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Show providing insurance to the uninsured and uninsurable. However, that legislation did not pass. In the summer and early fall of 1990, Senator John Holmgren, who was also impressed by what the Oregon Legislature had done, asked the Utah Department of Health to develop a plan that would gradually expand the eligibility for the Medicaid program. He wanted all persons with incomes below the federal poverty level to be eligible for Medicaid. A small group of department staff met with Senator Holmgren several times to discuss and refine the plan. Emphasis on primary care and case management to control costs were discussed as new ways to deliver Medicaid services. The possibility of involving employers in the expansion was also studied. However, the plan met with objections from within the department. While the department would like to have seen eligibility expanded, some officials argued that it made little sense to increase the number of Medicaid recipients when the existing program consistently failed to meet the needs of those who were currently eligible. At that time, the Medicaid program was running a deficit and the Legislature was being asked for supplemental appropriations. Also, it was unclear whether the state could obtain the federal waivers necessary to implement the program. Finally, Senator Holmgren had no clear source for the $5 million to $7 million in state funds needed to operate the program. In the Utah Legislature, when a difficult policy question needs to be addressed, a task force is commonly formed. This case was no exception. During the 1991 General Session, Senator Holmgren sponsored SB 143, creating the Access to Health Care Task Force. Two other bills introduced that session desired to create additional health care reform task forces. Senator Holmgren's bill was finally enacted and the task force held its first meeting in May, 1991. The first year's work of the Access to Health Care Task Force resulted in three bills and one appropriation request. While the funding request was approved, none of the substantive legislation recommended by the task force was enacted by the Legislature. The task force, with new membership, was reauthorized for another year and was directed to submit more recommendations to the 1993 General Session of the Legislature. HB 64--Utah Universal Health Insurance Plan Sponsored by Representative Janet Rose, HB 64 was modeled largely after legislation developed by Ohio State Representative William Hagen and his "Canadian-styled" Universal Health Insurance for Every Ohioan (UHIO) program. The bill proposed a single-payer, state financed health insurance plan, the Utah Universal Health Insurance Plan (UHIP) for all residents of the state. Under the plan, the state would apply for waivers from the federal government to combine the Medicaid and Medicare programs into UHIP. The legislation also established a comprehensive benefit package that included in-patient care, hospitalization, preventive services, laboratory tests, prescription drugs, mental health and substance abuse services, vision care, and medical supplies. HB 64 also established an annual global budget for UHIP. Institutional providers were to negotiate an annual contract amount with UHIP while professional groups would be paid according to a fee schedule. Other than HMOs, all providers were to be reimbursed on a fee-for-service basis. To fund the new health insurance system, HB 64 would levy a 9 percent payroll tax on each employer, a 1.25 percent tax on each employee, and a 10 percent tax on the self-employed. Along with the flat 9 percent payroll tax, an additional payroll tax of up to 4 percent (depending on the number of employees) was to be levied on employers. HB 64 received considerable public input in the course of its standing committee review during the 1992 session. While it was reported favorably out of committee, it was never considered by the full House 104 HEALTH CARE REFORM |