Tuesday, August 9, 2011

The Utah Health Exchange: A Retort to the Rebuttal

Professor Norman Thurston of the Utah Department of Health has decided to rebut my criticism of the Utah Health Exchange.  His article is posted at The Apothecary.

Prof. Thurston repeatedly charges that I mischaracterize the Utah Health Exchange (UHE) and present false information.

Whether one believes that the very small numbers of beneficiaries currently enrolled in the exchange is inadequate or a promising start is a matter of opinion.  However, the actual numbers that I cite come from the Utah Health Exchange itself.

Two specific charges demand repudiation.  First, Prof. Thurston states that my March blog entry "laments the fact that the Exchange had not produced an annual report, which is simply not true."  When my colleague Avik Roy asked Prof. Thurston for the report that was available in March 2011, he was directed to self-styled "Annual Reports" from the Governor's Office of Economic Development".

These are very interesting documents, but they are promotional material for the state's business development.  They are not legally binding "annual reports" that present audited financial statements, which was my clear meaning in the March blog post.

Prof. Thurston also asserts that "no one at the Utah Health Exchange has been contacted ..... to get an explanation or clear up any questions."  I spoke with Don Garlitz by phone on October 21, 2010.  Mr. Garlitz is a member of the UHE's board of advisors and was named the UHE's "broker of the month" for March 2011.  I have also communicated by phone or e-mail or in person with Catherine Du Pont, Associate General Counsel of the Utah Legislature, who was a key player in crafting the legislation enabling the Utah Health Exchange; and Cheryl Smith, formerly of the governor's office and currently with Leavitt Partners.  Leavitt Partners is a consulting firm that specializes in advising clients how to establish exchanges.  All three have been very helpful.

Nevertheless, I do not report phone calls or private e-mails as "facts," but wait for offical data to emerge.  When the Utah Health Exchange finally started producing its "dashboard" with enrollment data, it appeared to confirm my growing suspicion: The UHE was an interesting experiment, but it was not succeeding.

So, I amended my previously (slightly) optimistic outlook in response to new data - which I think is a research analyst's responsible reaction! Prof. Thurston launched his rebuttal by criticising my goal of preventing the implementation of the Affordable Care Act (PPACA), which has nothing to do with the UHE.

This is hardly an intra-conservative squabble.  The defeat of Obamacare, through Congressional repeal and/or being overturned as unconstitutional by the Supreme Court, is a generally agreed goal of conservatives.

That is why the newly installed majority in the House of Representatives passed a "clean" repeal bill in January 2011.  This is why the Attorney-Generals of many states, including Utah, are asking the federal judiciary to declare Obamacare unconstitutional.  This is why states have passed the Health Care Freedom of Choice Act either as a statute or constitutional amendment.

Prof. Thurston can rest assured that conservatives who oppose Obamacare are hardly "doing nothing," as he asserts!

While these challenges are underway, state collaboration with Obamacare threatens their success, for reasons that I have previously described.

However, none of this has to do with the UHE.  I believe that the statutes which establish the UHE prevent it from becoming a PPACA-certified Health Benefits Exchange.  In other words, I believe that the governor cannot apply for the federal government's approval as an Obamacare exchange without amendments to the legislation creating the UHE.

Utah's most recent health-related statute, H.B. 128, signed by governor Herbert on May 30, 2011, creates an 11-member Health System Reform Task Force.  One of the Task Force's duties duties is to recommend "whether the state should develop an American Health Benefit Exchange under the federal Affordable Care Act..."

This language rejects the theory that the UHE, as currently constituted, is a potential Obamacare exchange.

I will not predict whether the Utah legislature will make the mistake of creating an Obamacare Health Benefits Exchange.  However, the Governor's Office of Economic Development, in the latest "Annual Report" to which Prof. Thurston has directed our attention, predicts that enrollment in the UHE "could easily exceed 40,000 covered lives in 2011" (p. 25).

Well, we shall see.  There is a move afoot to move the state's public employees into the UHE, but that wouln't really count, would it?  They would not be voluntary enrollees.  We would need to see over 36,000 more private employees join in less than five months for the UHE to hit the governor's target.

Or, for its advocates to decide to continue to describe it as a "beta-test."

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