by Marcia Stedman
Advocates and Commissioners alike asked this question at the August 2024 meeting. They are eager to move on to designing a healthcare system that would lower costs and increase access for all residents statewide, if only it were in place. Instead, the meetings continue to focus on how features of our current fragmented and costly system could fit into a different and as-yet-unknown system.
The topic at this meeting was Prior Authorization (PA). Continued support for the Apple Health Expansion was also on the agenda although it is unclear why the Commission needs to sign off on this.
No Quorum, No Votes, No Action
With only 6 of the current 14 members present, no votes could be taken. Facilitator Gary Cohen opened the discussion with 2 key questions:
- What is the role of PA in the universal system?
- Given that PA’s are the tool of insurers, what role will health plans have in the new system?
Only the first question was considered, and Commissioners again focused on how PA’s could be useful in an as-yet-unknown universal system:
- Can PA’s be limited to certain services and procedures, given that most are approved?
- Are we talking about added value for patients? Or for insurers?
- Who makes the determination? Is oversight needed?
- Is electronic submission a way to improve the PA process?
- Will AI be involved? Will a human be involved? Or is this outside of UHCC’s scope?
Is there any hope for meaningful reform?
Glimmers of Hope
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We anticipate that the December reports on these 3 studies that HCFA-WA and our allies lobbied for this year will help the Commission design the universal system:
- transitioning those losing Medicaid coverage to low-cost Health Benefit Exchange plans
- increasing efficiency in state-purchased health care programs
- expanding access to Medicaid for low-income Medicare beneficiaries
- The lost funding has been found! After an administrative snafu at the Health Care Authority was resolved, the Commission is now staffed with a dedicated manager and 2 additional FTE staff, and actuarial consultants have been retained. HCFA-WA, together with our advocate allies, was instrumental in securing this funding in 2023, and we look forward to an improved workflow and outcomes in 2025.
Please please please speak up and let the Commission and FTAC know that we do not want a universal health care system that is modeled off of or run by the for-profit insurance industrial complex!
Join us as we track the next meeting of the UHCC on Thurs, Oct. 10, 2024, 2-5 p.m.
We encourage you to:
- Sign up to provide public comment by 5 p.m. the day before the meeting occurs.
- We urge our members to push for a single payer plan in their public comments.
- Read our take on past UHCC and FTAC meetings