- - Tuesday, July 31, 2012

The full title of what most call Obamacare is the Patient Protection and Affordable Care Act (PPACA). The irony is it neither protects patients nor is it affordable. In fact, PPACA is a misguided budget-buster that falls short of real health care reform, undermines state solvency and subverts individual liberty. For those reasons, Utah is in no rush to adopt any Medicaid expansion and will continue to pursue pragmatic, principle-based reforms, regardless of elections or Congress’ partisan balance.

Of course, we care about better health and an improved system, but it’s breathtaking that in order to comply with the individual mandate for insurance, just covering Utahns presently eligible for Medicaid but not yet enrolled will cost the state $940 million the first decade and $1.88 billion the next decade. Then the Medicaid expansion tacks on an additional $240 million the first decade, and $480 million the next. In other words, even if Utah does nothing, Obamacare will completely unravel our state’s uniquely positive financial outlook.

Utah has defined a clear vision for health care: We will pioneer health care innovation and reform, harnessing the power of collective efforts and market principles as we become the healthiest people in the nation. Our efforts include solutions for low-income, uninsured and vulnerable populations.

But in contrast to federal solutions, the philosophical framework for Utah’s vision is personal responsibility. Reform must align incentives and empower people to make better choices — and reward them when they do. Most importantly, reform must reinforce basic principles of free markets — principles like flexibility and certainty. PPACA stifles both.

Washington appears to have forgotten that Medicaid is supposed to be a bridge, not a hammock. To that end, Utah has proposed thoughtful and potent Medicaid waivers to deliver care to the most vulnerable while protecting the program’s long-term viability. Our goal is to help people in need but prepare and empower them as their situation improves.

Yet it is those most vulnerable — those whom Obamacare professes to protect — who will be most victimized by shrinking access to eligible providers, and hidden taxes and regulation that drive up the costs of life-saving medical devices.

Utah continues to use and explore customized reforms like greater flexibility, accountable care organizations and paying for quality instead of quantity, cost-controlling features, electronic records management systems like Utah’s Clinical Health Information Exchange, a market-oriented health insurance exchange, and our All Payer Claims Database. True reform adds real value.

At this time of economic uncertainty, Obamacare will effectively kill every state’s efforts to maintain balanced budgets — all at the sacrifice of other critical priorities. Right now, Medicaid consumes 21.5 percent of Utah’s budget, nearly double what it was a decade ago. Adopting the expansion could cost Utah $1.3 billion over the next 10 years. Where will that money come from? Take no consolation in false assurances that the federal government will offset costs. It all comes from the same wallet — the American taxpayer’s — and alarming federal deficits should be a major concern for every one of us.

If we truly want to cut costs, the administration should cut strings attached to Medicaid and issue block grants to states. Give me less money and no strings, and I’ll deliver better services.

PPACA has too many rules and too few answers. Unfortunately, the Supreme Court’s ruling has only exacerbated marketplace uncertainty. Restoring market confidence and stability will come when we strike the right balance between costs and benefits, between compassion and dependence, and between freedom and accountability.

Unfortunately, with its top-down, one-size-fits all approach, Obamacare doesn’t really fit anybody. At this juncture, as states assess their options, it comes down to this: The statehouse, not the White House, should be leading the charge on one of the most complex issues of our day. It is time to reset the health reform conversation, and repeal and replace PPACA with state-driven, people-centered and market-oriented innovations. States simply cannot afford the Affordable Care Act, and neither can the American people.

Gary R. Herbert is the Republican governor of Utah.

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