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Looking to hold down spending on health care, employers have made unpopular choices, scaling back workers' health coverage or eliminating it altogether.
But there's another way: get Medicaid to pick up the tab.
An analysis by The Salt Lake Tribune of Utah Department of Health data shows taxpayers footed the health insurance bill for 7,220 working Wasatch Front Utahns and their children in 2004. That's an estimated $42 million subsidy for low-wage employers such as Wal-Mart, Convergys Corp. and McDonalds. Also benefitting: public schools, universities and the LDS Church.
There are 250,000 Medicaid consumers in Utah. The Tribune's findings reflect those who work - and most don't - and live in Weber, Davis, Salt Lake and Utah counties.
The subsidies have broad implications for the country's health insurance crisis. This year, Utah will spend more than $1.5 billion on Medicaid, with Uncle Sam paying more than $1 billion of that total.
Last month, Maryland became the first state to mandate that large employers, those with 10,000 workers or more, spend at least 8 percent of their payroll on health care or contribute to a state fund. Other states have ordered the public disclosure of large employers whose workers receive government-paid healthcare.
Who is on Utah's List? Topping Utah's roster is Wal-Mart, which has 234 workers getting Medicaid or related assistance through the Primary Care Network and Children's Health Insurance Program.
Convergys Corp., with 8,000 workers at Utah call centers, had the second-highest total, at 181 employees. Other large Utah employers benefitting from state-funded insurance include Intermountain Health Care (IHC), the University of Utah and The Church of Jesus Christ of Latter-day Saints.
Household names like McDonalds, Burger King and the Delta Center, home of the Utah Jazz, also are on the list. Businesses with high totals were concentrated mostly in retailers, fast-food chains, call centers and temporary employment agencies.
"I'm tired of seeing businesses getting state, county and municipal tax breaks and then telling their workers, 'You can go here and get Medicaid, food stamps and free child care,'" remarked Sen. Ed Mayne on the findings.
"They're not meeting their corporate and civic responsibilities. And they're taking advantage of the taxpayers and businesses that are doing their fair share." A minimum solution? Mayne, a West Valley City Democrat, is sponsoring legislation he says would make private insurance more affordable - hiking the state's minimum wage from the current federal $5.15 to $7 an hour.
Wages at many large businesses, including Wal-Mart, already start above minimum wage. But Mayne said the change would be a "first step" toward a living wage, which might help the uninsured afford private coverage. As the pool of insured grows, costs for everyone drop, he said.
Republican lawmakers and Gov. Jon Huntsman Jr. have agreed not to debate a minimum wage measure this election year. Huntsman instead appointed long-time advocate for the homeless Pamela Atkinson to investigate.
Utah's enrollment in Medicaid, a health safety net for the disabled, low-income children and their parents, pregnant mothers and seniors, is flattening out as the economy improves. But from 2001 to 2005, it grew 52 percent, faster than any other state program. The average annual cost per Utahn on Medicaid: $5,838.
Atkinson plans a comprehensive analysis of workers on Medicaid, food stamps and other aid. Among the issues: Is the expansion of Medicaid to cover the working poor an outcome of welfare reform, which had moved them off cash assistance and into low-paying jobs? Or are employers exploiting workers to reap bigger profits? The Wal-Mart controversy. Wal-Mart has no shortage of critics unhappy with the big-box retailer's methods for reining in benefit costs, such as hiring more part-time workers and, as disclosed in an internal memo published by The New York Times last fall, discouraging unhealthy people from working at its stores.
Company spokesman Dan Fogleman did not dispute the authenticity of the memo but said Wal-Mart is unfairly targeted. Wal-Mart has the most workers on Medicaid in Utah and in other states because of its sheer size, he said.
"It's a numbers game. This isn't about just one company. This is about a health care crisis in America. We're doing what we can to try and make coverage affordable," said Fogleman.
