Senator Carlyle’s quote introduces The Prescription Drug Affordability Board!  

From the establishment of the prescription drug affordability board to charity care, we celebrate 2022! Below is the down and dirty of our successes and the ones that died.   

by Consuelo Echeverria

SB 5532 EFFECTIVE DATE: June 9, 2022

Establishing a prescription drug affordability board under the Health Care Authority

Timeline: 
On Dec. 15, 2022 each yr.: baseline report is due 
On Jan. 1, 2024: Must establish a formula for calculating savings.
On Jan. 1, 2027: Establish an upper payment limit for prescription drugs 

This is a keystone piece of legislation for universal health care as it establishes a Prescription Drug Affordability Board (Board) of experts appointed by the governor to do affordability reviews on 24 drugs a year that have been subject to high price increases while being on the market for years. The Board will set an upper payment limit for up to 12 of those 24 drugs a year to establish the price our public programs and private insurance plans will pay.

We deeply appreciate the work of the bill’s sponsors Sens. Keiser, Robinson, Conway, Hasegawa, Nobles, Pedersen, Randall, Stanford, Wilson, C. 

This bill passed with some Republican support. Thank you Reps. Schmick and Harris who both voted against their party to lower what comes out of your pocket when you pay for prescription medication! 

ACTION: Please thank those who supported this bill. 

SB 5546  EFFECTIVE DATE: Jan 1, 2023

Concerning insulin affordability

This bill ensures that the people who need insulin the most have access to it. It exemplifies WA state legislature’s work through a health equity lens. Diabetes unduly burdens those who can least afford to be sick, low-income communities. That is why it is exceptionally harmful that the cost of insulin has tripled over the past 15 years. This for a 100-year-old drug! 

What this means is low-income Washingtonians are skipping doses, stretching their medication. But while they are saving their wallets, they are sacrificing their health. Undertreated diabetes carries a significant cost to the state in emergency medical care, hospitalization and loss to productivity in the state’s economy.

This bill caps the cost of insulin to $35 for a 30-day supply. Meaning every Washingtonian can afford this life saving drug and we as a state can better manage this hydra-headed disease. 

In the Senate, this bill had strong support from both sides of the isles with 1 Republican voting Nay. In the House, bipartisan support was also very strong with only 10 Republican voting Nay. The 11 Republicans who voted Nay: Sen. Padden and Reps. Chandler, Corry, Harris, Kraft, MacEwen, McEntire, Stokesbary, Vick, Walsh, Wilcox.

ACTION: Please thank your legislator who passed this bill to make this life saving drug affordable!  

HB 1728 EFFECTIVE DATE: June 9, 2022 

Reauthorizing and amending dates for the total cost of insulin work group under the Health Care Authority 

This iteration reauthoring the work group replaces some industry representatives with members of the public living with diabetes or advocates. The Work Group must identify strategies to provide a once yearly emergency 30-day supply of insulin. The bill defines reporting requirements and extends funding through Dec 1, 2024.

ACTION: Please thank Reps. Maycumber, Cody, Callan, Eslick, Macri, Ramos, Griffey, Riccelli, Leavitt for sponsoring this bill.

HB 1616  EFFECTIVE DATE: Jan 1, 2023 

This act applies prospectively only to care provided on or after July 1, 2022.
Concerning the charity care act

This is another equity-lens law to protect the rights of Washingtonians living in poverty to go to the hospital. There are hospitals in Washington who have a history of transferring or denying emergency care to avoid having to foot the bill. There are also some who deny in-patient services because the patient cannot pay the full amount. Some also have a history of sending eligible charity care patients to collections agencies who utilize aggressive unethical tactics.

The charity care act ensures that hospitals give emergency care regardless of the ability to pay. Furthermore, it states that hospitals cannot deny in-patient services if the payment is anticipated to be less than the potential costs of services. Finally Hospitals cannot refuse to admit patients who require unusually costly treatments based solely on financial considerations.

The Attorney General requested that we, HCFA-WA, advocate for its passage! 

We are happy to report that in the Senate the bill passed with the support of 3 Republicans. In the House 8 Republicans voted Yea with 33 voting Nay. 

ACTION: Please thank Sens. Gildon, Rivers, Sefzik as well as Reps. Caldier, Chambers, Chandler, Graham, Griffey, Jacobsen, MacEwen and Ybarra who voted to protect access to hospital care for those who are eligible.

