Young African American family having fun while drawing together at home.

3 Things the Family Prosperity Index shows Utah legislators

By Krisana Finlay

This Utah legislative session covers 1,200-plus bills, and with only 45 days to cover them all, legislators need to know what issues matters most.

Luckily the newly published Family Prosperity Index (FPI), of which Sutherland gave a recent general overview, gives legislators a few things to keep in mind.

  1. Thanks in part to Utah legislators, Utah ranks No. 1 in the nation for family prosperity.

It’s important to remember where we are doing well, and as a whole, Utah surpasses all other states with flying colors. It takes the national lead in five of the six FPI major indexes. In the economics category Utah comes in second to North Dakota, thanks to that state’s fracking boom, which affected the statistics this year and since then has reportedly declined.1

Why is Utah ranked No. 1 nationally?

Utah citizens and lawmakers uphold the cherished principle that family is the fundamental unit of society. This fundamental unit is the driving force behind everything they do – framing how they go about the day’s work and the night’s play. All is geared toward building strong families. Strong families facilitate functional cultures, capable communities and enriched economies. And the FPI proves it.

Utah is experiencing true prosperity considering its robust scores on almost all major prosperity index scores. But all of its flying banners of success cannot discount two areas of real concern: self-mortality overall, and conditions in Salt Lake County.

  1. Utah Legislators need to take an uncomfortable but direct look at self-mortality.

Utah does well in the major index of family health. We’re in the top 10 states for low rates of tobacco, alcohol, and obesity, illicit drug use, sexually transmitted disease rates, and high rates of infant survival. But Utah has a serious problem with self-mortality, ranking 45th in the nation because of its suicide and drug-overdose rates.

Suicide Rates

It’s bad. Utah’s suicide rate has consistently measured above the national average and has accelerated at a faster rate, increasing 43 percent between 2000 and 2014 (the national average increased 29 percent).1 Leaders have been confounded when it comes to resolving this problem, in part from the myriad risk factors: domestic violence, bullying, alcohol or drug abuse, local epidemics of suicide,2 increased elevation, or feeling constrained when it comes to seeking help.3

This combination of risk factors may be providing the perfect storm. Domestic abuse, high stress in school or work, high expectations, addiction, and technology offering counterfeit connections instead of real relationships and resources may cause a person to consider dire alternatives.

Drug-Overdose Rates and Opioid Addiction

Utah’s drug-overdose rates are also a concern. Utah’s rates have been higher than the national average, although growing at a slower rate.1 Luckily, the 21st Century Cure Act Congress passed just last December offers help. This bipartisan legislation takes a comprehensive approach in solving opioid overdoses and distributes $1 billion of its budget to states to address local health concerns. This funding distribution will take place early this year, in perfect timing for the Utah legislative session.

U.S. House Speaker Paul Ryan in a recent town hall meeting commented, “We have to have a full-front war against this opioid epidemic, and that is exactly what we passed and funded.” Along with that help, Salt Lake County must also solve some full-front wars of its own.

  1. Salt Lake County needs help

The most populous county in the state, Salt Lake County reports having a higher violent crime rate, higher rate of families with children below poverty level, and the lowest level of married taxpayers in the state. It also had 4,412 of the 9,687 unwed births in the state (46 percent).1

To answer the why behind these statistics, the FPI offers the following insight, citing a 2012 domestic policy report from The Heritage Foundation:

“Not surprisingly, many of these factors are interrelated. For example, children from single-parent homes, emanating from a high unwed birth rate, are more prone to criminal activities in youth (more than twice as likely to be arrested) and young adulthood (three times more likely to be in jail by age 30) relative to children from intact married families.” 1

A guide to resolving self-mortality and Salt Lake County concerns

Boyd Matheson recently said, “In areas where we lack effective solutions it is usually because we are avoiding uncomfortable conversations.”

Taking on these uncomfortable conversations will inevitably cause leaders to engage with various community participants: community officials, families, churches, industry professionals, and other legislators. These engagements will bring understanding and naturally community-driven solutions.

Simply put, community problems require community engagement. Community engagement brings community solutions. Community solutions bring community prosperity. We applaud and encourage community officials who initiate difficult conversations in the hopes of resolving family health and Salt Lake County problems.


