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Interviews
Jon Huntsman, Jr.
Governor, State of Utah
Interviewer
Governor, just to get a sense of it, our uninsured rate is a little bit higher than the national average. Are we facing a crisis at this time?
Jon Huntsman
Anytime you have 10% of your population, maybe 12%, which I think is closer to the national norm, I think you're reaching crisis levels. I think it's totally unacceptable. For me, as an elected official, it's unacceptable. For me as a human being it's unacceptable, and I sense increasingly that there is a desire, as there should be, on the part of the electorate to get something done on this, and in a political context I think what we have in the political world is what we refer as a bully pulpit, and that is defining and framing, and putting into context this very important issue of healthcare and the uninsured and then rallying the best brains you can find to fix it, and that's kind of where we are today, but it is in my mind to crisis levels. When you have that many people who fundamentally can't cover the cost of health care and that then reverberates in terms of how the world sees our U.S. Health Care System and the way in which it's ranked based upon the OECD (Organisation for Economic Co-operation and Development) ranking or the WHO (World Health Organization) ranking, it's unacceptable.
Interviewer
In dealing with this crisis, what can you do in your role as the Governor? What is your responsibility?
Jon Huntsman
Framing it, defining, and then going to work toward a solution. The state has to play a role. It has to find solutions. It has to work with private and public sectors. It has to work with the Federal Government on some of these issues. But it takes a great deal of political will to get something of this magnitude done. I've decided that you have to first of all define the issue, and that is to lay out who it impacts, and we've got 10% of our population... you figure you've got 72,000 kids, you've got probably 105,000 small business employees. You've got maybe 25 to 30,000 Higher Ed students who are part of what I call "the young immortal population"--you're never going to die, therefore you never need insurance. Moreover if you wanted it, there's nothing affordable so why even bother? So when you start breaking down these demographic segments, each kind of requires a different approach and solution and fix and I said early on that we would start somewhere, and I felt that the appropriate place to start was with our kids. We have the CHIP program and at current levels, about 50,000 or so were being covered. I wanted to get our funding up to about 4 million dollars, which we got this last legislative session, and that takes us probably $12,000 higher. We're still off a little bit; maybe $10,000 to $12,000, $14,000 away from covering all of our needy kids. But we'll go back next year, and so we'll close that gap with kids. That's our first order of business. And then we have to begin to find solutions for small businesses, and many out there who are employees of small businesses and the young immortal population--the college students. And who knows where the federal government is going to be. But they're throwing around some ideas. Suffice it to say I think they're taking it seriously for the first time and beginning to throw some ideas around that would represent some reasonably good solutions, like a tax credit of $2,000 per individual. I don't think this has been vetted formally, but I've heard rumblings of a tax credit of sorts for which tax payers would be eligible that you could go out into the marketplace and you could find a healthcare program that best suited your needs, and if it didn't cost $2,000 it would be money in your pocket--that's $1500, and you'd get $500 back. But at least it would incentivize people and give them the financial wherewithal to begin looking at policies. Now concomitant with that you've got to have the insurance industry begin to provide policies that actually make sense and when there is a marketplace created through a tax credit, no doubt the insurance sector is going to respond by providing affordable and I would say a multiplicity of options that today are just not available. So I'm encouraged by what I'm hearing longer term about the larger fix that we must find for health care. But here at the state level, it really is kids who I'm interested in first and foremost. And then we're going to convene under the auspices of the United Way over the next few weeks--a working group. I called in the State of the State for a rallying of forces--the best and the brightest around a table representing industry, representing health care, representing academia, representing the advocate community, representing our community-based clinics so we can all find a relatively acceptable pathway forward. The political will is there. The brainpower is there, and the ideas I think are there in different corners of population. They just need to be aggregated, synthesized, and put into public policy so that we can get on with something this important.
Interviewer
I know the federal government is just beginning, as you said, to look at this and offer some solutions. It appears that the issue of healthcare has been left up to the states to try and fix on their own. Has the federal government shirked its responsibility?