SB 5610 EFFECTIVE DATE: June 9, 2022

Requiring cost sharing for prescription drugs to be counted against an enrollee's obligation, regardless of source

We supported this bill because it allows out of pocket expenses for some prescription drugs to be applied towards deductibles, coinsurance and copays if the drug is approved through a utilization review. This, in effect, will lower the cost of some prescription drugs. The insurance commissioner will adopt any rules necessary to implement this bill. 

This bill passed with overwhelming bipartisan support, a chorus of YEAs with nary a Nay.

SB 5589  EFFECTIVE DATE: June 9, 2022 

Concerning statewide spending on primary care under the Health Care Cost Transparency Board

Timeline: By December 1, 2022, the board shall submit a preliminary report 

Primary care is the most essential step to not only staying healthy but to reduce healthcare costs overall. It is much cheaper to treat earlier than to treat later. In that view, this bill authorizes the Health Care Cost Transparency Board (Board) to make progress towards increasing primary care to 12% of total health care expenditures. The Board must consult with primary care providers and organizations as well as review the existing work in this and other states regarding primary care.  It should address social determinants of health within the primary care setting.

This bill also enjoyed near-unanimous support. 

SB 5753 EFFECTIVE DATE: June 9, 2022

Enhancing the capacity of health profession boards, commissions, and advisory committees

This bill updates the member composition, quorum rules, and member qualification requirements for various health profession boards, commissions, and advisory committees. It removes the requirement to be a United States citizen to be a member of the Board. It also gives set allowances for subsistence, lodging, and travel expenses for members of the Board.

We are happy to report that in the Senate the bill passed with the support of 2 Republicans. In the House the bill passed on straight party lines. 

ACTION: Please thank Sens. King and Holy who voted to increase the capacity boards and committees.

In summary:

Seven of our nine priority bills are now law!  

• The two that did not pass were HB1813 Concerning freedom of pharmacy choice and SB5620 Concerning Medicaid expenditures. We support their re-introduction in 2023. 

Protecting Women & Child Health 

• Preserving access to abortion care
• Providing a monthly diaper subsidy for parents receiving temporary assistance 
• Allowing providers to bill separately for immediate postpartum contraception

Protection against Surprise Billing 

• In alignment with the feds, this bill expanded protection for Washington consumers from charges for out-of-network health care services

Protecting the vulnerable 

• Allowing nurses to dispense opioid overdose reversal medication in the ER
• Assisting persons receiving community support services through medical assistance programs to receive supportive housing
• Preventing homelessness among persons discharging from inpatient behavioral health settings

In closing, we would like to thank Rep. Schmick for his strong support of making health care affordable in the 2022 legislative session as well as his service on the Universal Health Care Commission. 

Who Knew?  

or 

Yes, It Really Is This Complicated!

By Marcia Stedman

Image Credit: Matt Wuerker, Politico

Meeting #4 of the Universal Health Care Commission (UHCC) included  an overview of recent legislation including advancements in behavioral health, housing, and Medicaid and two bills strongly supported by HCFA-WA: SB 5532, creating the Prescription Drug Affordability Board, and SB 5589, requiring annual reporting of primary care spending, and many others. 

• A comprehensive review of Federal coverage structures
• A review of past analyses and current health care coverage in Washington
• A daunting list of elements for the UHCC to cover as they develop our plan

The entire meeting is well worth watching.

Meanwhile, here are our top takeaways.

Takeaway #1:  

States need access to Federal funding to enact their state-based health care systems, and this is challenging. 

A bit of background was presented by Dan Meuse, Princeton University Lecturer in Public Affairs: Medicaid is jointly funded by the federal government and states, therefore the state already has access to these funds. However, Medicare is a federally administered program that funds individuals which is why waivers are needed. 

Medicare innovation waivers offer the best savings opportunities, but are difficult to get. He gave two examples of state based strategies for the waivers:

• Maryland’s statewide waiver allows them to set a ceiling for healthcare payments and leverage the savings to other state populations
• Pennsylvania’s waiver allows rural hospitals to switch from fee-for-service billing to global budgeting

Medicaid demonstration waivers cover a state-run program that already exists. Options to utilize these waivers include:

• Adding populations
• Changing funding and payment models

Employer Sponsored Insurance includes Washington’s public employees and is the largest pool of portable dollars, as employers overpay by 200 - 400% of public programs. However there are challenges: 

• ERISA and Taft-Hartley unions are protected by federal regulations
• Multi-state employers such as Boeing and Microsoft seek coverage plans that are uniform nation-wide which would be difficult for a  state administered program to reconcile

Individual and small group markets are state-regulated, well-established, and easy to scale, however they rely on the current insurance system.

