Utah's Health Insurance Exchange Is No Great Success


ObamaCare's state-based health insurance exchanges have proven a bit of a challenge for some conservative critics because many on the right argued for years that states should be setting up exchanges of their own. The Heritage Foundation's support for state-based insurance exchanges, for example, helped give us RomneyCare, which relies on an individual insurance exchange. And RomneyCare, in turn, helped give us ObamaCare, which relies on a network of state-based exchanges created under federal guidance—the first draft of which was released last week. 

These days, you can still find critics of ObamaCare who think exchanges might not be such a bad idea. The problem with ObamaCare's exchanges, the argument goes, is that they're too tightly regulated, and that under ObamaCare, federal authorities exert too much control. As evidence, they sometimes point to the barebones, lightly regulated health exchange run by Utah. 

Now, as I've noted previously, ObamaCare's rules and regulations will force Utah's state officials to abandon an exchange they like in favor of a far-bulkier federal model. That cuts against the federal government's frequent insistence that its rules and regulations somehow give states "flexibility" in implementing ObamaCare. 

But it doesn't mean that Utah's exchange is a success in its own right. As John Graham of the Pacific Research Institute explains, its impact has been minimal at best:

 As I wrote last October, the Utah Health Exchange launched in August 2009, with 136 businesses enrolling their employees.  However, only 13 groups remained enrolled by December 2009.   The reason for the initial failure was a classic death spiral of anti-selection.  Because carriers had greater underwriting latitude outside the exchange than inside it, firms with sicker employees gravitated to the exchange and those with healthier employees stayed out. 

Legislative amendments passed in March 2010 forced carriers to use the same underwriting both inside and outside the exchange.  The new rules took effect in September 2010 and the new exchange began coverage last January, having enrolled groups for a quarter of a year before the re-launch.   In January 2011, the new Utah Health Exchange covered 41 businesses including 1,042 employees and dependents.  At the end of June, according to a recently published update, the count was 112 businesses including 2,793 employees and dependents.  By August, the exchange forecasts covering 157 employers including 4,059 lives.  Well, I suppose that one way to look at this is that enrolment grew by 289 percent in a year.

…Another way to look at it is that Utah has a population of 2.8 million, of which 1.1 million have full-time jobs. Of those, about 200,000 work in firms of less than twenty employees and 540,000 are in firms of less than 500 employees.  The Utah Health Exchange defines small businesses as those with up to 50 employees.  So, let's say about 300,000 Utahans work for such businesses.  The exchange covers 1,424 of them.  Once again, that is an utterly trivial proportion of the exchange's target market.

There's little question that the federal rules governing ObamaCare's exchanges are onerous. If states are going to set up exchanges, they ought to have the flexibility to do so on their own terms. Yet at the same time, there's little reason to believe that state-designed exchanges will be dramatically more successful than their federally regulated counterparts. 


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  1. I’m waiting for the repeal of ObamaCare, followed by a systematic nullification of all health regulations at all levels of government. Think it’ll happen?

    OT: https://reason.com/blog/2011/07…..nt_2407346

    There are no grammatical or functional mistakes in the examples given, and nobody gives a shit about stylistic preferences. This is a great demonstration of pretentious and supercilious Limey fucks playing the “my culture’s linguistic customs are superior” game.

    As if that weren’t enough, the fervor and outrage with which they bitch and moan is exasperated by the fact that it’s specifically Americanisms that they’re dealing with. Anti-Americanism, of course, is pandemic in socialist Europe, and especially Britain — the most degenerate European nation of all.

    The final irony of all of this is that not only do Brits generally suck at rudimentary English much, much more than Americans, I’ve noted in my time among the Limey hordes that their vocabularies and familiarity with, and ability to form or derive, unconventional (aberrant, but valid) grammatical constructs, which are pretty much one of the essentials for making language more diverse and interesting, are substantially worse than ours.

    Tire. Color. Cart. Trunk. Hood. Aluminum. Soccer. Airplane. Truck. Freeway. Soda. Subsidize. Galvanize. Energize.

