When the Affordable Care Act (ACA or Obamacare) became law in 2010, Utah was one of only two states (the other being Massachusetts) that already had an insurance exchange operating within the state. This exchange, called Avenue H, was designed to help small businesses obtain coverage for their employees.
The success of this program is debatable, however. Despite having 140 health plans and 789 insurance brokers in the exchange and about 60,000 small businesses¹ within the state, only 326 businesses have actually purchased insurance through the exchange.²
When Utah asked the federal government for permission to build an individual insurance exchange on top of its existing platform, it received "conditional approval," but only if the state complied with a long and exacting list of mandatory changes. Patty Conner, who serves as Utah Gov. Gary Herbert's exchange chief, said that the list of changes "wasn't what we wanted to hear. We wanted to hear that they would approve the exchange that we have. I think we have a different definition of flexible."
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