Utah Gov. Gary Herbert (R) reached out directly to President Barack Obama Tuesday, seeking help getting the state's small-business health insurance marketplace approved as good enough for Obama's health care reform law.
The national law will establish health insurance exchanges in every state, where uninsured individuals and small businesses can comparison shop for health coverage and access financial assistance. Utah created a health insurance exchange for small businesses in 2007 and Herbert doesn't want to extend its reach to other aspects of Obamacare, including its Medicaid expansion, tax credits for private health insurance or individual mandate that nearly everyone obtain health insurance coverage.
Herbert wants Obama to order the U.S. Department of Health and Human Services to approve Utah's exchange under the law and allow other states to copy it, even though it wouldn't carry out all of the functions intended by the Affordable Care Act, he said in a letter to the president Tuesday.
"Please instruct the Department of Health and Human Services to certify the current Utah version of an exchange as compliant with the Affordable Care Act," Herbert wrote in a letter to the president, published online by the Salt Lake Tribune. "You have supported giving flexibility for states. Certifying our current exchange will give us that flexibility. I am confident that if you make this change, several other states will join Utah.
"I believe HHS officials' current interpretation of the ACA is to require states to take a more government-centric, standardized approach to exchanges. This results in less choice and more reliance on public programs," Herbert wrote. "We never intended for our exchange to administer Medicaid, enforce the individual mandate or distribute federal tax credits."
The Department of Health and Human Services was reviewing the letter, Erin Shields Britt, a spokeswoman, said in an email to The Huffington Post.
Utah set up the the nation's second health insurance exchange, after Massachusetts reformed its health care system in 2006. Because Utah's health insurance exchange, called Avenue H, is only for small businesses, upgrading it to comply with Obamacare would require significant changes, reports the Daily Herald of Provo, Utah. Herbert wrote that the 7,646 workers at 318 companies have obtained coverage through Utah's exchange.
'We are now embarking on a dramatic expansion of our exchange to more small businesses and we plan to include individuals and larger businesses in our exchange in the near future," Herbert wrote.
Nevertheless, it doesn't include those features now. So agreeing to Herbert's request would scale back the reach of Obama's health care law, which is designed to provide one-stop shopping for health coverage on the exchanges to small employers and anyone who doesn't get health benefits at work. That includes enrolling people earning less than 133 percent of the federal poverty level -- $14,856 for a single person this year -- into Medicaid and providing tax credits those who earn from the poverty level, $11,170 for an individual this year, to four times that amount.
Herbert also wants Obama to act before Friday, the deadline for undecided states to notify the Department of Health and Human Services whether they intend to create health insurance exchanges, partner with the federal authorities or allow the federal government to run exchanges in their states.
Congress intended the federal and state governments to share the burden of implementing the health care law and to provide states with some leeway in how the health insurance exchanges operated in their states, such as leaving states with the authority to approve what health insurance companies are permitted to sell plans to their residents.
But the Obama administration has run into stiff resistance from some state officials, mostly Republican, with less than a year before the exchanges need to be operational on Oct. 1, 2013, to sell health insurance that would take effect on Jan. 1, 2014.
After a Monday announcement by Tennessee Gov. Bill Haslam (R), 21 states so far has refused to establish health insurance exchanges, leaving the task to federal officials. Seventeen states and the District of Columbia plan to build their own exchanges and six of those received conditional approval from the Department of Health and Human Services Monday. At least six states will partner with the federal government, according to the Henry J. Kaiser Family Foundation. Including Utah, six states remain officially undecided, though two of those, Virginia and Indiana, have indicated they will not manage their own exchanges.
A smaller number of states also are rebuffing Obamacare's Medicaid expansion. To date, nine Republican governors have declared they won't add poor people to Medicaid, using an option provided to them by the Supreme Court, which ruled states could block the expansion.
READ GOV. GARY HERBERT'S LETTER TO PRESIDENT OBAMA: