By Marcia Stedman, HCFA-WA Board member 

Insurance Commissioner Patty Kuderer pledges strong support for the Universal Health Care Commission and its work:

“Healthcare is a human right and getting to Universal coverage is paramount. We at the OIC and myself personally are ready to help in any way that we can, and I hope that you'll see us as a resource, partnering with you on this very important work.”

Healthcare reform advocates again speak to the urgent need to address Governance now and accurately track all Milestones.  

Commission votes to support the reference-based pricing bills (HB 1123 and SB 5083) currently being considered by the Legislature: 8 “yea,” 1 abstention, support to include testifying “pro” at Committee hearings and sending a letter of support from the UHCC.  

Oregon’s positive experience with reference based pricing: starts at 1hr 8min mark of the Meeting Recording

• Applies to hospital inpatient and outpatient services.
• Rural and children’s hospitals are exempt.
• Cost growth held to 3.4%.
• No impact on access to care
• Savings achieved:
  • 2020 - $59 Million
  • 2021 - $112 Million

Spotlight on Rural Health in Washington - begins at 2 h 2 min mark of the Meeting Recording 

Saving the best for last, the Commission heard a fascinating discussion of the rural perspective on health care.  The panel included Brad Becker of Mason Health and The Rural Collaborative, Shane McGuire of the Columbia County Health System, and Ashlen Strong of the Washington State Hospital Association.

The Lay of the Land:  

• Three-fourths of Washington’s geographic area is considered “rural,” yet only 21% of the state’s population lives in a rural area, resulting in long travel times to receive care
• Rural hospitals are often the largest employer in their community
• Most rural hospitals are public and therefore tax-supported
• There is an acute shortage of hospital beds, with WA ranking 50th in the nation in number of beds per capita

Why operating costs are higher in rural facilities than in urban settings: 

• Generally low patient volumes fluctuate, yet facilities must remain open all year, 24/7
• Older inefficient facilities, many dating from 1960’s
• Older residents – 30% are over 65.
• High expense of setting up Electronic Health Records and maintaining them 
• High labor costs for positions that must compete with those at Starbucks and McDonalds. 83% of Columbia County’s costs are labor or labor-related
• Per-case payment reimbursements don’t cover the cost of care
• Costs of transportation between widely dispersed facilities
• “Out-of-network” status of rural hospitals, while insurers continue to sell plans there
• Basing reimbursement on “approved” or “allowable” costs is unsustainable, generating a 9-20% operating loss for the past 2 years in Columbia County.

The bottom line:

• Reimbursements based on “approved” or “allowed” amounts do not cover the real cost of care, resulting in a 9-20% operational loss for some rural hospitals
• The burden of underinsurance leads to uncompensated care
  • At Columbia County, their balance sheet is a negative $2,000,000 
  • At Mason Health, 83% of outstanding accounts were under $5K, the standard insurance-plan deductible

A Sustainable Rural Health Care System Needs: 

• Consistent rules and processes
• Lower administrative costs
• Include “standby time”
• Include Long Term Care – chronic shortage of Medicaid beds
• Opportunity to innovate
  • Home health
  • “Aging in Place” – either at home or in an assisted living facility
  • Advanced Wound Care Treatment to avoid amputations and promote better quality of life

Next Up:  The Finance Technical Advisory Committee (FTAC) meets Thursday, March 13th, from 2-4:30 pm Join on Zoom 

The next meeting of the UHCC is Thursday, April 17th from 2–5 p.m.

We encourage you to:

• Sign up to provide public comment by 5 p.m. the day before the meeting occurs.
• Push for a single payer plan in your public comments.
• Read our take on past UHCC and FTAC meetings

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