    “”””””I caught myself saying “shopping cart” instead of shopping trolley today and was thoroughly disgusted with myself. I’ve never lived nor been to the US either. Graham Nicholson, Glasgow

    When people ask for something, I often hear: “Can I get a…” It infuriates me. It’s not New York. It’s not the 90s. You’re not in Central Perk with the rest of the Friends. Really.” Steve, Rossendale, Lancashire””””””

    Cry me a fucking river, assholes.

    1. I have noticed a shift in the accent of foreign nationals who speak English as a second language. It’s now typically with an American accent, not an English one. I think that pisses them off.

      For the most part, I like most people from the West, English speaking or otherwise, and I’m not all that sensitive to their various bitchings about us. Fact is, we all really get along pretty well, as nations go.

      1. Soviet schools all switched to American English by the 1970s, whereas before there were no distinctions made as to what dialect they were studying.

        “”I have noticed a shift in the accent of foreign nationals who speak English as a second language. It’s now typically with an American accent, not an English one. I think that pisses them off.””

        That’s been the case for a very long time, at least where I’ve encountered it there, but more than that, what pisses them off is that American English has become the lingua franca of the world, not British English.

        The fact that we’ve added so much to the language and that languages evolve also seems to irritate Brits to no end.

    2. shopping cart? trolley? the word is buggy.

      1. Are you insane? It’s shopping cart. Buggy–ha!

        1. it’s the one piece of regional slang that has always stuck with me, passed down from my parents.

        2. Here’s an example of what I meant before — in all my life, I’ve never once met an American that asserts his is the only legitimate version of the word, phrase, or pronunciation. “Oh, well, we call it “soccer” here in America”, instead of “IT’S FOOTBALL, MATE, NOT SOCCER”.

          1. RPA ~ I’ve read previous posts by you on your miserable encounters with Euros — what exactly happened? Were they soccer hooligans?

            I’ve never been to England but the continental Euros treated me with great respect. French youth think that every American dude is a gun-packin’ badass….

            1. I’ve had a decent time in general in most European countries I’ve been to, whether it’s because people were either intrigued or at least cautiously courteous towards that there American — like the Germans — and I had no immediate cause to dislike them as individuals, or because, regardless of other aspects of the society, the country had interesting architecture — like Italy.

              In Germany, as an example, it was pretty peculiar how some people really hated your guts, and some were pro-American, which was weird. The approachable ones, unfortunately, seemed to be highly apolitical people, and I suspect their attitude towards us/me would have differed considerably had they been sufficiently in tune with the typical socialistic statism of their country. Overall, it was okay.

              I’ve been to Britain many times, spent substantial amounts of time there on work, and it’s the European country I’ve had the most experience with. There’d be too many encounters, pleasant or otherwise, to list. But the one you’re probably referring to happened a couple of years ago near Wembley Stadium in London, in a “pub”, outside the pub, and along the street, in that order.

              Me, my colleagues, and the Brits showing us the city were having drinks, and a large group of the guys that had come from the stadium some time earlier obviously noticed our accents and realized who we were.

              They started flinging insults, and they didn’t seem too happy about the fact that we didn’t just slither out of the bar in fear; one of them, as I recall, told me that me and my “yank friends are fucking cunts” and that we should have died in… yeah, 9/11 — this is the group that had a strange fixation with 9/11.

              Ignoring them didn’t help, because somebody threw a glass at us, and we decided to leave, so they followed us outside and started throwing bottles, stones, and shoes at us, while spewing some of the most upsetting shit I’d heard.

              They were basically condemning (specifically, in no particular order) our parents, siblings, possessions, intellects, genitalia, and country to eternal damnation, in a great many different words and phrases, finishing it off with, and I shit you not, how all Americans should have died in 9/11, that the racist and bloodthirsty and religious (must have been tutored by Shrike) Americans got exactly what they deserved, that we didn’t get it bad enough with 9/11, or how slitting our yank throats (this one I remember vividly) should be rewarded with medals. Cuts and bruises were plentiful, but like all pussified shitheads, I guess they weren’t man enough to pick a fight. This was a pretty huge crowd by the time we left — a lot of that happened while we were waiting for a taxi.

              That, among other encounters, made sure I’d go looking for another firm if they ever decided to send me to Britain again.

              If you ever go, I hope to God you’re treated better than we were.

  2. Welcome to America, Run by the rich, FOR the rich!


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