Combatting negative publicity because less than 45 percent of its 1.33 million U.S. workforce receive company insurance, Wal-Mart announced a new plan this fall: allowing some employees to buy insurance for $11 a month.
Fogleman said in Utah, full-and part-time employees have access to plans that charge $23 a month. Family coverage starts at $65. Wal-Mart's ranks of company-insured now stand at 47 percent, Fogleman said.
Wal-Mart Watch, a nonprofit group allied with labor unions in Washington D.C., is unimpressed. "It's unacceptable that a company with $10.3 billion in profits has a health plan that covers less than half of its employees," said the group's president, Nu Wexler.
Utah's large employers split: Two of Utah's Top 10 employers, Hill Air Force Base and Skywest Airlines, have zero Wasatch Front workers on state-funded insurance, according to Health Department records.
The state's largest, IHC, has 26,000 employees - nearly double Wal-Mart's Utah workforce - but only 48 workers on Medicaid.
Also, 85 percent of the hospital chain's workforce are "benefits eligible," with 81 percent of those taking advantage of company plans, said Jeff Lowder, assistant vice president for human resources.
"We're in the healthcare business, but we still have to pay for it," said Lowder.
IHC is unique in that what it doesn't pay now it will pay later in the form of charity care for the uninsured. Also, only a third of its staff are part-time, whereas Wal-Mart and call centers Convergys and Teleperformance USA hire many part-time senior citizens, college students and second wage-earners.
Few of Convergys's part-timers opt for company insurance, though it is offered to all employees. Bare bones coverage is available for as low as $9.16 a month.
"We're doing every bit as much as we can, and then some, other than to say it's free; and that's not going to happen," said Convergys benefits director Lynn Peterson.
Schools' health problems . The AFL-CIO plans to push legislation similar to Maryland's new mandate in more than 30 states. No large private employers contacted by The Tribune would disclose what percentage of their payroll is spent on health benefits.
But University of Utah officials say the public research university spends 7 percent, and Alpine School District spends 21 percent. In a Catch-22 cycle, schools also contribute to Medicaid spending. Alpine (with 59), Granite (24), Jordan (25) and Nebo (25) school districts have workers drawing on Medicaid.
So do the U. (38), Weber State University (14), Utah Valley State College (16), and other public entities, including state government (29) and Internal Revenue Service center in Ogden (30).
"That tells you what people are earning," said Utah Board of Education attorney Carol Lear.
Asked whether government should take the lead in insuring its workforce, Lear said, "Yes. But this is Utah and we're talking schools. They pay what they can afford." Schools and colleges offer rich health plans with low or no premiums, which they leverage against low wages to retain teachers. But the schools can't afford to also cover their bus drivers, custodial staff and lunchroom workers. Alpine, for example, only offers paid insurance to full-time staff, about 3,561 of its 6,054 employees.
Alpine School District Accountant Jim Hansen said, "This year we spent $35.5 million on healthcare benefits." Part-timers can buy insurance through the district. But last year, only 15 did, probably because the Cadillac plan costs $345 a month for one person or $1,094 for a family.
Also on the list: BYU, small businesses: LDS Church-owned Brigham Young University has 51 workers on Medicaid, mostly between the ages of 19 and 26.
BYU officials say they place upwards of 10,000 students in campus jobs each year.
Its chain of thrift stores, Deseret Industries, employs large numbers of disabled Utahns and has 74 workers on Medicaid.
The vast majority of Utah workers on Medicaid - 4,563 - have jobs at small businesses, which struggle to afford coverage.
Huntsman's advisers had explored allowing small businesses to buy insurance from Utah's Public Employee Health Plan, but the idea was recently shelved under intense lobbying by the insurance industry.
Utah healthcare reformist and advocate for the poor Judi Hilman backed the proposal. She said, "We're at a crossroads. Are we going to build on an employer-based system or go toward a single-payer route? If we build on the employer-based system, as unsustainable as that is, then we have to level the playing field."