Blog: The Utah Approach to Health Care Reform

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Blog: The Utah Approach to Health Care Reform

By: Laura Summers

Utah is known for its low per-capita health care costs and high rankings on healthy measures. It is home to some of the top health care systems in the country. But when you start talking about cutting-edge state health care reform, Utah’s name does not usually rise to the top. When you take a deeper look, you realize there is more going on here than what is being recognized at the national level.

Utah’s 2018 General Session is an example of this innovation. Several bills illustrate how Utah is continually thinking of ways to improve health care in order to best meet the needs of the state.

Lowering Costs and Improving Price Transparency

H.B. 19, Health Insurance Right to Shop Amendments, 2018 General Session, requires Utah’s public employees’ benefit and insurance program to reward enrollees for making cost-effective health care choices. By selecting services that are in-network and cost less than the average cost of the same service, an enrollee could earn financial incentives such as premium discounts, rebates, or a reduction in out-of-pocket costs.

While the concept of rewarding healthy behaviors and promoting more conscious consumers is not new, Utah’s savings reward program aligns with a growing trend among states seeking to lower health care costs. California proposed a measure this year that would have regulated provider rate-setting by using Medicare rates as the benchmark for calculating commercial insurance payments to providers.[1] New Jersey passed a bill that requires providers to tell patients whether a service is covered by a patient’s insurance plan as well as disclose the patient’s likely financial liability.[2]

Curbing the Rising Costs of Pharmaceuticals

S.B. 208, Pharmacy Benefits Manager or Coordinator, 2018 General Session, prohibits pharmacy benefit managers from preventing their network pharmacists from disclosing cost information to customers, including the insurance copay, the availability of a therapeutically equivalent, and possibly cheaper drug, or the drug’s cash price. While this seems a like a relatively small change, increasing price transparency allows customers to make more informed decisions about their health care relative to their household budget.

Another bill that did not pass, but placed Utah on the map, was H.B. 163, Prescription Drug Amendments, 2018 General Session. This bill would have required the state to seek federal approval to allow for the importation of prescription drugs from Canada.

The bill served as a model for other states submitting similar legislative proposals and pushed Utah to the forefront of states seeking solutions to reducing rising pharmaceutical costs. Vermont became the first state to pass importation legislation in May 2018 and now the Food and Drug Administration (FDA) is planning to create a workgroup to examine possible importation situations.

Continuing its Success into the Future

As we start gearing up for the next legislative session, Utah’s innovative and independent approach to state health care reform should not be understated. By enacting policy that meets the state’s changing health care needs, Utah may not always make national headlines, but it will continue to be a leader in sound health care policy.

Laura Summers is the senior health care analyst at the Kem C. Gardner Policy Institute. 

[1] Note: the proposed measure did not pass in 2018. CA AB-3087, California Health Care Cost, Quality, and Equity Commission, 2018.

[2] New Jersey Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act.

2018-09-12T12:06:49+00:00September 12th, 2018|Blog, Economics and Public Policy, Health Care, Practice Areas|