Jon Huntsman
That's sometimes the easy answer. If the political will or the inter-scene warfare between the executive and the legislative branches are such that you can't get big bold ideas off the ground, then you leave it to the laboratories, called the individual states to kind of do their experimentation and maybe come up with some ideas, the latter part of which I think is not a bad idea because I think you're finding some of the states that are actually coming forward with some reasonably good ideas. At our last Governors Gathering in Washington two weeks ago, we all sat around… probably 35 to 50 governors there, and we all sat around a table together and this came up as the most pressing, the most compelling issue of the day--republicans and democrats alike in the room, and we were given the charge by Governor Napolitano--Janet Napolitano in Arizona, a good friend of mine--to find some solutions. So many of us are going to begin to find the best thinking out there, take it back to our next Governors Gathering and start sharing what some of our individual states are doing. No doubt, that is going to percolate along and manifest itself at the national level. That's the way these things work. So letting the states lead out is not a bad thing. I'm just concerned about time here. I mean real people are at stake, and so the fact that we're taking so much time to find a solution here is something that irritates me just a little bit.
Interviewer
What about financial aid? I know the SCHIP program is up for reauthorization. It sounds like they're not going to add money to that, or if they do; it’s going to be a battle. Are you frustrated in terms of the level of financial support that you're getting from the federal government?
Jon Huntsman
Yes, we spoke loud and clear when we were with the President two weeks ago about reauthorization of SCHIP and congressional visits were made about reauthorization and it's hard to know what that number is going to look like in the end. The President proposes a budget, it meanders its way through and changes are made and I don't know where we're going to be at the end of that process. But the governor's were pretty unanimous in terms of their belief that SCHIP is critically important--reauthorization and the support that they're getting at the state level. This is a very, very important program and has been since '94, '95 when it was created. We rely on it here and I don't need to reiterate what I've already said about the 72,000 kids who, in some way, shape, or form are going to be helped and supported by SCHIP.
Interviewer
As you mentioned, kids are your first priority, but you did make the statement that you will cut the number of uninsured by half by the year 2010. It sounds like there is a lot of study that's going on, but do you see any bold direction that we could take as a state to make that happen?
Jon Huntsman
If we cover our kids, 72,000 of the 275,000 in our state, that's a big number. You're getting toward one third of our needs. And we also passed this legislative session what I'm calling "a connector" which is taken from what a couple of other states are doing to another level. A connector would effectively be kind of a repository of information policies that are available for many who don't today understand what they are or necessarily where to go. If we had information in the hands of many in this state about policies or programs that are available, guaranteed you could take another third out of that 275,000 and find them proper coverage, or at least maybe improve the access side where many might not be aware of community facilities that they could call upon. So I think our SCHIP expansion this year and I hope next combined with this aggregator--this collector that we're funding now and supporting for the first time ever--a repository of real information once we get word out to people that they have somewhere to go to get more information about this. I think we're going to be to the 50% mark by 2010, that's our goal and I certainly hope we're able to get there. But I hope, not only our state, but indeed the entire nation I hope that they are moving commensurately towards something that, you know in the next few years we can say that we've arrived at that point where we've got the best ideas and we now know what is needed in order to solve this Herculean challenge.
Interviewer
A lot of states like Massachusetts and California are doing mandates for coverage. Do you see Utah going anywhere in that direction?
Jon Huntsman
I mentioned yesterday to somebody asking a question that I wouldn't shy away from mandates. I think if you're going to get it done and get it done right, mandate has to be part of it in some way, shape, or form whether it's the college age population or whether it's something beyond, it's got to be a serious attempt, and I'm not sure you get to the point of serious attempt without some sort of mandate associated with what you're trying to do. Certainly a market-based approach is part of the solution as well. We forget that. If a tax credit is something that the federal government ultimately works out, then you've got some market solutions tossed in and nobody likes the word mandate, but without that kind of insistence--that directness, I don't know that you can achieve something this challenging in a short period of time, which is what I think we need to do as a nation.
Interviewer
Speaking of mandates, most of the states are also providing some form of supplemental funding for people who can't afford it—for people with incomes up to 300-400% of poverty level. Do you see us having the resources to do something like that?
