http://www.nytimes.com/2005/02/24/national/24utah.html?ei=5094&en=49081cb8d0bb951f&hp=&ex=1109221200&partner=homepage&pagewanted=print&position=Anyone looking for clues as to how the Bush administration might overhaul the Medicaid system should come to Utah and read the fine print of Tony Martinez's health insurance plan.
Mr. Martinez, 56, was homeless and without any health coverage a year ago. Now, under an experimental plan of partial insurance devised under Michael O. Leavitt when he was governor of Utah, Mr. Martinez can see a doctor or go to the emergency room for only a small fee.
But he and his wife, Lisa, are not covered at all for the potentially catastrophic costs of extended hospitalization or specialty medical treatment, from dermatology to oncology. For those services, they must rely, as they did when they were homeless, on charity.
And that brings the story back to Mr. Leavitt, who as President Bush's new secretary of health and human services is now leading a drive to change how Medicaid works and often points to Utah as an illuminating example that other states might consider - although it is an innovation that policy experts, doctors and advocates for the poor are deeply ambivalent about.
In Utah, Mr. Leavitt's plan departs from the traditional Medicaid program on two main fronts. First, it spreads out a lower, more basic level of care to more people, and reduces coverage for some traditional beneficiaries by imposing co-payments for services. And second, it relies on the generosity of doctors and hospitals to provide specialty services free of charge.
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