The state Health Care Exchange last month approved new “Cascade Care” health plans under a state law approved last year that sought to address affordability by regulating deductibles and the number of provider visits covered. The law is seen by critics as a step toward single-payer, or universal, health care – a concept currently being studied by a state work group which is developing a report to the state legislature that will outline recommendations on how to implement such a system.
While work group members are divided over what the universal system would look like – and whether it’s feasible at all – some have previously expressed support for a gradual shift in that direction.
In such a system, a single-payer model would replace insurance coverage with a public health plan funded by new tax revenue; the estimates vary, with one study concluding it would require $28 billion in additional taxes, while another study says the system would cost $55-58 billion.
The implementation and administrative costs would depend on whether the state ran the system directly or contracted a third party to do so. A third possible route for policymakers would be to focus on de facto universal healthcare by identifying certain demographics lacking coverage, though some critics of this strategy say it avoids addressing affordability within the current industry.
Since the establishment of the work group, discussions have often focused on the issue of feasibility. National Federation of Independent Business (NFIB) Washington State Director Patrick Connor, a work group member, told colleagues at the group’s Oct. 29 meeting that “whatever the new system looks like, it does need to be financially feasible,” while noting that the draft report goal focuses only on administrative and operational feasibility.
Dziedzic Public Affairs Policy Consultant Carrie Glover, also a group member, told colleagues that the “financial feasibility is worth calling out separately. There actually has to be the funds to do it. (There’s a) massive shift in who is paying for what.”
Even if it was possible to raise the required money via new taxes to pay for a single-payer system, group member Rep. Joe Schmick (R-9) noted it would be a “tough sell,” requiring that a majority in both state chambers and the governor would “all be on the same page.” The estimated additional tax revenue would represent an entire biennial operating budget’s worth of new spending – more than $50 million annually.
Fellow member and anesthesiologist Dr. Rod Trytko said that a single-payer funding model component would also require federal cooperation and should include with it an administrative or operational model. “Just changing the financing of healthcare…is doing it completely backwards.”
In addition to political and fiscal realities, Connor said a single-payer system raises another feasibility issue regarding medical professionals. “This isn’t just going to be based on whether there’s the political will to do it. Are we going to get medical professionals willing to buy into…some new undefined financing and administrative structure? I’ve heard from some providers whose hair is on fire” over fears of effectively becoming either state employees or having their reimbursement capped by the state, he said.
The work group will submit its report to the legislature by Nov. 15.