All in all, Utah is doing incredibly well in regard to family prosperity. FPI authors wrote, “[I]t’s not even a close race with Utah’s dominating performance on the FPI across nearly every major index.”1

Utah holds a high standard for true prosperity. It leads the nation because Utah residents understand the family is the economic engine of society. The stronger the family, the stronger the engine, and the further Utah will go amid whatever lies ahead. As legislators look to resolve Utah’s unique struggles, a prosperous and enduring community will result. Such endurance and strength only comes through sustaining core principles, ones that Sutherland is committed to uphold.



  1. P. Warcholik and J.S. Moody, Utah Family Prosperity Index, January 2017, American Conservative Union Foundation, website.
  2. “Complete Health Indicator Report of Suicide,” July 15, 2016, accessed January 12, 2017,
  3. L. Price, “Utah officials unsure why youth suicide has nearly tripled since 2007,” Salt Lake Tribune, July 3, 2016,


Opioid epidemic in Utah

In Utah, and across the nation, we have seen the rise of an opioid epidemic that continues to explode exponentially. It is a topic we have been uncomfortable discussing, but is clearly an issue that must be discussed.

There have been a few legislators locally and nationally who have tackled the opioid epidemic head on. We applaud their efforts – and recognize that there is much more that needs to be done.

In some ways America’s approach to the opioid problem is similar to the famous poem written by Joseph Malin in 1895 titled, “The Ambulance Down in the Valley.” You remember the story of the tiny town, which boasted of a mountain lookout with magnificent views of the valley. While the scenes were spectacular, the cliff was unacceptably dangerous. Many local citizens and passing visitors alike had tragically fallen from the cliff to the valley below.

Some of the citizens in the town advocated for putting a fence around the cliff, but others more persuasively made the case for simply parking an ambulance down below in the valley.

“For the cliff is all right, if you’re careful,” they said,

“And, if folks even slip and are dropping,

It isn’t the slipping that hurts them so much

As the shock down below when they’re stopping.”

So day after day, as these mishaps occurred,

Quick forth would these rescuers sally;

To pick up the victims who fell off the cliff,

With their ambulance down in the valley.

So, the citizens relied on the ambulance to deal with the ever-present and potentially lethal problem.

Then an old sage remarked: “It is a marvel to me

That people give far more attention

To repairing results than to stopping the cause,

When they’d much better aim at prevention.

Let us stop at its source all this mischief,” cried he,

“Come neighbors and friends, let us rally;

If the cliffs we will fence we might almost dispense

With the ambulance down in the valley.”

As it relates to our opioid cliff, we have added many new tools to the ambulance down in the valley, including vital overdose-reversing injections, needle exchanges, and counseling and rehabilitation programs for those who have become addicted. Unfortunately, we have done far too little to build the fence at the top of the cliff. It is time for a fence-building discussion between families, churches, legislators, doctors, health care providers and drug companies.

The opioid cliff is but one ledge where we would be wise to focus more on fence-building instead of ambulance production. Many of our state and federal programs designed to deal with poverty, homelessness, long-term unemployment, health care and hunger have spawned fleets of ambulances parked in the valley of government assistance.

As James Malin concluded, “To rescue the fallen is good, but ’tis best

To prevent other people from falling.”

We must get better at building fences in our communities, and when appropriate through government. In areas where we lack effective solutions, it is usually because we avoided the uncomfortable conversation.

For Sutherland Institute, this is Boyd Matheson. Thanks for engaging – because principle matters.

This post is an edited transcript of Principle Matters, a weekly radio commentary broadcast on several radio stations across the country. The podcast can be found below.

Receive this broadcast each week directly via iTunes by clicking here

Poster map of United States of America with state names. Print map of USA for t-shirt, poster or geographic themes. Hand-drawn colorful map with states. Vector Illustration

Federal funding: far from free

Recently, the Tax Foundation released a study showing which states rely most on federal aid and what percentage of their budgets come from these federal dollars.

States receive a significant amount of assistance from the federal government in the form of federal grants-in-aid. In fact, when averaged together state governments relied on federal money for almost one-third of their general revenue in 2014.



