Health care reform: Utah’s ‘Supreme Court paralysis’

Today the Legislature’s Health System Reform Task Force met to discuss issues regarding the Affordable Care Act (i.e., Obamacare) and the Health Care Compact. In discussions regarding how the state should respond to Obamacare requirements, the overriding sentiment was uncertainty.

Dr. Norman Thurston, health reform implementation coordinator for the state of Utah, described Utah as being in a state of “Supreme Court paralysis.” In other words, until the Supreme Court issues its ruling on the constitutionality of Obamacare, state officials are unsure how far to proceed in complying with the mandates of the federal law. Cathy Dupont, associate general counsel for the Legislature, likened the scenario to a tornado: It might knock down your house or it might miss it completely, and no one knows until after the tornado has passed. 

The complexity and breadth of the federal law has also put Utah in a difficult situation. The task force must address pages and pages of issues and choose from many options as it responds to ever-evolving federal regulations, and it must accomplish as much as possible this summer. As Ms. Dupont informed the committee, its mission essentially is to “assemble a 5,000-piece puzzle.”

Here are some of the major questions the task force needs to address:

  • Should Utah comply with federal requirements by revamping its health insurance exchange, or should it allow the federal government to set up its own exchange in the state?
  • What are the costs and benefits of running a federally approved state exchange, and does Utah have the resources necessary to establish and operate such an exchange by 2014?
  • Should the state select a benchmark plan for an essential health benefits package to comply with Obamacare, and, if so, which of the 10 federally approved packages should it choose?

Other states have reacted in a variety of ways to these questions. Some, like Oregon, are enthusiastically moving ahead full throttle while many are resisting compliance. Others are playing a wait-and-see game until the Supreme Court issues its opinion and/or until the presidential race is decided this fall.

According to Thurston, Utah is far ahead of other states in health reform, and while it didn’t sign up for a massive expansion of public health care spending and programs, it faces many significant questions and must decide what works best for Utah. Certainly, Utah policymakers and interested stakeholders are capable and up to the task.

All of this uncertainty regarding federal health care regulations is one reason Utah passed the Health Care Compact this year. If approved by Congress, it would allow Utah to operate its own health care programs while still receiving federal funding for them.

In the meantime, as Ms. Dupont noted, the only thing we really know about Obamacare and Utah is that “change is inevitable.”