Health Care Utah Families Can Afford

Why this matters

Ask a Utah family what keeps them up at night, and a medical bill is near the top of the list.

This summer, 43% of Utah voters said that in the past year they or someone in their immediate family skipped a treatment, cut back on a prescription, or put off seeing a doctor because of the cost. Six in ten Utahns say they couldn’t pay a surprise $1,000 medical bill without going into debt. More than one in five have already borrowed money or put medical bills on a credit card.

These aren’t people without jobs. They’re teachers, contractors, small business owners, and young families. Many are doing everything right, and they still can’t keep up.

What Washington did to your premiums this year

About 400,000 Utahns buy their own health insurance through the federal marketplace, one of the highest rates in the country. Many work for small businesses, run their own, or work for themselves. Since 2021, an expanded tax credit kept their premiums tied to what they earn.

On January 1, that help expired. Nationally, the average enrollee’s premium payment more than doubled. In Utah, some families saw their bills triple: one Utah couple now pays nearly $2,000 a month for coverage. Since January, more than 63,000 Utahns have dropped their plans. Most didn’t stop needing a doctor. They just couldn’t pay.

In January, the House voted 230 to 196 to bring the help back. Seventeen Republicans broke with their party leaders to vote yes. Every member of Utah’s House delegation voted no. The Senate still hasn’t passed it.

Then there’s Medicaid. The 2025 budget law cut close to a trillion dollars from it nationally, and as many as 40,000 Utahns could lose coverage starting next year. That fight gets its own plan: Protect Medicaid, Then Make It Better.

Washington works for ideology and dark money. Here, the ideology was a decade-long grudge against the Affordable Care Act. The bill landed on Utah families.

Why health care costs so much

Most of the problem isn’t that Americans see the doctor too often. It’s what we’re charged when we do.

• The prices are too high. Private insurance pays hospitals about two and a half times what Medicare pays for the same care. That shows up in your premium, whether you buy your own plan or get one at work.
• Hospitals add fees. When a hospital buys a doctor’s office, the same visit in the same building can suddenly cost more.
• Nobody tells you the price. In most of the economy, you know what something costs before you buy it. In health care, you find out weeks later.
• Drugs cost more here than almost anywhere else in the world.
• When people lose coverage, we all pay. Uninsured patients end up in the emergency room, and those costs get passed on to everyone else’s bills.

A market, not a takeover

It’s worth remembering what the marketplace actually is. It’s private insurance. Utahns pick from plans sold by private companies, and the tax credit helps working families afford them. The idea came from Republicans long before it became law: a private market with help for people who need it, instead of a government-run system. Many of us in Utah grew up hearing that was the conservative answer.

I still think it’s the right answer. I don’t want to put everyone on a government plan, and I don’t want to take away the coverage you get at work. I want the market we already have to work for the people who depend on it, and I want Washington to stop breaking it on purpose. And I want to add one more choice to that market: Medicare, for anyone who wants to buy it.

On most issues, I look to markets first. Health care is different, because when you’re in the back of an ambulance, you can’t shop around. That’s why government has a bigger role here than in most of the economy. But the goal is the same: real choices, honest prices, and costs that working families can manage.

My plan, in three parts

3. Bring prices down for everyone

Whatever plan you have, these steps lower what you pay.

Help working families with premiums

I’d vote to restore the marketplace tax credits, so that no family pays more than a fair share of its income for a benchmark plan. Critics have raised real concerns about fraud, and I’d fix those, not use them as an excuse:

• No more $0 plans that nobody asked for. Some brokers signed people up for free plans without their knowledge. Require every enrollee to confirm their own coverage, and punish the brokers who cheat.
• Verify income up front, using data the IRS already has, so the credit goes to the people it’s meant for.
• Pay for it. A three-year extension would cost about $80 billion over ten years. Ending hospital billing markups, below, would save far more than that.

Put real prices on the menu

You can’t have a free market without prices. Yet in health care, you usually find out what something costs weeks after it’s done.

Since 2021, federal rules have required hospitals to post their prices. Five years later, only about half of hospitals fully comply. I’d make the rule law and give it teeth:

• Real dollar prices, posted in advance, for common procedures, from both hospitals and insurers.
• Penalties big enough to matter for hospitals that hide their prices.
• A fair estimate before a planned procedure, in writing, so families can compare and plan.

Committees in both parties have already passed bills to do this, one of them 45 to 0. Congress should finish the job.

