For those lucky Utahns who have medical insurance, the change in premiums, carriers or both is an annual rite that leaves you feeling like a gutted buck. The rest - 300,000 working people who can't even afford to run the insurance gantlet - are roadkill.

But there's something different in the crisp air this fall.

The Salt Lake Chamber of Commerce is working on a nebulous health care reform proposal. State Health Department leaders are promoting rebates to help low-income workers pay their premiums. And Zions Bank President Scott Anderson is asking legislators to mandate affordable health coverage for all Utahns. Business, it seems, needs government help.

For conservative Utah lawmakers, this is a tight spot.

Most thump the privatization drum as hard as any small-government libertarian. Even after the biggest private school subsidy program in the country crashed and burned at the ballot box, Utah Taxpayer Association President Howard Stephenson nevertheless is working on weaving favoritism for private businesses into the state's fabric. To start, he wants to hear complaints from aggrieved companies trying to compete with municipal golf courses and recreation centers.

"Why does government have such an appetite for getting into the business of business?" the Republican state senator from Draper asks.

But what happens when business wants to get out of the business of business? What's a conservative to do?

"Generally speaking, the Legislature is very responsive to businesses. And this is a business concern," says Matthew Burbank, a University of Utah political science professor. "Businesses would love to shift this to government. But that's going to run smack against this privatization sense."

Utahns struggling to pay increasing co-payments for doctor visits or surcharges for working spouses probably will be lost in the middle of this political philosophy debate. Insurance costs for a Utah family have increased 72 percent since 2000 while median salaries grew only 10 percent. Of course, Utah lawmakers are insulated from that roller coaster because they get top-tier, taxpayer-subsidized medical benefits.

While business leaders cloak themselves in compassion, their number crunchers are figuring out new and creative ways to shift health care costs on to workers or other businesses - cutting the percentage of premiums they will pay, increasing out-of-pocket caps or kicking off family members who have policies available at their own workplaces.

"We're right on the tipping point," says Utah Health Policy Project Director Judi Hilman. "We have this really once-in-a-lifetime convergence of interests."

We know Utah lawmakers care about business. Soon, we'll find out if they care as much about their workers.

walsh@sltrib.com