The state Universal Health Care Work Group is working on a new report update for the state legislature outlining end goals to pursue, ultimately focused on achieving a single-payer system. With ongoing issues regarding implementation and operational costs, some work group members are advocating a gradual phase-in of these policies.
Advocates of this approach point to decades of legislation focusing on universal health care coverage for children, starting in 1989 with the Maternity Care Act and concluding with the 2005 Cover All Kids Act that was fully implemented in 2009.
Office of the Insurance Commissioner Senior Health Policy Advisor Jane Beyer told colleagues at its Oct. 7 meeting that “as the legislature works through each of these incremental steps, it tackles many of the issues that are before the work group today.”
However, Work Group member Kelly Powers said a decades-long strategy isn’t feasible. “It’s not going to be 27 years. It’s going to be five years, two years. What can we do next year?”
The answer to that question depends on the overall vision for health care in Washington state. The work group’s draft end state goals define the system as follows:
- Provides all Washingtonians with full access to comprehensive, essential, equitable, effective, and appropriate health services that are affordable to everyone;
- Promotes equity in access to quality care;
- Ensures person-centered care;
- Promotes the consistent delivery of quality health care;
- An administratively simple and efficient system that manages costs effectively; and
- Politically and administratively feasible and implemented in a considered way.
The preferred health care system model will also shape potential legislative proposals. A single-payer system could be administered directly through the state or contracted to a third party. While Work Group draft documents estimate a state-run system would reduce overall health care costs in the state by $3 billion, it would cost $52-58 billion to cover the entire state. A third party-managed system could demand even more – $60 billion – and reduce overall health care expenditures by up to $2.6 billion.
A third option would be to maintain the current health care system and close coverage gaps for certain demographics such as illegal immigrants or the remaining three percent of children in Washington who lack health insurance. Rep. Nicole Macri (D-43) said “it’s important to understand not only who is covered, but who is falling through the cracks. If we can get information about the three percent of kids who have not been insured in Washington state…I think that goes to the equity goals we’ve been talking about.”
However, UW School of Public Health Principal Lecturer Aaron Katz argued “when the next pandemic hits and the recession caused by it hits, we’re going to retrench on coverage because we won’t be able to afford it. A big part of the goal…is to create a system that can control how much money the health care system consumed. Filling gaps in coverage is not the same.”
Mid-Valley Insurance Inc Founder Don Hinman added that seeking to close coverage gaps within the current system doesn’t tackle “self-inflicted barriers,” which he said is “a big hindrance why the remaining people aren’t insured. I think the real reason is that they’re healthy and buying an insurance policy or getting insured is outside of their budget.”
Health Care Authority Director Sue Birch noted during the Oct. 7 meeting that the goals ultimately adopted don’t represent universal agreement among work group members. Yet National Federation of Independent Business (NFIB) Washington State Director Patrick Connor questioned the direction of the work group. “It seems like a lot of the path that we’ve been on so far has been driven by voices talking the loudest. In general, the draft report…summarizes more the people who have talked the most, made the points the most – and some of the voice maybe haven’t been heard.”
The work group’s next meeting is scheduled for Oct. 29.