| OCR Text |
Show assist small employers to obtain and retain affordable health insurance for their employees. The provisions for modified community rating and the establishment of a reinsurance pool would all work to improve the spreading and sharing of risk. The Steering Committee recommends a return to community rating and socialization of risk. Linkage with Employment-All proposals, except HB 64, build on the employer-sponsored health insurance system and assume that it will be a major source of financing for health insurance well into the future. In fact, rather than arguing against the linkage between employment and health care, the Blue Ribbon Committee encourages employers to take an even more active and aggressive role in the way they purchase health care for their employees. The recommendation that employers form coalitions and force changes in the way health care is purchased will mean significant purchaser intervention in the health care system. Rather than remain passive bill payers, employers are encouraged to change the organization and incentives of health care providers. The Steering Committee report and SB 195 also strengthen this linkage through the adoption of the "pay or play" proposal. Cost Containment Strategies-Nearly all of the proposals reviewed in this article contain recommendations to control health care costs. An interesting contrast between the Steering Committee and Blue Ribbon Committee reports is the way each report views the cost problem. For the Steering Committee, the problem is due primarily to unrestrained demand-we simply are buying too much health care, and buying it inefficiently. The Blue Ribbon Committee, while implying that excess demand may be a problem, views the problem as one where demand is unorganized and that it should be organized to purchase care more efficiently, rather than restrained. Both reports agree that government regulation of the marketplace is not the way to control health care costs. Not surprisingly, the Blue Ribbon Committee, being a committee of self-insured employers, makes no mention of the need to change ERISA. The Steering Committee, being predominantly insurers, providers, and state government officials, strongly argues that ERISA needs to be changed to allow states to regulate self-insured plans. The two reports also disagree on the question of leadership- who should be in charge of implementing the needed system changes. The Blue Ribbon Committee "made an explicit decision to maximize the potential of private sector efforts" (Blue Ribbon Committee on Health Care, 1992, p. 14). The "obligation for leadership and action (must come from) employers such as those represented on the. . . committee" (Blue Ribbon Committee on Health Care, 1992, p. 14). While the Steering Committee also favors private solutions, it argues that "state government, with the personal leadership of the Governor, is in the best position to assume overall responsibility for coordination and implementation of these recommendations" (Utah Health Care Access Steering Committee, 1991, p. 36). Both SB 195 and HB 64 provide a strong government role in leadership and direct control in solving the health care cost problem. Like the two private sector reports, SB 195 also encourages the development of integrated service networks and the use of primary care. While SB 195 hopes that market forces will control health care costs, it and HB 64 rely primarily on a global health care budget to control costs. Under the bills, government commissions would establish health care budgets for the state. Since, under HB 64, all health care funding flows through the government's single payer plan, it is technically possible to ensure that the budget targets are met. Under SB 195, the government's control of total health care expenditures is more tenuous. If the global health care expenditure target is exceeded, then price regulation takes effect. Utah's Health: An Annual Review 1993 113 |
