By Ben Lockhart

Deseret News

SALT LAKE CITY - Supporters of full Medicaid expansion in Utah officially filed an application Monday at the state Capitol to take the issue to voters in 2018.

The campaign, Utah Decides Healthcare, is pushing for Medicaid eligibility for tens of thousands of Utahns who do not qualify for all- important tax credits on health insurance plans offered on the federal exchange.

"The initiative will provide vitally needed health care to our most vulnerable citizens, hardworking families and low-income individuals who need it the most," Dina Blaes, initiative campaign spokeswoman, said in a statement.

The application was submitted to the lieutenant governor's office, which has 30 days to review the language of the initiative to make sure it meets minimum thresholds such as not being blatantly unconstitutional or nonsensical. If given the green light, organizers will need to collect 113,000 signatures by April 15, 2018, meeting certain thresholds of signees in 26 of Utah's 29 Senate districts, in order to get the initiative on the ballot.

The initiative would expand Medicaid coverage eligibility to all Utahns whose income is 138 percent or less of the federal poverty level, making insurance available to Utahns who make too much to qualify for Medicaid but not enough to be eligible for vital tax credits toward any coverage plans on the federal health exchange.

Organizers said the initiative calls for a state sales tax increase from 4.7 percent to 4.85 percent to raise $91 million to pay for the expansion. Those funds would then draw down matching funds of a little more than $800 million from the federal government, according to the campaign.

Signatories on the application include Sen. Brian Shiozawa, R-Cottonwood Heights, and the Right Rev. Scott B. Hayashi, bishop of the Episcopal Diocese of Utah. The others are Beth Armstrong, executive director of the nonprofit People's Health Clinic in Park City; Alan Ormsby, directory of AARP in Utah; and Karina Brown, a Logan mother whose own mom was uninsured when she recently died at 64 years old.

Bishop Hayashi said he is optimistic the initiative will both make it to the ballot and pass.

"(Utahns) care deeply about each other," he said. "I'm very, very hopeful. ... I know people are very compassionate."

Bishop Hayashi and other supporters of the initiative say they're encouraged by polling showing most Utahns favor Medicaid expansion.

"We're speaking directly to the people of Utah ... after four years talking about it at the Capitol," he said.

Shiozawa, an emergency room doctor who serves on the Utah Legislature's Health Reform Task Force, was traveling Monday but offered an economic argument in favor of the initiative in a prepared statement.

"We can either be proactive and get some of our federal tax dollars coming back to Utah in the form of federal match grants, or we can sit here doing nothing and watch our homelessness problem and overall health care worsen, while continuing to pay these taxes," Shiozawa said. "That makes no sense at all. I think we ought to let the people of Utah have a say in this."

State lawmakers settled on a significantly limited Medicaid package in 2016, following years of intense debate over whether to implement full expansion under the Affordable Care Act.

Most Utahns with dependant children and who make between 55 percent and 100 percent of the federal poverty level fall into a coverage gap - earning too much to qualify for Medicaid and too little to qualify for tax credits.

Those tax credits cover 72 percent of the cost of premiums for Utahns on the exchange on average, meaning paying for a plan without them dramatically balloons a person's monthly costs, according to the Utah Health Policy Project, one of the advocacy organizations supporting the initiative.

The coverage gap is even larger for most Utahn adults without dependants. Only a few thousand people in that demographic - largely the most needy, such as those who are homeless - are the target of limited Medicaid eligibility expansion that state officials hope will be federally approved this fall.

In total, about 80,000 Utahns do not qualify for either Medicaid or for getting tax credits toward a plan on the Affordable Care Act, said Jason Stevenson, spokesman for the Utah Health Policy Project.

The initiative would also explicitly outlaw the creating of caps on enrollment in both Medicaid and the Children's Health Insurance Program in Utah.

Utah House Speaker Greg Hughes, R-Draper, who has been at the forefront of the debate over Medicaid expansion in recent years, said last week that the initiative seems to him to be fiscally unsound. That was largely due to Medicaid being an open-ended government program, with no fixed spending limit, he said at the time.

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Credit: By Ben Lockhart Deseret News

Consumer advocates are urging life insurance regulators to strengthen death-claim searches, warning that relying on the federal Death Master File may be missing millions of deaths each year.

Richard M. Weber, a 59-year veteran of the life insurance industry, told regulators Monday that only about 16% of U.S. deaths are now captured in the Social Security Administration's limited-access Death Master File, the primary federal database insurers are required to check under many state unclaimed life insurance laws.

"Millions of families risk delayed or lost benefits," Weber said during a special meeting Monday of the National Association of Insurance Commissioners’ Life Insurance and Annuities Committee.

The discussion focused on whether regulators should modernize standards governing how insurers identify deceased policyholders and locate beneficiaries.

The DMF once captured as much as 95% of deaths, Weber explained. That changed after the Social Security Administration removed more than 4 million death records from the public database in 2011 amid privacy and identity theft concerns. Subsequent restrictions enacted under the Bipartisan Budget Act of 2013 further limited access to death records, Weber said.

As a result, he argued, insurers may not learn of many deaths unless family members file claims or use the NAIC's Life Insurance Policy Locator tool.

A helpful tool

The NAIC's locator service, launched in 2016, allows consumers to submit information about deceased relatives, which participating insurers compare against their own policy records. If a match is found, insurers contact beneficiaries.

However, the locator tool does not maintain a central database of life insurance policies, does not independently identify deaths and depends on beneficiaries knowing the service exists.

"When the beneficiary doesn't know the recently deceased family member had purchased and paid for a life insurance policy, or was covered under group benefits, the beneficiary doesn't know the LIPL exists or how to access it," Weber said.

Weber was joined by Kathy Belfi, former director of financial regulation at the Connecticut Insurance Department.

They urged regulators to consider developing a new NAIC model regulation that would require insurers to search additional sources of death information, including state vital records, obituary databases, funeral home records and other commercially available death-data services.

Among the recommendations were requiring monthly death searches instead of semiannual or quarterly reviews, shortening beneficiary-search timelines from 90 days to 60 days, and establishing annual reporting metrics on death matches and successful beneficiary contacts.

Inconsistent state adoption of unclaimed-life-insurance requirements has created uneven consumer protections, the consumer reps said. About half the states have adopted versions of the National Council of Insurance Legislators' model unclaimed life insurance law, while others have adopted different requirements or none at all.

“One of the best reasons our state-based system works so well is because states try to be as consistent as possible with our regulation and our policyholder protection,” Belfi said.

'We want to pay'

Industry representatives pushed back on suggestions that insurers are failing to locate beneficiaries. Leah Walters is senior vice president, state relations for the American Council of Life Insurers.

Life insurance companies share the goal of paying benefits, she said, adding that 38 states have adopted either the NCOIL model or their own Death Master File search requirements.

“We share your goal,” she told Weber. “We want to pay money to the beneficiaries that we make a long-term promise, and we intend to keep those promises.”

Walters pointed to the success of the NAIC Life Insurance Policy Locator tool, noting that the NAIC reported last year that the service had helped uncover more than $13 billion in benefits since its launch.

Life insurers paid $223 billion in benefits in 2023 and $198 billion in 2024, Walters said.

Regulators on the call acknowledged both the success of the locator program and concerns about consistency among states.

The call ended without a commitment for future action, but Iowa Insurance Commissioner Doug Ommen, chairman of the committee, suggested the potential for “discussion time” at a future national meeting.

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