This dependence diminishes local priorities in favor of national special interests, incentivizes unnecessary spending at the state and local levels, mandates burdensome regulations, and leaves states vulnerable to future federal spending crises. Simply put, these dollars aren’t free – and the economic, social and financial costs are passed along to taxpayers.

Sutherland Institute wrote an article a year ago about the negative consequences of federal aid in an op-ed in the Daily Herald titled The Myth of Free Federal Money:

“No such thing as a free lunch.”

“If it sounds too good to be true, it probably is.”

“You don’t get something for nothing.”

We know all this. Yet the allure of “buy one, get one free!” “no money down!” and “get 6 months free!” still draws us in.

We see this natural impulse at work when “free” federal money is offered to our elected officials. With billions of tax dollars dangling in front of state and local governments, the sales pitch of better schools, stimulated economies and improved roads usually proves too enticing to turn away.

Unfortunately, this promise is based on a misconception. Federal funding isn’t free at all. In fact, according to new research, it costs Utah taxpayers hundreds of millions of dollars per year.

A new study from Economics International (EI) reports that each additional dollar of federal grant money to the states is associated with an average increase of 82 cents in new state and local taxes.

In Utah, the extra tax burden from every dollar of federal funding is 72 cents. To illustrate, a hypothetical 10 percent increase in federal grants to Utah ($560 million) would be associated with approximately $400 million more in spending from state and local government — an additional tax burden of about $140 per Utahn.

That’s slightly below the national average, but it is cause for genuine concern. It means Utah’s elected officials are being manipulated by the federal government into increasing the financial burden on Utah taxpayers in ways they wouldn’t do otherwise.

We encourage the public and policymakers to reread this op-ed and reject federal funding’s empty promises.

Man desperate and alone in the dark

Chaffetz is right – D.C. should not promote suicide

In November, the District of Columbia Council overwhelmingly approved a bill that would allow doctors to help patients commit suicide if doctors believed the person had six months or less to live.

Utah Representative Jason Chaffetz announced last week that he will seek to have Congress overturn the law. Congress, of course, has this responsibility to oversee District laws under the Constitution (Article I, section 8), and all D.C. Council legislation is submitted to Congress for review before it goes into effect.

The author of the bill responded to the announcement: “This is entirely a local matter and he may have philosophical or perhaps even religious objections, but we have made our own choice and it should be respected.” The “local matter” remark suggests a misunderstanding of the Constitution, but the more interesting comment is the dismissive reference to Representative Chaffetz’s “philosophical or perhaps even religious objections.”

This kind of comment is a common tactic to denigrate unwanted opinions. It is to say, in effect, “That is your idiosyncratic belief based on some subjective, probably irrational, thought process but it need not restrain us from doing what we like.” That dismissal is particularly inapt here because there are compelling reasons to oppose the District of Columbia’s promotion of suicide for the ill and infirm.

For instance, we should be particularly cautious about embracing a right to suicide for vulnerable individuals. The experience of other nations suggests that this “right,” initially limited to those experiencing terminal diseases and advertised as strictly voluntary, begins to be applied to a wider variety of cases, including some not strictly medical and, as in the case of Belgium, now extended to non-voluntary situations such as the euthanasia of children.

Second, the much-valued “choice” to end one’s life does not occur in a vacuum. A person who is ill enough that the doctors guess (and it is usually just that, a guess) she or he will soon die, must act in the context of pressures, real and imagined, from other people – family and friends, physicians and insurance providers (including, often, the state itself). As reports from Oregon (the first state to approve this option) suggest, the doctors involved in these cases are not so much wise counselors giving ethical advice as resources called in near the end to dispense drugs.

Insurance companies, and the state as the provider of medical care to the needy, have a possible motivation of encouraging the less-costly route of suicide. One patient in Oregon was told by her insurance company that it would pay for the inexpensive suicide drugs but not for medication her doctor prescribed to extend her life.

Nearly half of those who opted for assisted suicide in Oregon in 2015 reported a concern with being a burden on family, friends and caregivers. Even where family members have no desire to encourage suicide by an ill family member, the existence of that option colors their interactions and may lead a sick person, particularly one with undiagnosed emotional or psychiatric illness (a very real possibility, as the evidence makes clear), to conclude that others would be better off if they died, even if those others don’t actually feel that way.

