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House passes bill to require insurers to cover medical foods for metabolic disorders
Summary
The House passed First Substitute HB205, requiring insurers to cover formula and modified food products for certain inborn metabolic disorders (such as PKU). Sponsors said the measure is cost‑effective and humanitarian; opponents warned about insurance mandates and market effects. Final vote was 66‑4.
The Utah House passed First Substitute House Bill 205 on Jan. 22, 1998, directing insurers to cover medical formula and modified food products used to treat inborn errors of metabolism, such as phenylketonuria (PKU). The measure passed the House by a vote of 66 yes and 4 no and will move to the Senate for consideration.
Sponsor Representative Tricia S. Beck told the chamber the change had been vetted in interim committee and with the Health Insurance Association. She said the requirement directs the insurance commissioner to establish by rule coverage levels consistent with major medical benefits and emphasized the long‑term savings from early treatment: "This legislation...says the insurance companies will cover the formula and modified food products for treatment of inborn errors of amino acid or urea cycle metabolism at levels consistent with the major medical benefit provided under the insurance policy." (Representative Beck)
Sponsor and supporters described the covered population as small — Representative Beck cited about 75 identified people in Utah who have PKU or related metabolic disorders — and said actuarial estimates showed little premium impact. The bill’s fiscal note to the general fund was reported at about $40,000; supporters estimated the per‑policy effect would be minimal, with one sponsor characterizing the expected premium increase at less than $0.05 per month.
Opponents cautioned about the cumulative effect of insurance mandates. Representative Valentine argued mandates have contributed to market consolidation and fewer domestic HMOs, saying "we're making a monopoly out there because people can't compete." Proponents responded that the Health Insurance Association supports the change after review and that covering the medical foods prevents severe and irreversible developmental harms if untreated.
Representative Beck and others answered several technical questions on who currently bears costs and whether government subsidies cover needs: sponsors said government programs pay some costs for low‑income families but not all, and private coverage would spread costs across a larger risk pool.
After extended debate, the House closed debate and adopted the substitute bill. The House clerk recorded the vote as 66 yes and 4 no.
The next step for HB205 is Senate consideration; the sponsor requested support to ensure continued access to medical foods for affected Utahns.
