December 6, 2013

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December 6, 2013

As our healthcare system undergoes a historic transformation, our panel of healthcare experts offer their two cents regarding what the changes mean for Utah’s businesses. The group also weighs the pros and cons of expanding Medicaid and discusses the need for enhanced personal wellness, more healthcare education and how technology is impacting the industry.

We’d like to give a special thank you to Dave Gessel, vice president of government relations and legal affairs at the Utah Hospital Association, for moderating the event.


Back Row:

  • Brent Bennett, Spectrum Management
  • Scott Barlow, Central Utah Clinic
  • Blaine Bernard, Holland & Hart
  • Bob Howard, Diversified Insurance Group
  • Steve Bateman, St. Mark’s Hospital
  • Dave Gessel, Utah Hospital Association

Front Row:

  • Patty Conner, Avenue H
  • Jeffrey Kluge, GBS Benefits
  • Kevin Lawlor, Altius/Aetna
  • Ken Johnson, WSU Dumke College of Health Professions
  • Dr. Richard Sperry, Matheson Center for Health Care
  • Kevin Johnson, Mountain View Hospital
  • Dr. John Langell, U of U Center for Medical Innovation


  • Dr. Michael Webb, Mountain Medical Physician Specialists
  • Miguel Rovira, Regence
  • Amy Bosworth, United Way of Salt Lake
  • Earl Hurst, Moreton & Co.

We’re now in open enrollment for health insurance under the ACA with the state and federal exchanges. What advice do you have for businesses or individuals as far as accessing health insurance in this new world?

CONNER: A lot of things have changed for 2014. Everyone needs to evaluate their own personal situations, their budgets and their needs for healthcare and understand how the healthcare law impacts them. If they’re not eligible for coverage through their employer, there are lots of options available through the marketplaces, whether it’s the individual marketplace through or small business marketplace through Avenue H.

HURST: Boy, it’s a can of worms. There are lots of dynamics with these changes affecting the healthcare landscape today, particularly in group or individual insurance. The impact of community rating is a significant impact beginning January 1, 2014 for small group employers. Those small group employers have to evaluate the impact of community rating versus some of the early renewal strategies that some of our carrier partners have deployed.

In our experience, about 30 percent of the small group employers would have benefited from a community rating approach, where 70 percent would still benefit under the current underwriting systems. Those are some pretty big dynamics from a small business perspective. The small business owner has some key decisions to make, whether or not they want to continue to offer benefits. There are some key things they need to try to understand related to the taxable benefits and offering benefits versus not offering benefits.

Each individual really needs to understand the impact of the individual mandate and what that means to them: Do I pay a penalty or don’t I pay a penalty? I’m a small employer; do I want to continue to offer benefits or don’t I? And if I do, what’s the cost impact?

We all know one thing for sure: The cost of healthcare is going up.       

HOWARD: The first projections for employers dropping healthcare and running to the exchange were six out of 10. According to recent polls and surveys, they are projecting now one out of 10 will actually go there. A lot of employers still see the value of offering employee benefits to recruit and maintain their employee base. So they’re not anticipating as much of a run to that.

But there are a lot of employers in that smaller segment that just can’t afford it, and they will let their employees go to the exchange. But there’s a lot of resources for those that do go to get help and find care through that means.

ROVIRA: Most carriers are still offering off-exchange products on both the individual and small employer side. And the P&L is really going to dictate which way the employers go, but also the industry. In industries that are very heavy on services—for example, a law firm—you might have a small law firm that still will need to be able to provide health insurance if you want to attract and retain talent.

BATEMAN: Speaking from the hospital perspective, assuming that federal help and state Medicaid expansion occurs in the way that it’s currently conceived, that is probably going to represent an additional demand on hospital services for the next two to three years. In fact, it should be noted that demand for hospital services in Utah has fallen during the last year and a half to levels that we haven’t seen before. No one’s really certain as to why that is, whether it’s the economic downturn, the effect of lingering unemployment, or unwillingness of people to access healthcare and part with resources associated with that.

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