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SALT LAKE CITY — A program designed to help low-income families afford their health insurance premiums may help narrow the “coverage gap” in Utah.
Alan Pruhs, executive director of the Association for Utah Community Health, said the association started the program after noticing that many patients were struggling to afford federal marketplace plans even with the subsidies offered to low-income families.
"Without a Medicaid expansion, we're seeing folks choose not to be insured," Pruhs said. "It's not that they don't want to be insured; it's just a matter of choosing. They're making really tough decisions. 'Do we subject ourselves to possibly not paying rent or not having food on the table to make this premium?'"
The Association for Utah Community Health, which oversees 52 clinics across the state, partnered with the Intermountain Community Care Foundation to provide financial assistance to an initial 158 individuals at three community health centers.
Now they hope to expand assistance to more than 1,100 households statewide.
Among the nation's community health centers, the average uninsured rate is 24 percent and dropping, according to data from the U.S. Department of Health and Human Services.
In Utah, however, more than 53 percent of the patients at these centers are uninsured.
"There's a substantial amount of our customers who are in that gap," Pruhs said, referring to people with incomes between 100 percent and 138 percent of the federal poverty level living in states that did not expand Medicaid eligibility — including an estimated 41,000 Utahns, according to the Kaiser Family Foundation.
Mikelle Moore, president of Intermountain Community Care Foundation, said the foundation has pledged $3 million to the program over three years.
That's an unusual move for the foundation, which typically focuses on providing funding directly to health centers on an ongoing basis, according to Moore.
"We've never bought insurance coverage for people before," she said. "But we thought it fit right with our mission. We thought it made sense to try."
Administered by the Association for Utah Community Health and supported by the Intermountain Community Care Foundation, the program currently offers financial assistance to 820 households, or about 1,350 people.
To qualify, a patient must earn between 100 percent and 200 percent of the federal poverty level, be eligible to enroll in a health plan on the federal marketplace and be uninsured.
Once accepted, enrollment specialists work with the patients to help them obtain and understand their insurance.
The association is gathering data to understand how patients are utilizing their insurance, Pruhs said.
Angela Roberts, a certified application counselor at Mountainlands Community Health Center in Provo, said the experience can be eye-opening.
She was able to help a man in his mid-20s with cancer cut his $250 per month plan down to $50 a month.
"He left in tears," Roberts said. "He was really thankful for the program. It was an eye-opener for me."
Moore noted that Intermountain Healthcare already provides a substantial amount of financial assistance indirectly through the emergency room.
"But that's not good health care," she said. "To really achieve health or maintain health or restore health, you need a primary care physician who can look out for your well-being — not just when you need an emergency.
"Health insurance," Moore added, "reinforces that."