Jon Huntsman
Well we have resources and we're using them for education and for transportation and for human services generally. I mean when you look at filling the Medicaid hole of 19 million this year and methamphetamine support and drug courts, so on and so forth, there was really a lot of good things done in the social services area. So resources... yes, we've got resources and I think as our economy continues to expand, resources will be there for the right things that we can all get around as a community and I think we're going to know exactly what that is going to take when this effort, again under the aegis of the United Way, begins to make progress and defines what it is we're up against, but we're all going to have to be willing to buy into a solution that really does work. And the cost part of it is it's multifaceted. I mean you've got everything from the cost of pharmaceuticals, which I would argue we ought to be able to trade freely with Canada on. I know that some of my friends in the pharmaceutical sector don't like that--don't like it when I say that. But, if you can... for my daughter who is a juvenile diabetic... if you can find a vial of insulin from Canada, subject it to the same rigorous scrutiny for health and efficacy, for a fifth of the price you would pay here, would I choose to get it cheaper? You bet I would, and I think most people would. Now we're home to 75% of the pharmaceutical sector right here in the United States so I understand the compelling need to protect intellectual property and to somehow allay the costs of a very rigorous FDA mandated clinical trials process, which goes on six, seven, eight years. It starts with animal studies, human studies and efficacy studies of various kinds and seven or eight years later you get a pharmaceutical that rolls off the line that costs on average of a half a billion dollars, and that cost obviously is passed on to the consumer. So you've got tied up in the whole pharmaceutical process enormous costs that are part of it. You have frivolous law suits that are part of it as well. Why is it that we're not producing the same number of OBGYN graduates here at our illustrious medical school that we did 20 years ago? I think some, including one of my good friends who is an OBGYN who I've known for a good many years, the insurance that one must carry (malpractice insurance) is exceedingly high, and in some medical pursuits it's higher than others, and why pay that extra amount when you could go into a different specialization and not have to worry about it? So that too adds to the cost burden as well.
Interviewer
So what do you think... in terms of as a state, as a governor... what do you think we could do?
Jon Huntsman
Well you can work on injury caps. California has done a little bit of that. I think we've already got some in place that are at a reasonable level so that anything beyond it's either capped or maybe beyond someone who is bringing the suit covers, like they do in the U.K. I guess there are different ways to solve that, but some sort of torque reform in general that gets to the heart and soul of frivolous law suits at the federal level is probably needed.
Interviewer
It seems like there is often a battle with the legislature to get funding. The state didn't get additional funding for the UCHIP program until the last minute. Is that something that you see as an inevitable, ongoing struggle-- that we have a limited pool of resources and a lot of needs? Are there any solutions that you can see to the difficulty in funding healthcare programs?
Jon Huntsman
If it's an iterative piecemeal approach, I think it's harder to do. If it's part of a broader vision and a broader, bold solution that gets us to the end-point, I think it's easier to do. I think legislators, and I'd say this Governor too, are more apt to buy into ideas that have a well-defined end-point and a strategy that takes us there. And that is ill defined at this point, so if you're a legislator, you would have a hard time piecemealing currently what we're doing without any kind of vision of what the end-point looks like. I can kind of see the end-point, and I can kind of know some of the steps we're going to have to take to get there--we've talked about some of them, and we're probably going to learn more of them as we convene our working group, which I'm very excited about. And then you turn around and you work with the legislature, and you work with various groups that are natural constituencies of this issue, in getting it done.
Interviewer
What do you see the end-point looking like?
Jon Huntsman
The end-point looks like coverage for all of our citizens; access and coverage. And that's what I'm determined to get done. I don't know if I'll be here long enough. I hope that I am, but I've already term-limited myself so it better happen pretty fast. But I think the end-point must be a world in which there is access and there is affordability, and there is the ability for all of our citizens to get proper coverage for health care. And that means that the providers are going to have to step up. It means the insurance companies are going to have to step up and do more, that federal government in terms of a creative approach like the tax credit that we talked about earlier might have to step up... not "might" but would definitely have to step up. And the state will have to play a supporting role as we've been doing so far. They'll all have to come together in taking us to that end-point, which must be the kind of coverage that would be available for all of our citizens.
Interviewer
We're following some community health clinics throughout the valley and the state and they have some pretty big frustrations. There are actually a group of clinics in Salt Lake that might not be around next year. They might not be viable, and they serve about 30,000 people, and that's a big chunk. There is a lot of frustration out there with people who want to access care. They don't qualify for Medicaid; you know they fall in between the cracks. They want to access care, but they can't get care, and they can't get it today. They can't just call up these clinics and get in because these clinics are at capacity. What do you say to those people?
Jon Huntsman
Well I say we've got to do more like we've done up in Ogden most recently, and that's to move from old dilapidated facilities into newer facilities, and even with that they are still not able to accommodate all that need access. I would say that access needs to run in parallel with our whole health care reform and insurance undertaking. You can't do one without the other. Even when everyone is properly insured, you're still going to have access needs. You're still going to have barriers that exist that will require traditional community-based clinics and we're going to have to work with people like I.H.C.--already very generous in supporting a lot of the needs, and others as we add another million people to our population base to insure that. This has always been a challenge. We're growing, we're never static as a state, so our needs are always going to be there and we seem to meet them generally with each passing year. And we're going to have to be mindful that our community-based clinics are extremely important and some of our health care providers will have to do more about stepping up. Those who are of an older culture that may have said, this is a competitor, this is not something that I like juxtaposed with our traditional facilities, I think that philosophy is changing and evolving into more acceptance into our community-based clinics and the role that they play and as that mind-set changes I think there will be more of an appetite to support, even beyond the traditional means, what it is we're trying to do.
