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Show Stapley, Vice President, Desert Mutual Benefit Association, and David M. Burton, then Vice President of Intermountain Health Care. The report was written as "a beginning point for discussion and for financial analysis and other analysis to guide the refinement of these or other proposals" (Utah Health Care Access Steering Committee, 1991, p. 4). The report argued that a successful strategy to reform our health care system must be comprehensive and simultaneously address access, cost, and quality. It suggested that state government, with the personal leadership of the Governor, is in the best position to implement and coordinate recommendations. The report viewed the health care cost problem primarily in terms of unrestrained demand by patients. It noted that the United States spends more per person and a higher percentage of its gross national product on health care than any other country in the world, yet its citizens seem to have poorer health outcomes than countries mat spend considerably less. The key feature of the Steering Committee's strategy to reform the health care system was to create the Utah Health Access Program (UHAP). Under UHAP, several changes would be made to the state's health care financing and delivery systems. First, the state would reform the health care financing system. The committee argued for the return of "community rating" in the health insurance market. Under a community rating system, companies selling health insurance cover the claims they pay by distributing the costs through a very large group of beneficiaries who pay premiums. However, community rating has now largely been replaced by "experience rating" where the insurance premiums are based on a company's own claims experience. While this is beneficial for companies that have predominantly healthy workers, it excludes potentially high cost groups by simply making the premium too high. Second, the committee recommended that the state provide a safety net for employers and individuals who could not purchase insurance through the employer based system, including those who could not afford to pay for health insurance, those who were uninsurable, and those who were covered by Medicaid. Third, to fund this safety net the state would encourage employers to provide health insurance by establishing a "pay or play" system. Under this plan, a special head tax would be established for each employee. However, each employee who was covered by health insurance would be excluded from this tax. In discussing the need to reform the financing system, the committee identified the most important barrier states face in regulating the health insurance industry- the Employee Retirement Income Security Act of 1974 (ERISA). Originally enacted by Congress to protect worker's pension plans, ERISA pre-empts any state regulation of employee welfare benefit plans or "self-insured" plans. Under ERISA, states cannot prevent companies from leaving the broad community insurance pool to "self-insure" and assume risk for only their own medical costs. The ability of companies to leave the community pool makes it more difficult for an insurance carrier to spread risk over a sufficiently large number of persons. Other recommendations of the steering committee included establishing minimum benefits and uniform options for benefits, emphasizing primary and preventive care in urban and rural areas, supporting public health programs, and reducing practice variations among physicians. Further, the committee urged die state to improve data on cost and quality, increase individual responsibility for health care costs, reduce administrative costs, and minimize abuses from self-referrals from physicians to laboratories and equipment in which they own a financial interest. The steering committee also recommended studies to address ethical issues in the delivery of health care and to reform malpractice laws and the tort injury system. The steering committee presented its final report to the Access to Health Care Task Force in July, 1991 at an opportune time. The task force was just beginning to develop its own conclusions and used the findings of the steering committee as the Utah's Health: An Annual Review 1993 109 |