The motives of family and friends can be mixed. Take an example from the summer 2016 newsletter of End of Life Washington (slogan: “Your life. Your death. Your choice.”). The story is told by a psychotherapist about a former patient referred to her for anxiety and depression. The patient had twice planned suicide only to change his mind. After 25 years of no contact, the patient called to say goodbye after he’d picked up his suicide prescription to end his life in the face of a terminal cancer diagnosis.

The therapist reported: “He died in the loving presence of his brother and the close friend he had stayed connected with through the years, both of whom actively supported his choice.” In fact, his family and friends had “entreated” him to pursue physician-assisted suicide so that he did not take his own life by jumping from a bridge. The article reports family and friends were “horrified by the suffering his suicide would cause not only him but them.” So, he took advantage of Washington’s law with “their help, encouragement and advocacy.”

The option of legal suicide certainly makes such pressure more effective. It is like the pressure reported by parents of children prenatally diagnosed with Down Syndrome to abort their children.

It is a serious problem that we speak of the crisis of suicide in some contexts and in other contexts we valorize it as an exercise of personal autonomy. That mixed message may be fatal.

A supporter of the D.C. law carried a sign that neatly encapsulates the fundamental problem with assisted suicide laws. The sign read: “You would do it for your dog. Why not for me?”

Chaffetz is right to reject the idea that we should “put down” those who are sick like we would a pet. That’s not a narrow theological belief but a basic tenet of human decency, of protection for the vulnerable.

Utah ranks #1 for family prosperity

A joint project by Sutherland Institute and the American Conservative Union Foundation found Utah ranks first in the nation according to the Family Prosperity Index, or FPI. The FPI measures more than 50 of the economic and social factors that indicate family prosperity, including but not limited to marriage and divorce rates, crime rates, STD rates and household income. A state that scores well on the FPI is one that is moving toward the goal of creating family prosperity. 

This new study found Utah dominates the 2016 Family Prosperity Index, not only ranking at the top but also holding commanding leads over the second-ranked state and the national average. In fact, Utah’s FPI score has increased by 3.6 percent over the last five indexes – from 7.12 in 2012 to 7.38 in 2016. The FPI national average is normalized at 5.0. 



From Sutherland Institute President Boyd Matheson:

“Of all the awards and accolades Utah has received, this may very well be the most significant. While Utah has long recognized family as a critical social engine, this report illustrates the power of the family as an economic engine. Lawmakers would be wise to recognize that just as a strong economy helps families, strong families strengthen economies.” 

From Sutherland Institute Director of Public Policy Derek Monson:

“Rather than measuring and ranking a stand-alone niche of Utah’s economy that many never see or experience, the Family Prosperity Index measures whether Utah’s economic prosperity is reaching Utah’s families, and how Utah’s families are driving Utah’s economic prosperity. Clearly, Utah has room to improve in its most populous county when it comes to the related issues of drug use and suicide – and these are critically important things that demand our attention. But Utahns can be proud in our understanding that we lead the nation economically because we lead the nation in how we create, build and devote ourselves to our families, and by extension our communities.”

From American Conservative Union Foundation Chairman Matt Schlapp: 

“The Family Prosperity Index provides a blueprint for creating an environment for families to flourish, and Utah, with its No. 1 rank on the 2016 FPI, has set the standard for the rest of the country. I hope leaders across the county will come to understand the factors driving Utah’s success and use the FPI as a tool to expand prosperity in their own states.”


  • Six indexes (and their corresponding sub-indexes) make up the FPI: Economics, Demographics, Family Self-Sufficiency, Family Structure, Family Culture, and Family Health. All sub-indexes can be viewed in the attachment.
  • Utah takes the lead in every index aside from Economics, where North Dakota comes in first. This data was impacted by North Dakota’s fracking boom, which has since slowed.
  • An area of concern for Utah includes the drop in the Family Health index caused by the self-mortality sub-index, which consists of suicide and drug overdoses as a percent of population. Utah has higher-than-average rates.
  • Additionally, a county-level FPI analysis raises alarms for Salt Lake County. Negative trends are noted when it comes to children in poverty, violent crime rate, property crime rate, the level of married taxpayers, and unwed child birth.


