With all the political noise about health care reform coming out of Washington, D.C., you may have overlooked that Utah has its own reform plan, including a Web-based health insurance market for small employers. Trouble is, that Utah Health Insurance Exchange, as the market is called, hasn't worked very well. The policies offered on it were so expensive that there weren't many takers. So, the Legislature is about to make some changes.

HB294 would prohibit insurers in the defined benefit market from treating groups as new business, subject to higher premiums, just because the employer decides to move from the traditional market into the Health Insurance Exchange. That was a major cause of the high premiums in the exchange. This, together with other provisions in the bill, should remedy that. The House already has passed it, and the Senate should do the same.

Utah is taking a market-based approach to reform that does not force people to buy insurance or companies to provide it. Some experts argue that universal coverage and cost control are impossible without mandates, and we suspect those experts may be right. But Rep. Dave Clark, the godfather of Utah health care reform, and other Utah lawmakers are determined to prove that it can be done. Frankly, their approach fits the free-market and libertarian values of many people in this state.

Even so, some in the Legislature are complaining about provisions in HB294 that would expand the Utah Risk Adjuster, a nonprofit entity within the insurance department that figures out ways to share risk among insurers. A board authorizes payments from a pool to insurance companies that suffer unanticipated losses because they are selected by sicker customers. Essentially, it's insurance for insurance companies.

If Utah reformers are determined to stay away from mandates, and cannot spread risk that way, then it makes sense, as Rep. Clark argues, to provide another mechanism to adjust risk. This can hardly be viewed as wealth redistribution, as some conservatives charge. If that is the case, then all insurance is wealth redistribution, and there's no point in continuing any insurance-based system to pay for health care. That may work well for multimillionaires, but last time we checked, even they insure themselves.

Among many other valuable reforms, HB294 creates a database of all payers (not identified by individual) to help consumers compare costs. It also would require providers to post prices for patients. The Senate should pass this bill.