Interviewer
Do you think we need to do more as a state? I was just looking at the funding resources, and private sources, like Intermountain Healthcare, actually put a lot more money into community health clinics than the state does. Do we need to do more financially?
Jon Huntsman
We can always do better. Traditionally we have had a culture of health care awareness in our state and our community has rallied around some of these needs in sometimes nontraditional ways so that therefore, when you look at funding ratios, we're probably never going to be what other states have. We'll probably approach more the mean over time as we are in practically every other category, but we have always been a healthcare conscious society. We have always kind of believed in preventive medicine--getting out and being active, and educating our communities in terms of early intervention and early diagnosis. You never do it enough, but I think we probably do that a whole lot better than most states do. So consequently, our ratio of funding for some of these community-based clinics might be a little bit different, but we can always do more. When you're talking about real human beings at the end of the day and you have those who are being left behind, you can never be satisfied.
Interviewer
What is your biggest frustration in dealing with the healthcare issue?
Jon Huntsman
It flows like frozen molasses and when you want something done now, as opposed to two, three, five years from now, that's a frustration because you know there are a lot of people who are in need and whose health is unraveling, or whose quality of life is being diminished because we don't have an answer today, and I guess I'm a little impetuous in that regard. I'd like for there to be an answer today, and it's going to take some time, as we're finding at the national level, to get to that point. Now the good news, and what gives me solace in our community--we're not California, we're not New York, we're not kind of an impenetrable state in terms of new and innovative ideas--getting them tabled and implemented, and in a lot of states this thing would be downright impossible. We're a state that's pretty fast on its feet, and guaranteed, when the answers are there and when the road map is clear about what we need to do to get to that end-point, we're going to rally together as a state and probably be able to execute down that pathway faster than virtually any other state would be able to get it done. That's what gives me some comfort.
Interviewer
Utah is unique in that we do a much better job than most states in terms of quality and cost control in our hospitals and our healthcare system. Will we also be a leader in finding solutions to this issue? Do you see solutions happening two years down the road? Ten years down the road? Is this going to happen anytime soon or is this just a long process?
Jon Huntsman
It will happen as soon as the political will allow it to happen, and the political will is, I think, manifesting itself in very positive ways. Once the political will is there, then you're left to the ideas, the solutions. So right now we're up against real solutions that will get us to where we need to be and some of those solutions are Gordian knots of sorts --you've got to think very carefully about where you go and the implications that might result from option A, B, or C. But I think we're beyond the political will question. I think the political will is there, which I think is a very important thing for people to understand. I don't think a lot of people are politically hung up in terms of finding and end-point here. I think now we're up against solutions, the real solutions which heartens me because I know, you know, where there is a will, there is a way and a solution around the corner. But that's going to take some doing. These aren't easy questions to grapple with.
Interviewer
In terms of solutions, do you ever see us doing a universal coverage plan?
Jon Huntsman
I don't know what we're going to be looking like in the end, but chances are it's going to share an outcome that is reflective of different ideas because I don't think there is any one fix. If we had one fix, we would be there or not, and therefore I think there will be kind of a shared solution in the end. When we get there it will be fun to dissect and as historians and political scientists kind of look at how we got there and what the ultimate outcome looks like and why, and I think we'll have that opportunity in the not-too-distant future.
Interviewer
Finally, a fundamental question about health care, one that was raised during the 2007 legislative session… is health care a right?
Jon Huntsman
I think at certain income levels it is a right and I think the emergency rooms in this country recognize that right, but I would go beyond and say that it is a responsibility for everybody. We all have to share in finding a solution. We all have to educate ourselves so that the $500 per hour emergency room visits doesn’t take place with the frequency they do today. Instead, people call upon a $70 per hour clinic visit. That takes shared responsibility, and so a right I would argue to a certain extent it is a right, and I will be the first to run to those for whom I think it is a right. Beyond, I think it's a shared responsibility for all of us to take part in. Thank you for taking this up as an issue. I think that's very important. I think it really helps the debate, and helps to crystallize many of the things that are on the minds of many of our community leaders.
