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Show Utah Health Print: Two Perspectives on Utah's Health Reform Thoughtful Progress by Patrick J. Johnson The 1992 Presidential Campaign fostered intense focus on health care reform. Regardless of how one felt about the Clinton proposal there is little question that health care reform was propelled to the top of the public policy agenda. In the end, however, it became clear that the Health Security Act of 1993 simply tried to do too much too soon. Much of the debate focused on the role of government vis-avis that of the private sector. The various states watched the development of the health reform agenda in the nation's capitol with great interest and no small amount of trepidation and concern. There were audible signs of relief in most state capitols when the President's proposal met its demise. The states were not merely observers, however. Health care reform initiatives became a central focus of many governors and state legislatures. While the Clinton plan was unacceptable, state elected officials recognized that rising health care costs, lack of access and concerns about the quality of care all needed to be addressed. Utah was no different. Historically, health care costs in Utah were generally below the national average but were rising more rapidly than in many states. Some ten percent of the population was without access to health care due to the lack of health insurance. In addition, more sophisticated and comprehensive measures of quality and cost were needed. On the other hand, Utah consistently ranked among the top five states, relative to health care status, and had what most people considered to be an excellent health care system. Utah launched its health care reform initiative in 1993 under the leadership of Governor Mike Leavitt. The Governor and the legislature created the Health Policy Options Jury. The commission was comprised of legislators, community leaders and representatives from the business community. The options jury made a recommendation describing three different health care reform scenarios for the state to consider. The option favored by the Governor and the Legislature was predicated on an incremental approach to addressing the issues of cost, access and quality. The recommendation was formalized through the creation of the Utah Health Policy Commission and adoption of HealthPrint. The commission is comprised of thirteen members including the Governor who serves as chair, the Lt. Governor who serves as co-chair, six members of the Legislature and six representatives from the business sector, academia and the community. The commission is staffed by an executive director, health policy consultants and support staff. The commission employs a various technical advisory groups (TAGs) to study the various health care reform issues set forth in HealthPrint. Membership on the commission is restricted to nonstakeholders, i.e., health providers, carriers, etc., whose expertise and input in gathered through the TAG process. The health care reform process prescribed in HealthPrint is intentionally incremental. It is based on the belief that health care reform in the state of Utah must be done in a market oriented environment in order to fully incorporate the existing health care system, respect the political environment and strike the proper balance between the role of government and that of the private sector. Since its inception, numerous reforms have been implemented including the expansion of Medicaid to cover more children ages 12-17 and establishing a regulatory framework for the initiation of alliances to encourage like groups to come together to pool their collective buying power. The commission has also successfully proposed numerous small group insurance reforms that have enhanced portability, increased dependent coverage up to age 26 and open avenues to insurance for people with preexisting conditions. While many people are frustrated with what they perceive as a lack of progress or movement toward health care reform that is too slow, it is very important to note that only minor adjustments have been necessary in the reforms that have been implemented in Utah. In many states, including Washington, broad sweeping reforms have been implemented and subsequently repealed because of the injury to the market and other problems. Thus, the general philosophy of HealthPrint is working because it is thoughtful and deliberative in Utah's Health: An Annual Review 1996 25 |