• 1332 federal waivers can be requested to address affordability in the state administered plan

Takeaway #2:  

Elements of a single statewide payment structure would need to include: 

• Global budgeting for hospitals
• A state-run Pharmacy Benefit Manager

Takeaway #3: 

While Washington has made many improvements in health care delivery there are unmet needs as presented by Liz Arjun, Health Management Associates:

• Workforce shortages, especially nursing and behavioral health  
• Racial and ethnic disparities in access to care
• The Draft Report requires more work

Takeway #4:  

CAUTION: Much Work Ahead as presented by Gary Cohen, Health Management Associates: 

• Integrate coverage disparities into a single list of covered benefits
• Think about Medicare early on
• Decide on a single reimbursement model: Value-based payment (MCO’s) or fee for service (CMS).  This is destined to be a hot-button topic. 
• Infrastructure needed, e.g., a public Pharmacy Benefit Manager. Fortunately, WA is a step ahead with the passage in 2021 of SB 5203 Producing, distributing, and purchasing generic prescription drugs.
• Governance – who administers the system? Here again, Washington is a step ahead thanks to HCFA-WA’s signature Washington Health Security Trust bill outlining an administrative structure. 

Takeaway #5: Public comments are crucial to open meetings. Several public comments mentioned: 

• The mysterious omission in the UHC Work Group Report of the $5.5 billion in health care savings achieved annually in a publicly funded and administered system 
• The immediate need to establish the finance advisory committee to begin the application process for the necessary Federal waivers
• In the meeting Ms. Arjun, the consultant from HMA, acknowledged the public comments
• An editable Word document of the Draft Report will be made available to UHCC members to facilitate any necessary revisions

Next UHCC Meeting:  Thursday, June 16, 3-5 p.m. 
Complete Commission details here.

2nd Wednesday Speakers Series - A reflection on victories!

by Consuelo Echeverria 

This earth month, Sen. Carlyle highlighted climate action as public health action! Universal health care can only be truly equitable when it works to mitigate the health impact of climate change on communities who are unduly burdened by that change. Our focus on access, affordability and quality has made Washington a thought leader in health and that is something to celebrate!  In this celebration, however, there is a place for reflection, “I think there's a lot of grace, intentionality and humility in acknowledging the magnitude of the work.”  HCFA-WA thanks Sen. Carlyle for his powerful floor speech on the Prescription Drug Affordability Board, emphasizing the importance of this bill which HCFA-WA championed in 2022. 

Attorney General Bob Ferguson shared insights into the legislative process around the expansion of our state’s existing Charity Care law.  In 2019, Oregon passed a similar law. When he reached out to the Oregon Health Authority in 2021, they reported no evidence that their charity care requirements had caused financial difficulties for hospitals. This was key to  gathering bipartisan support for the bill. Ferguson also called out the importance of grassroots support, how all of our phone calls, emails and testimony motivated legislators and we passed this law that will benefit a million low-income Washingtonians. 

The AG also spoke to the role of his office in enforcing the existing Charity Care Law, specifically his ongoing lawsuit against Swedish, Providence, and Kaldec affiliated facilities regarding their practices of routinely:

• Training employees to aggressively collect payment 
• Failing to notify patients they were eligible for charity care financial assistance when they qualified 
• Sending 54,000 patient accounts to debt collection, despite knowing the patients were eligible for financial assistance

We thank AG Ferguson for protecting the rights of vulnerable Washingtonians to access health care. 

Sen. Karen Keiser, one of our key Health Care Champions, spoke on the importance of the Prescription Drug Affordability Board.

“I often point to the real problem that people who have multiple sclerosis face when they have 100,000 dollars plus prescription drug bills every year just to live. We know when the costs increase that much, health decreases. Why? Because people skip doses, they cut pills in half, and they do whatever they can to make it all work out. But it doesn't work out for their health!” 

Sen Kaiser Floor Speech on Prescription Drug Affordability Board

These are just a few of the highlights from our speakers. If you would like to see the whole talk, just click here. 

Bill of the Month: He Donated His Kidney and Received a $13,064 Bill in Return
ProPublica, Date accessed April 30, 2022

Articles 

Investors Extracted $400 Million From a Hospital Chain That Sometimes Couldn’t Pay for Medical Supplies or Gas for Ambulances

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Hospital industry peddling programs to treat acute-care patients in their homes

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