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Before President Obama was even elected, Utah studied this issue and decided to take a market-based, business-friendly approach to health system reform. One piece of that plan was to implement a new defined contribution market that would make it easier for small businesses to offer health insurance to their employees. Under this new type of market, employers give each employee a specific allowance that they apply toward the purchase of the health plan of their choice. The support of this market is one of the key functions of the Utah Health Exchange. [...]
However, even without a concerted marketing effort, the Exchange continues to grow at a steady pace, enrolling new businesses and employees each month. Currently, over 4,000 people are getting the advantages of participating in a defined contribution health arrangement through the Exchange. Once the technology is refined to the point of being able to handle the pressure of large volumes, the Exchange will work with the private sector to create more public awareness and volume will likely accelerate and provide increased value to more Utah citizens.
Now, the Utah approach might not be the right solution for every state, however, for Mr. Graham to argue that states should avoid looking at it based on the false information and biased analysis he puts forward is inappropriate. This has nothing to do with being conservative or liberal, but rather encouraging each state to look at all of their options, including the Utah and Massachusetts approaches, and develop a state-designed approach to address state-specific issues.
If all 50 states were to proceed in this manner, the federal government would have no choice but to give them the flexibility they need. On the other hand, if a large number of states refuse to take any action, it would give those in Washington who really want a narrow, federal solution full license to impose a one-size-fits-all solution.
I don't know of any state that doesn't have an individual or small group health insurance market so I'm not sure what you're getting at. You don't think small employers should be able to make a defined contribution to employees' health insurance premiums (reducing their own uncertainty over health costs) and then let their employees loose into the market to choose a plan for themselves?
Perhaps you prefer the current models in which small businesses that choose to offer coverage are on the hook for uncertain amounts of money and employees are deprived of choice, as employers choose the company's plan for them. It's unclear what relevance the population of New York City has to the differences between those two models.
San Francisco doesn't have anything resembling the Utah Health Exchange. If you're looking for comparable (albeit smaller) examples, you want something like HealthPass New York.
The population of the state of Utah is around 2,800,000. The population of New York City is 18.000,000. Little Utah is free to experiment with whatever works or seems to work but please don't ever assume that what might be acceptable in Utah is good for the United States of America.
