Friday, January 7, 2011


The trials and tribulations of Utah’s much-touted Health Exchange continued in December, with the announcement that yet another chief executive had quit, along with the admission that very few eligible employer groups had signed up for the exchange.

The Utah exchange differs from that of Massachusetts in that it currently focuses on coverage for small employers offering defined contribution plans, a policy that was hoped to demonstrate the effectiveness of such plans. However, so far enrollment has been far too low to test the merits of this approach.

The Salt Lake Tribune reported in late December that a new executive director had been appointed to head the exchange, which is administratively located in the Governor’s Office, making the third director in just over six months.

The Tribune went on to compare the expectations of State officials, who had anticipated enrolling 3,000 small employers with an estimated total of 40,000 employees, with the current reality. As of late December, with coverage scheduled to start on January 1, 2011, just 43 of the State’s estimated 50,000 small businesses had signed up and been determined eligible.

Back in September, when the Utah exchange started to accept coverage applications, Utah’s Governor Gary Herbert was quoted as saying: “[the exchange] is quickly becoming a model for the rest of the nation when it comes to health care reform."

Hopefully not.


  1. What do you think about Utah's program for prescriptions? I've heard good things about that program. Any wisdom you can share?

  2. What's wrong with Utah's exchange? It's far more complete then Massachusetts, it has risk adjustment. The individual mandate is meaningless without that.

    Every country with private health insurance has risk adjustment, it seems to work fairly well. From a conservative point of view, Utah is using a truly insurance-based risk adjustment approach. From a liberal point of view, this happens to be identical to shuffling funds from insurers with healthy clients to insurers with sick ones.

  3. Also, the risk adjustment isn't within the exchange--it applies to all insurance plans, inside or outside the exchange. That was one of the changes they did after the 2009 pilot.

    The exchange isn't the only part of their reforms.

  4. Joe, What's wrong with Utah's exchange is that it has scarcely any enrollees. It's certainly nowhere near as complete as the Connector in Massachusetts, which serves a large subsidized population, allows individuals to enroll directly, and now has a operational small business program.

    By the way, PPACA provides for risk adjustment as part of the exchanges.