Universal health coverage in Utah? One economist makes an argument for it

If state leadership thought about implementing Finkelstein’s proposed solution, there could be advantages, a Utah-based researcher said

(Chris Samuels | The Salt Lake Tribune) Professor and economist Amy Finkelstein at the Massachusetts Institute of Technology speaks during a panel discussion on health insurance policy at the Kem C. Gardner Policy Institute at the University of Utah in Salt Lake City, Monday, Feb. 26, 2024.

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Universal health coverage could start at a state level in Utah, said an economics professor who makes the case for an “ideal” American health insurance system.

Amy Finkelstein, who teaches at the Massachusetts Institute of Technology and researches health economics, argued before a Utah audience Monday in favor of a two-level medical insurance system — with basic coverage that’s free and automatic, and paid supplementary coverage based on the market.

Finkelstein — co-author, with Stanford economist Liran Einav, of the 2023 book “We’ve Got You Covered: Rebooting American Health Care” — spoke at a lunch event Monday at the Kem C. Gardner Policy Institute.

That system would achieve the fundamental goal of providing “access to essential medical care regardless of resources,” Finkelstein said as part of the event co-sponsored by The Salt Lake Tribune and Gardner, as part of their quarterly “Storytelling Through Data” conversation series.

If Utah leaders thought about implementing Finkelstein’s proposed solution, the state could reap advantages, said Laura Summers, the institute’s director of industry research.

Policymakers could create a system that works best for Utah, Summers said, taking into account the state’s demographics, needs and affordability concerns.

Close to 70% of Utahns surveyed in 2023 experienced at least one health care affordability burden in the previous year. Such burdens include going without insurance because of high costs, delaying or going without health care because of the expense, skipping or rationing increasingly costly prescriptions and struggling to pay medical bills.

Utahns’ opinions of health care costs are similarly pessimistic — with 86% saying they worry about affording health care in the future. That’s higher than a recent national survey that found 67% of respondents worry about affording health care.

Allison Witman, a health economist who teaches at the Marriner S. Eccles Institute, said recent survey results could indicate there’s some appetite for a basic plan among people at a lower income level.

Nearly 80% of former Medicaid members responded to a survey saying they probably or definitely would reenroll in the public coverage if they could. Cost and coverage, they said, are the best things about Medicaid.

(Chris Samuels | The Salt Lake Tribune) From left, Allison Witman, associate professor at the Marriner S. Eccles Institute, professor and economist Amy Finkelstein at the Massachusetts Institute of Technology, and Laura Summers, director of industry research at Kem C. Gardner Policy Institute, during a panel discussion on health insurance policy at the Kem C. Gardner Policy Institute at the University of Utah in Salt Lake City, Monday, Feb. 26, 2024.

Finkelstein said the free, automatic coverage in her proposal would be similar to Medicaid, with people paying for extra services. She estimated about ⅔ of people would pay for supplemental coverage.

Utah looks “relatively good” in health insurance rates compared to other states, Summers said. The state has the highest rate of employer coverage, she said, though it also has the lowest rate of public coverage.

But rates of people without insurance are higher among minorities and people with lower incomes, Summer said, despite improvements in the last decade.

For example, American Community Survey data shows 10.8% of households making $25,000 or less were uninsured in 2022, compared to 5.7% of households with incomes of $100,000 or more.

That data also shows nearly 95% of white Utahns were insured in 2022, compared to fewer than 80% of state residents identifying as Hispanic or Latino and American Indian or Alaskan Native (though there were some wide margins of error in 2022).

The system of basic, free coverage and paid, supplemental coverage could fix a set of “patchwork policies,” Finkelstein said, and would mean the United States would no longer be the only high-income country without universal insurance.

“We’ve already enacted universal coverage through the Affordable Care Act, we just haven’t achieved it,” she said.

While the new system would fix issues with access to coverage and gaps in health insurance, Finkelstein said, it wouldn’t tackle the affordability issue.

The average family in the United States pays about $25,000 a year for health insurance, between premiums and their plan deductible, according to data Gardner’s analysts provided. Numbers are similar in Utah, though the premium is a little less and the deductible is a little more.

Individually, Americans pay about $9,300 between premium and deductible, and Utahns pay around $8,600.

Finkelstein said she and her co-author “don’t have a silver bullet yet or even a bronze bullet” to bring those costs down, and only addressed the issue of insurance.

The new system, Summers said, could be helpful for people who don’t make a lot but sometimes make too much to be eligible for Medicaid or who are often uninsured, because they wouldn’t have to worry about losing insurance.

Megan Banta is The Salt Lake Tribune’s data enterprise reporter, a philanthropically supported position. The Tribune retains control over all editorial decisions.