This year is a very short 60-day session and there is alot to get done! While we certainly have been focused on the Universal Health Care Commission (UHCC), HCFA-WA is also advocating for the following bills. 

SB 5532 (Keiser, D-Des Moines) and companion bill in the House HB 1671 (Riccelli, D-Spokane): Establishing a prescription drug affordability board. This bill (or one close to it) was passed in 2020, but vetoed by Gov. Inslee when there was fear that a severe state revenue shortage was about to happen.  

SB 5546 (Keiser, D-Des Moines): Concerning insulin affordability. The insulin affordability bills that passed in 2020 placed a $100/month limitation on co-pays or co-insurance for insulin. This cap was a temporary step, assuming that the Total Cost of Insulin Work Group would propose a long-term solution by the end of 2022. Because of COVID-19, the work group has yet to be implemented, so the expiration date needs to be extended, and the cap on co-pays would be lowered to $35/month. Also, HB 1728 (Maycumber, R-Republic) would reauthorize and amend the dates for the work group.

HB 1713 (Thai, D-Mercer Island): Requiring cost sharing for prescription drugs to be counted against an enrollee's obligation, regardless of source. This is another insurance billing abuse. For example, co-pays or co-insurance for drugs currently may not count toward a patient's annual deductible, thereby increasing the patient's out-of-pocket costs for the year. We will support this effort to reduce the out-of-pocket costs of health care. SB 5610 (Frockt, D-NE Seattle) is the companion bill in the Senate.

HB 1688 (Cody, D-West Seattle): Protecting consumers from charges for out-of-network health care services, by aligning state law and the federal No Surprises Act and addressing coverage of treatment for emergency conditions. The title says it all, and this bill is a step toward treating everybody the same – our ultimate goal. The Senate companion bill is SB 5618 (Cleveland, D-Vancouver). 

HB 1708 (Cody, D-West Seattle): Concerning facility fees for audio-only telemedicine. This bill will prevent clinics from adding fees on top of the health care provider's fees, and it will expose (and maybe halt) abuse in medical billing.

HB 1676 (Harris, R-Clark County): Using the taxation of vapor products to fund additional tobacco and vapor use prevention and cessation programs and services. This bill has the makings of a bipartisan push to really do something about the negative impact of vaping.

SB 5589 (Robinson, D-Everett): Concerning statewide spending on primary care. This bill would set up measuring expenditures on primary care in the entire state, and then increase it by 12%. 

SB 5142 (Frockt, D-NE Seattle): Establishing the profession of dental therapists. This bill has been supported by health care champions in the Senate and House to address inequities in dental access in urban and rural areas of our state. (The bill is a carry-over from the 2021 legislative session.)

A bonus update from ACLU-WA on Keep Our Care Act - SB 5688 Health care marketplace

SB 5688 was heard in the Senate Committee on Law and Justice on January 18. Click here to watch the video of the hearing.  As stated by the ACLU:

 “Mergers and acquisitions between health care entities such as hospitals, hospital systems, and provider organizations are prolific in Washington state. These consolidations have been shown to negatively impact cost, quality, and access to necessary health care services. Yet in Washington, these health entity consolidations receive minimal oversight, allowing large health care systems to dictate patients’ access to care, including reproductive, end-of-life, and gender-affirming care.“

The next meeting for the Universal Health Care Commission is Friday, February 25, 2022 from 2-4 p.m. Please check in to see the agenda and other meeting materials so you can be prepared to comment! Here is where the Zoom link, the schedule and other materials will be posted. 

If you missed the January 4th meeting and would like to see it, here is the link.

For a  bit of background for new readers, click here. 

The January 4th meeting started with a summary of the findings from the WA State Institute for Public Policy as a comparison of countries that use a multi payer health care system as opposed to a single payer system. Germany, France, The Netherlands, Switzerland  are countries whose health insurance coverage is administered through multiple, mostly nonprofit, insurers. On the other hand the United Kingdom, Scandinavian countries utilize a single payer model where the national health service owns many hospitals and clinics. This is a slight difference in Canada and Australia where providers are typically private and are reimbursed through a tax-financed government plan.  In both single and multi payer systems, governments regulate insurers, subsidize coverage for low income residents, determine standardized benefit packages and finally control prices of services and drugs.

Unsurprisingly, in all countries the cost of health care was significantly lower  with significantly better health outcomes. The USA spends about 18% ($9,400/person) of our GDP with higher rates of infant mortality and maternal deaths than other countries which spend on average about 11% ($5000). 

We also heard from consulting firm Health Management Associates who started with a historical background including the 2006 Washington State Blue Ribbon Commission on Health Care Costs & Access. HCFA-WA Board Member Dr. Weinberg noted that no action was taken on the 2006 recommendations and emphasized the need to ensure the UHCC recommendations are enacted and do not suffer the same fate. 