Governor Gary Herbert and Pamela Atkinson launch the 2016 Homelessness Campaign

The Pamela Atkinson Homeless Trust Fund receives non-tax-deductible donations from individuals and businesses on their state tax form. All donations to the fund go directly to service organizations statewide. The annual tax campaign highlights the opportunity Utahns have to donate directly to the trust fund, which enables vital assistance and services to individuals and families experiencing homelessness.

Research: Consumer-driven health plans help ‘bend the cost curve’

Aesculap-serpentineHow do we reduce unnecessary or wasteful health care spending so that we can increase health care access and reduce the cost of health care? This is a policy question that has vexed policymakers for many years. But new research suggests that market innovations such as health savings accounts paired with high-deductible insurance coverage (collectively referred to as “consumer-driven health plans,” or CDHPs) may hold part of the answer.

The study, just published by the National Bureau of Economic Research, looked at a dataset of 13 million individuals employed at 54 “large U.S. firms” to see how making CDHPs available to employees influenced health care spending and costs. The researchers note that “there is robust empirical evidence” from previous studies that CDHPs “effectively incentivize patients to change their health care use and reduce costs in the first year” by reducing spending between 5 and 24 percent, according to past research. But, they continue, “the effects of CDHPs on spending in the longer term are … ambiguous and the empirical evidence … is limited.”

The researchers also explain how the longer-term CDHP studies also suffer from methodological limitations that make generalizing their results a questionable enterprise. Hence the justification for their study, which looked at health care spending up to three years after CDHPs are offered by employers to their employees and used better data than the previous studies, with a stronger statistical methodology.

The study found “that spending is reduced … in all three years” after an employer in their data began offering CDHPs to their employees. Read more

Major health care reform bills to be heard in committee Wednesday

On Tuesday, two significant health care reform bills came out of the House Rules Committee.

•        SB 164 (1st Subst.) – Access to Health Care Amendments, sponsored by Sen. Brian Shiozawa, is Governor Herbert’s proposed “Healthy Utah” plan.

•        HB 446 – Extension of Primary Care Network and Medicaid Benefits Under Existing 70/30 Federal/State Cost Sharing Amendments is the “Utah Cares” program proposed by Rep. Jim Dunnigan.

The two bills have been assigned to the House Business and Labor Committee, where they will be the only two items on the agenda when the committee meets on Wednesday evening, March 4, at 6 p.m.

Assignment to this committee is consistent with the pattern established several years ago subsequent to the passage by the U.S. Congress of the “Patient Protection and Affordable Care Act,” generally known as Obamacare. And, as I have observed through lengthy personal association with the Legislature’s Health Reform Task Force, health care reform related bills are assigned to and considered by this committee. Recent examples include last year’s HB 141 – Health Reform Amendments (2014) and HB 160 – Health System Reform Amendments (2013). Additionally, it is as appropriate for a bill to go to a committee that interacts with entities that deal with liabilities and costs as it is for a bill to be sent to a committee that interacts with entities that reap benefits associated with proposed legislation.

Sutherland has steadfastly opposed the “Healthy Utah” proposal. The Institute sees significant merit in the proposed “Utah Cares” bill. Readers are encouraged to familiarize themselves with these bills and communicate their views with their elected representatives.

King v. Burwell and Healthy Utah – Sutherland Soapbox, 3/3/15

800px-United_states_supreme_court_buildingThis post is a transcript of a 4-minute weekly radio commentary aired on several Utah radio stations. The podcast can be found at the bottom of this post.

Tomorrow [March 4], a case will be argued before the U.S. Supreme Court that may impact or even derail the viability of Obamacare and Governor Herbert’s proposed Healthy Utah plan, which the Congressional Research Service says will implement Obamacare’s Medicaid expansion provision in Utah.[1] The name of that court case is King v. Burwell.

