Vincent Garcia clears snow at the Capitol as the state Legislature begins its 2013 session, Monday, Jan. 28, 2013.

Ravell Call, Deseret News

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SALT LAKE CITY Health care access must be made available to every family before the year is over, and the responsibility for that lies in the hands of state lawmakers.

"Depending on your perspective, it may be the most important issue," said Rep. Jim Dunnigan, R-Taylorsville, of the work facing legislators as they balance health care reforms with the state's other pressing issues.

The Patient Protection and Affordable Care Act, passed in 2010, is intended to decrease the number of uninsured American citizens, as well as drive lower health care costs by enforcing various mechanisms, including mandates, subsidies and tax credits, all controversial measures.

It brings about several deadlines and decisions for states, including for the conditionally approved state-run health insurance exchange and Medicaid expansion, that the Legislature may take into consideration during the 45-day session that began Monday.

"Either we make the decision to run Affordable Care Act programs that will benefit and cover all citizens, or we fail and that role falls to our federal government," Sen. Gene Davis, D-Salt Lake City, told a gathering of stakeholders and citizens at a pre-legislative health reform discussion earlier this month.

Avenue H, Utah's existing health insurance exchange, is only available to small business employers and not individuals. Individuals need to be included in the online insurance marketplace by Oct. 1 in order to meet the federal deadline.

The law, however, contains a mandate that requires that all individuals not covered by insurance through their work place, Medicaid or Medicare, or other public insurance program, to obtain a private health insurance policy or pay a penalty, unless a waiver is secured first. A waiver can only be obtained through application and denial through the law's projected insurance exchange system, which would likely net anyone eligible for Medicaid coverage.

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2013 decisions could be key to your family's health care