health insurance for the uninsured

Brittin Themann inherited the family trade, working at her father's 22-year-old antique-auto shop.

But inheriting the family tradition of going without health insurance "simply wasn't an option," says Themann who watched her now-deceased mother nearly go bankrupt paying $75,000 in medical bills for cancer treatments.

So Themann shopped eHealthInsurance.com and found a policy she can "barely" afford, but can't afford to do without. "It's better to have something than nothing," she says.

Her conclusion was the prevailing message Tuesday at Gov. Jon Huntsman Jr.'s daylong health summit, organized to explore solutions to Utah's growing number of uninsured.

The state Health Department puts the uninsured population at 10.2 percent, or 250,000 Utahns. Other reports suggest it's as high as 18 percent.

It is a middle-of-the-road ranking and rising more slowly than in other states, but too high, said Health Director David Sundwall. Based on ideas floated at the summit, Sundwall says he will submit "a menu of [health care reform] options" to the governor for use in his 2006 budget. The goal is to reduce the number of individuals in Utah without insurance by at least 50 percent by 2010.

Sundwall offered no specifics, except to say proposals for moving toward government-subsidized health care are politically unfeasible.

"I don't rule out going to a single-payer system [or universal coverage] one day. But that won't come until we try to get a handle on more conventional methods," Sundwall said.

Those who are critical of funding health care in the same way states pay for public schools say it would stifle innovation.

Robert Moffit, health policy director at The Heritage Foundation, argued the best way to reach the uninsured is to empower them as consumers. His plan entails awarding tax credits to people who purchase health insurance on their own.

The federal government gives unlimited tax relief to people who get insurance through their employers, allowing premiums to be deducted before taxes are calculated, he noted.

But "if you shop for insurance on your own, you get zero tax breaks," says Moffit, stressing that the tax policy favors higher-income workers, restricts consumer choice and fuels higher spending.

Consumers who arrange their own health care are less likely to have skipped doctors visits, which translate to missed diagnoses and more heroic and expensive medical interventions, reasons Moffit.

They also can maintain coverage through job changes. "If you lose your job or move, you don't lose your life or car insurance," he said. Moffit's plan hinges on the assumption that the uninsured are not what he describes as "a Charles Dickens class of suffering souls," but a population of mostly working adults who either drift in and out of health plans as they change jobs, or work for small businesses that don't offer health plans.

That's true for Utah, where two-thirds come from working families, like the Themanns. Brittin Themann and her husband, Seth, both work full time for small businesses that don't offer employer-based coverage.

For the policy they found on-line, the Themanns pay a $300 monthly premium and have a $2,500 deductible with no co-payments and fairly comprehensive coverage. The policy paid off this April when Themann prematurely delivered a baby boy who spent a week in intensive care.

Moffit acknowledges there is little states can do to change federal tax policy. And critics of his plan note it doesn't address the needs of the poorest of the working poor. Two-thirds of Utah's uninsured earn less than 200 percent of the federal poverty level, which is $18,850 for a family of four.

The Themanns point out that if their premiums continue to rise, as they have in the past year, they will be priced out.

"That's what is bad about individual policies. If you're in a group policy, the premium hikes are spread out and everyone shares the pain," says Brittin Themann.

According to data from the Centers for Disease Control analyzed by the Robert Wood Johnson Foundation, Utah also has the second-highest rate of uninsured Latinos, at 54.7 percent.

To lower the cost for everyone, Moffit suggests reproducing the Federal Employee Health Benefits Plan - which allows federal workers to pick coverage from a pool of competing health plans - at the state level.

State employees and Medicaid recipients could jump-start the pool, which would be expanded to include private employers. Such a pool would cut administrative costs.

The uninsured share another characteristic in that they're young and relatively healthy, Moffit says. "You want them in the pool because they will drive claims costs down."