The King v. Burwell case hinges on how the ACA governs federal subsidies of health insurance premiums, which are currently offered through Obamacare’s insurance exchanges. The plaintiffs argue that the ACA’s plain language says the only legal way for the federal government to subsidize health insurance is through a state-run exchange. If this is true, then the Obama administration has been illegally subsidizing health insurance purchases for millions of Americans enrolled in the federally run insurance exchange. The federal government, on the other hand, argues that the full text of Obamacare makes it clear that they can legally subsidize health insurance in both state and federal exchanges.

The ramifications of the Supreme Court’s ruling could be quite significant. Politically, if the court rules for the plaintiffs, President Obama would be in the uncomfortable position of having his administration’s implementation of his signature policy achievement ruled illegal. Additionally, to resolve the issue he would have to either convince a bunch of Republican governors and state legislatures to create insurance exchanges, which they oppose, or he would have to negotiate a fix with a Congress that wants to repeal the law outright.

Beyond political ramifications, though, people across the spectrum have pointed out that without the insurance subsidies, the federal exchange would probably cease to function in the 34 states that rely upon it, including Utah. Without federal subsidies, the vast majority of the 11 million federal exchange customers – including more than 100,000 Utahns – will no longer be able to afford health insurance. And without a broad customer base, health insurance providers are likely to pull out of the exchange altogether, potentially leaving few, if any, insurance options for any customers that remain.

Amazingly, with all of these political and policy impacts, the Obama administration has told Congress that they have no contingency plan should the ruling go against them. Read more

Testimony on SB 164 (Medicaid expansion)

sutherland file pictures 007Testimony presented by Derek Monson, director of public policy, Sutherland Institute, on Feb. 11, 2015, before the Senate Health and Human Services Committee of the Utah Legislature regarding SB 164 (Access to Health Care Amendments):

Thank you, Mr. Chair and members of the committee. I am Derek Monson, policy director for Sutherland Institute, and I appreciate the opportunity to present our viewpoint on this important issue to you.

I would like to draw your attention to what we think is a basic policy issue regarding Senator Shiozawa’s bill. That is its impact on the people for whom the Medicaid program was actually designed to serve: disabled Utahns and low-income single parents and children.

Both thoughtful analysis and fact suggest that Sen. Shiozawa’s bill will increase the difficulties and suffering of the more than 300,000 disabled Utahns and low-income single parents and children currently in Medicaid. This is not a partisan or ideological issue. While Sutherland recognizes this problem, so do nonpartisan research organizations that argue in favor of Medicaid expansion, such as the RAND Corporation.

Neither is this just a theoretical question. In Oregon, so many people were added to the ranks of the insured through Medicaid expansion, basically overnight, that doctors and hospitals were forced to “lock out” Medicaid patients and make them “wait months for medical appointments,” as reported by the Associated Press. And in Arkansas, which expanded Medicaid using private insurance subsidies just like Healthy Utah envisions, a legislative committee heard testimony last April from state officials that providers are more “anxious” to serve newly privately insured patients than traditional Medicaid patients.

And why shouldn’t they be? In Arkansas as well as in Utah, the typical private insurance policy pays providers better than Medicaid does. And as basic economics teaches us, people respond to price incentives. The enactment of Healthy Utah clearly says to providers that they ought to prioritize the health care needs of the estimated 89,000 Medicaid expansion enrollees over the needs of the 300,000 single mothers, disabled Utahns and children left behind in traditional Medicaid. Utah’s most vulnerable will find it more difficult to find a doctor, and they will suffer longer waiting in line for needed surgeries and more intensive health care services.

Good public policy, on the other hand, would put traditional Medicaid enrollees on the same health care access footing as Medicaid expansion enrollees and everyone else, rather than excluding them and by so doing making their lives worse. Additionally, good public policy would not say to uninsured Utahns that we intend to care for their needs, only to toss them into the street the moment Washington, D.C., gets jittery about their finances. We don’t think that reflects the Utah values of providing service and helping to our neighbors in need, even when it’s difficult to do so.

In short, if “doing the right thing” means putting Medicaid expansion on the backs of disabled Utahns, single mothers and their children, then this is the bill for you. If, on the other hand, you think that serious public policy proposals should recognize and address the negative impacts they are likely to have on Utah’s most vulnerable, then I would encourage you to not vote in favor of SB 164 until it at least includes some attempt to address this critical issue.

Thank you.