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FTAC Meeting 2: Transitional Solutions, Medicare Questions, and Lessons from the Indian Health Care Delivery System

by Marcia Stedman

If the devil is in the details when it comes to funding universal health care, members of the Finance Technical Advisory Committee showed they were ready to deal with the ogre in the room. At meeting #2, they tackled two important topics: sorting through transitional solutions to achieve the goal of universal health care and discussing options for including Medicare enrollees in Washington’s universal health care system. They also heard a solution-packed presentation on Washington’s Indian Health Care Delivery System

1. Transitional Solutions Toward Universal Health Care

Consolidated purchasing for state programs generated the widest-ranging discussion and general agreement that this solution be recommended to the full UHCC (the Commission) for further study. Because the state currently controls 30 percent of the insured market through the Medicaid, Exchange, and Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) benefit programs, this would be a high-impact (although somewhat resource-intensive) solution that would prepare Washington for a universal health care system. 

Auto-enrollment of those not eligible for Medicaid to the no-premium plans on the Health Benefits Exchange. Currently being done in other states, this high-impact and less resource-intensive solution also generated interest, particularly as the end of the public health emergency will result in many Washingtonians losing their Medicaid coverage within the next six months.  

Out-of-network price caps on providers is another high-impact and less resource-intensive solution that has led to lower in-network reimbursement rates in other states.

Regulated hospital global budgets would have the highest impact of the solutions discussed, but would be resource-intensive due to the current fractured payment system and the political challenge of obtaining the necessary legislation.   

2. Medicare: To Include or Not To Include?  

The Committee had plenty of questions:

  • How would Washington even do this, absent a consolidated system?
  • What cost/benefit analysis is needed? 
  • How would payment work? What would the benefits be? Would it be feasible?
  • Would this be a state plan, contracted through a managed-care organization? 
  • Would it be offered as an option to current Medicare patients?
  • Can we afford it?
  • Can we get per-capita trend data?
  • Can we pursue a waiver at this time?
  • Should we take Medicare off the table?

In the end, the Medicare question seemed a bit like a hot potato lobbed between the full Commission requesting options for including it in our state plan and the FTAC needing direction from the Commission around its vision for the system and benefit design.  Clearly, this topic needs further discussion, especially because it threatens to drain energy away from developing an achievable system that works for everyone who is not yet on Medicare. This topic is sure to be on the agenda for the next FTAC meeting on Thursday, May 11, 3-5 p.m.

3. Washington’s Indian Health Care Delivery System Is a Universal System

During this discussion, which was sandwiched between the transitional solutions and Medicare discussions, Vicki Lowe, Executive Director of the American Indian Health Commission (AHIC) and Chair of the Universal Health Care Commission, explained that by enrolling all tribal members in the state’s Medicaid program and providing wrap-around services as needed, they can deliver the same quality of affordable healthcare to all enrollees, regardless of age, income, or employment status. There are challenges, notably around funding, but this model can inform the Committee’s work and help our state achieve its goal of affordable, high-quality healthcare for every Washington resident.

Following are the meeting materials and a video recording of the meeting:

Mark your calendar for these upcoming meetings:

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Got comments? All UHCC and FTAC meetings are open to the public, and public comments are encouraged. Sign up to provide public comment during a meeting by 5 p.m. the day before the meeting. If you want your written comments to be included in an upcoming meeting, email your comments two weeks before that meeting by contacting the Health Care Authority (HCA) at any time. Subscribe here to receive meeting notices in your own inbox


Read the FTAC Meeting 1 recap

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