Office of Consumer Health Services – Avenue H
OVERVIEW U.C.A. 63M-1-2504 Avenue H is Utah’s state-based approach to Health Insurance Marketplace health reform. It is designed to help small businesses in the state offer health insurance to their employees through an innovative defined contribution mechanism. The system benefits both populations because it lets business owners contribute a flat dollar amount that their budget can bear, while employees use those funds to shop for insurance that perfectly fits their family’s needs.This also helps employees become engaged with health care since many have not before. They know how much insurance costs, and they take an active role in selecting and purchasing what they need. Small businesses are able to leverage group rating rules—just like in the wider traditional market—but with an increased focus on choice and value. Avenue H’s defined contribution model gives employee’s control over health care costs and lets employees choose the policy that works best for them. Three participating carriers currently offer more than 140 plans ranging from high-deductible options to comprehensive coverage.
Avenue H
Utah’s Health Insurance Solution Utah’s approach to health care is unique compared to the rest of the country. When the Affordable Care Act (ACA) was passed, it gave states three options for compliance: state-based exchange, state-federal partnership, or federally facilitated exchange. In early 2013, Governor Gary R. Herbert proposed a different approach to the Department of Health and Human Services. The Governor proposed a bifurcated approach that would see the state continue to run Avenue H as a health insurance marketplace for small businesses, while the federal government would create and implement an exchange for individuals. HHS accepted Governor Herbert’s proposal, and now “the Utah approach” is the official fourth option for compliance and is available for other states to consider as well. Utah’s option lets the state comply with the health reform law contained in the ACA, but also retain state control and flexibility in applying them. For instance, the state maintains oversight of qualified health plans and administration of Utah’s Medicaid program through the existing in-state structure. The federal marketplace will focus on individual consumers, and will also manage tax credits and subsidies, participation reporting, and overall compliance with the ACA. The split has been considered to be a big win for the state.
Governor’s Office of Economic Development • 2013 Annual Report • www.business.utah.gov
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