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Show The most controversial aspect of the legislation was its "guaranteed issue" provision. This required every small insurance carrier to guarantee to issue, without underwriting, a basic health benefit plan and a standard health benefit plan to small employers. The insurance industry argued that guaranteed issue invited "adverse selection." That is, small firms would buy insurance only when they needed it, leading to a carrier's financial insolvency. Another controversial provision of the bill was the establishment of an insurance pool called the Utah Small Employer Health Insurance Program. Initial drafts of the bill made participation in the pool mandatory for all carriers in the small group insurance market. Later drafts allowed carriers to "opt out" of the pool with the permission of the Commissioner of Insurance. Blue Cross and Blue Shield of Utah suggested in June, 1992 that, rather than establishing a new pool, the existing Health Insurance Pool for the uninsurable be used. Other carriers opposed using the uninsurable pool because they believed it would be underfunded by its inherent makeup. Other sections of the bill were also controversial and were not enacted. They provided for limitations on premium increases, restrictions on rating practices, disclosure of rating practices, and coverage of whole groups. The bill was never considered in committee. After a brief Senate floor debate, it was tabled and sent to interim study. None of the above mentioned legislation addressed the issue of the cost of health care as a driving force in the cost of insurance. SB 195-Health Care Reform Act Sponsored by Senator Karen Shepherd, SB 195 was the result of work by a study committee formed by the Democratic party of Utah. In January, 1992, the Deseret News reported that, at a press conference announcing its introduction, party leaders said they expected the plan to be rejected by the Republican-controlled legislature. Like SB 153, this legislation also contained insurance reform provisions but went further to require employers to offer health insurance. The key feature of SB 195 was the establishment of a permanent Health Care Cost Containment and Quality Assurance Commission. The commission was given broad powers with regard to monitoring the health care market to ensure that certain expenditure targets were met. It was also charged with implementing the program which would provide primary care to the uninsured. The cost containment strategy offered by SB 195 was based on the premise that rapid increases in health care costs are, in large measure, due to changes in the medical product. Simply put, the reason we spend more and more on health care is that there is more and more health care to buy. New equipment, medical procedures, drugs, and appliances rapidly enter the market. Often, these products replace existing products, but sometimes they just add to what can be put into our health care shopping basket. SB 195 did not attempt to control health care spending for the entire state, only the cost of a defined package of basic health care services. Because any society can potentially consume an unlimited amount of health care, SB 195 attempted to define, price, and establish expenditure targets for a defined package of basic health care. The commission was charged with developing a basic health care package and then establishing an allowable amount of money that could be spent on that package. If the amount of money spent on the package exceeded the targeted level, then regulation of the prices charged by medical providers would begin. The commission was given power only to regulate the amount spent on the basic health care package, not total health care costs. Another cost containment feature of SB 195 was the establishment of a cost-effective system to deliver primary care to all uninsured residents of the state. The bill guaranteed everyone access to "essential health care benefits." To ensure that these benefits were delivered as 106 HEALTH CARE REFORM |