Utah must enact its own brand of health care reform or risk sending Congress a message that only a federal approach is viable, according to some Republicans who discussed a reform bill during the majority caucus lunch on Tuesday.

House Speaker Dave Clark pitched a plan to expand a Utah insurance exchange that would allow employers to decide whether to keep offering workers what they now do or to give them a health stipend and let the individual shop for insurance.

Utah has to enact some reform or face rising health costs that in coming decades will equal all of a worker's wages, Clark told his colleagues.

Rep. Greg Hughes, R-Draper, said with a federal health plan stumbling politically, it's Utah's chance to lead by example. He likened it to Wisconsin's welfare reform of the early 1990s, before President Clinton embraced that change nationwide.

"We have to be that state," Hughes said. Failing to act, he said, will just put the initiative back on Washington. It will mean accepting something "10 times worse."

"I don't think saying 'no' can be an option here," he said. "We need something real."