Same care, same price

Today, if your doctor’s office is bought by a hospital, the same checkup or X-ray in the same building can suddenly cost much more, because the hospital adds a “facility fee.” Medicare pays more, and so do you.

The fix is called site-neutral payment: pay the same for the same service, no matter who owns the building. The Congressional Budget Office estimates that applying it across Medicare could save more than $170 billion over ten years, and lower costs for patients too. It has supporters in both parties.

I’d do it with one exception: protect rural hospitals, which need every dollar they get. Big-city hospital systems can live without the markup. The hospital in a town of 1,500 people can’t.

Lower what we pay for prescriptions

Medicare can finally bargain over the price of some of the most expensive drugs, and it’s working. The first ten negotiated prices took effect this year and are expected to save about 9 million seniors roughly $1.5 billion out of their own pockets in the first year alone. Seniors’ yearly drug costs are now capped at $2,100.

I’d protect that law, speed it up, and extend more of the savings to families with private insurance, starting with a $35 monthly cap on insulin for everyone. I’ll lay out a fuller plan on drug prices in a separate paper.

Keep rural hospitals open

Utah has 21 rural hospitals, and nine of them stand on their own, without a big health system behind them. In a small town, the hospital is often one of the biggest employers, and the next one can be hours away.

Utah is getting nearly $200 million this year from a new federal rural health fund, and that’s real money. But only a small slice of it, 15%, can go directly to hospitals and clinics, and it isn’t meant to replace what they’ll lose as more of their patients become uninsured. I’d let states put more of that money toward keeping hospital doors open, and back it with stable payments that rural hospitals can plan around.

Keep medical bills from wrecking your credit

Getting sick shouldn’t keep you from buying a house. Research from the federal consumer bureau found that medical debt is a poor predictor of whether someone will pay back a loan. A rule to keep medical bills off credit reports was thrown out in court in 2025, on the grounds that only Congress can make that call. Fifteen states have passed their own limits. Utah isn’t one of them.

So I’d make the call: keep medical debt off credit reports, by federal law, so one bad diagnosis doesn’t follow a family for seven years.

What I won’t do

• Take away your employer coverage or force everyone onto a government plan.
• Let insurers deny coverage for pre-existing conditions. That protection stays.
• Cut health care for working families to pay for tax cuts for people who don’t need them.

The bottom line

Health care costs too much for every Utah family, whether you get insurance at work, buy your own, or go without. The fix isn’t a government takeover, and it isn’t doing nothing. It’s three practical steps: let anyone buy into Medicare, protect Medicaid from Washington’s cuts, and bring prices down for everyone. That’s not left or right. It’s what Utah families have been asking for.

Sources

• RAND: private plans pay hospitals about 254% of Medicare prices
• KFF: 2026 Employer Health Benefits Survey, average family premium $28,303
• Deseret News: 43% of Utahns skipped or delayed care due to cost (Hinckley poll, June 2026)
• Utah Business: One Utah Health Collaborative survey, $1,000 bills and medical borrowing
• KUER: Utah lost more than 63,000 ACA enrollees after subsidies expired
• KPCW: 400,000 Utahns signed up through the federal marketplace
• Salt Lake Tribune: Utah premiums tripled for some families
• KFF: marketplace enrollees faced a 114% average increase in premium payments
• Deseret News: House votes 230-196; Utah delegation votes no
• WJLA: CBO estimate of the three-year extension’s cost
• Salt Lake Magazine: about $1 trillion in Medicaid cuts, and Utah’s 21 rural hospitals
• Salt Lake Tribune editorial: at least 40,000 Utahns expected to lose Medicaid
• PatientRightsAdvocate.org: 49.4% of hospitals fully comply with price transparency
• American Hospital Association: price transparency bills in Congress, 2026
• Congressional Research Service via Legis1: site-neutral savings of more than $170 billion
• KFF: site-neutral payment reforms and CBO estimates
• CMS: first ten negotiated drug prices and $1.5 billion in savings
• AARP: the $2,100 out-of-pocket cap for 2026
• Utah DHHS: $195.7 million Rural Health Transformation award
• Deseret News: direct payments to hospitals capped at 15%
• Rural health analysis: nine of Utah’s 21 rural hospitals are independent
• Salt Lake Tribune: the rural fund isn’t meant to replace lost revenue
• Congressional Research Service: medical debt and credit reporting
• CNN via ABC7: judge throws out the medical debt rule
• Checkbook: 15 states ban or restrict medical debt reporting