Governor Gary Herbert wants the Obama administration to approve Avenue H, Utah’s version of a health insurance exchange. While it fits some of the requirements of the Affordable Care Act, Avenue H does not meet all of the standards for state-based exchanges. The Governor is intending to go forward with Avenue H even if it is not approved.
The Affordable Care Act requires all states to have a health insurance exchange. There are three options. One option is to run a state-based exchange. Another option is to have an exchange that is a partnership between a state government and the federal government. The third option is for a state to allow the federal government to run their state’s insurance exchange.
The Governor of Utah, Gary Herbert, wants the Obama administration to approve Avenue H as the state-based health insurance exchange for Utah. It was launched in 2009. The U.S. Department of Health and Human Services has states that it wants to work with Utah to certify Avenue H. It appears that the Governor is intending to go forward with Avenue H with or without approval.
Avenue H does not meet all of the requirements for state-based health insurance exchanges. The Affordable Care Act requires the exchanges to be accessible for individuals and small businesses. Avenue H is only accessible to small businesses. Individuals cannot use it to find health insurance coverage.
The Avenue H website has a frequently asked questions page. One of the questions is: “Who is eligible to participate on Avenue H?” The answer is “Employers in Utah with a group size of 2 to 50 employees”.
According to the Salt Lake Tribune officials in Utah are planning to expand Avenue H to include plans for individuals. That’s a step in the right direction if the state wants to use Avenue H as their state-based health insurance exchange.
The federal government will help individuals who are low income to afford health insurance by distributing federal tax credits to them. In other words, a person who uses a health insurance exchange will get help with the cost of premiums.
Avenue H is not, at this time, set up to allow for that. The information that Governor Herbert sent to the Obama administration when he asked for approval of Avenue H includes a statement regarding tax credits. The Governor said:
We do not believe it is the proper role of the states to get involved with eligibility decisions for federal tax credits.
As it stands, if Avenue H is not improved in ways that will meet the Affordable Care Act’s requirements for a state-based health insurance exchange it will not be considered as one. Instead, the federal government will create and administer an exchange for Utah.
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