 126 will be a big benefit to health systems struggling with inflation.
“The hospitals are able to voluntarily contribute for at least their inpatient and outpatient reimbursement—the state portion of it,” Shiozawa said. “On the one hand, [hospitals will] get more Medicaid reimbursement, but on the other hand, the state doesn’t have the financial liability for this. So it’s really a nice combination of endeavors to get both federal funding and then also to shield the state from costly expenditures.”
The state’s Medicaid expansion fund is expected to grow to $300 million by the start of the next session, and lawmakers at the conference said they are already looking into ways to spend it.
The Legislative Management Committee approved the legislature’s interim schedule and a list of agenda items, including a review of how the Medicaid expansion fund is used, for the fund as well as an evaluation of Medicaid cost reduction and quality improvement measures. The Health and Human Services Interim Committee’s first meeting is scheduled for May 17th.
Lesser said she plans to reintroduce her bill to expand Medicaid eligibility for pregnant women next year and will examine related legislation during the interim. She stressed that while access to postpartum care is important, the quality and outcomes of that care are equally important.
“Our challenge in [maternal] health policy is now beyond [postpartum access]—making sure that people do indeed receive those services that are so desperately needed, not only for mental health, but ongoing treatment of high blood pressure and diabetes. Those are all very common conditions that we all deal with every day. And let’s hope that we can get a group of women on the road to good health.”
Meanwhile, Republicans at the conference expressed concerns over the country potentially defaulting on its debt and the devastating impacts such a scenario would have on the federal portion of the state’s budget.
House Health and Human Services Committee Chair Rep. Ken Ivory (R-West Jordan) said he will look into ways the state can navigate this potential economic uncertainty.
“We’re kind of playing a game of chicken with the most vulnerable in our society,” Ivory said. “And these are the sick, the poor, the elderly, [and] the disadvantaged that are largely funded with federal funds. We know that there’s an unsustainability—that’s clear. The Government Accountability Office says that outright every single year.
So to really look at what that means and how do we provide a meaningful contingency plan for the most vulnerable among us—so that’s something that you’re going to see a lot throughout the interim.”