The firm presented their analysis of the models put forth in the 2019 Universal Health Care Working Group with the final slide showing that Model A scored highest on their criteria of  Access, Affordability, Equity, Governance, Administration and Quality. Their conclusion of Model A as the least feasible drew pushback from Work Group members.

The actuaries found that if Model A were implemented, it would save $1.56 billion in health care spending statewide in the first year, and $5.5 billion each year thereafter, while also guaranteeing high-quality, comprehensive health care to every Washington resident. In fact in a straw poll the majority of the Work Group chose Model A as the most feasible model to deliver truly affordable and universal health care.   The Commission does need to hear why our readers think that Model A is feasible, so please plan to submit your comment to the Commission at its next meeting on February 25.  To receive the Zoom link, agenda, and meeting materials please click here to subscribe.  

If you would like the slides from the Jan 4th meeting, click this link. 

Local Action 1

Sign in “pro” 

SB 5589 (Robinson, D-Everett): Concerning statewide spending on primary care. 

When: Fri., Jan. 21st – 8:00 a.m.

What it does:  

• Requires WA’s Health Care Cost Transparency Board to measure and report on state primary care expenditures 
• Sets goal of increasing primary care spending to 12% total health care expenditures. 
• Allows OIC to consider this primary care spending target in health plan filings.

Why it’s important:   Establishes a benchmark to improve primary care utilization across the state

Sign in “pro” by 7:00 a.m.- 1/21:  https://app.leg.wa.gov/csi/Senate#

• Committee drop down menu choose: Senate Health & Long-Term Care Committee

• Select Jan 21st at 8am 

• Select Bill 5589

• Select My Position Noted 

• Position:  Select Pro  

• Enter your information 

• Do not forget to Submit 

Local Action 2 

Universal Health Care Commission Meeting Feb 25.

The Commission does need to hear why our readers think that Model A is feasible, so please plan to submit your comment to the Commission at its next meeting on Feb. 25th.  To receive the Zoom link, agenda, and meeting materials please click here to subscribe.  

Check our Facebook as we put up HCFA-WA actions by early next week! 

Federal Action 1

Stop Direct Contracting Entities (DCEs) from taking over traditional Medicare.

There is still time to sign the petition. 

Under this model, the Centers for Medicare and Medicaid Services (CMS) could move more than 30 million traditional Medicare beneficiaries into mostly commercial, for-profit plans called Direct Contracting Entities (DCE) without the enrollees’ understanding or consent.

In ways similar to commercial Medicare Advantage plans, DCEs have the potential to interfere with care decisions and waste taxpayer money when compared with the efficiency of traditional Medicare.   While the Biden Administration has put a hold on DCEs, the threat still remains.

This petition has been updated slightly for clarity. Click here to sign 

One-page fact sheet: pnhp.org/DCEFactSheet

DCE webinar recording: pnhp.org/DCEWebinar

1a. Write Your representative, op-ed and letters to the editor. Here are some points to get you started. Thank you to member Cris M. Currie, RN (ret.)

• Since 1972 various “risk bearing” entities such as HMOs, ACOs, and IDSs have failed miserably to control rising costs and improve outcomes.
• Fee for service is not the driver of health care costs in the USA. Corporate intermediaries are responsible for over 30% of the cost in useless overhead.  With DCEs, that overhead could increase to over 40%. 
• As demonstrated by Medicare Advantage Plans, DCE will lead to: 

  • even higher prices

  • reduced services   

Inflated diagnostic codes to make members appear sicker than they are to increase risk scores and maximize capitation payments.

We are spotlighting the members of the Universal Health Care Commission who introduced themselves at our Second Wednesday Speaker Series on December 8. On the recommendation of the offices of the Washington State Health Care Authority and the Attorney General, we invited only the committee Chair, Vicki Lowe. Following this recommendation enables us to comply with the Open Public Meetings Act. By inviting only Chairperson Vicki Lowe, we prevent the public perception of conflict that would be created if we were to hold a Universal Health Care Commission meeting without making an official announcement. However, we did want to introduce HCFA-WA members to the Commissioners, so we asked them to briefly introduce themselves after Chairperson Vicki Lowe spoke.  

To watch the video of this event, please click here. 

We first invited Universal Health Care Commission Chairperson, Vicki Lowe, to speak about the Open Public Meetings Act.  Speaking with her was Dr. Sarah K. (Sherry) Weinberg, co-chair of the HCFA-WA Policy Committee and President of the HCFA Education Fund."

Vicki Lowe:  I had the pleasure of taking the Open Public Meetings Act training three times last week because I am on the Universal Health Care Commission, the Missing and Murdered Indigenous Women and People Task Force, and a newly elected City Council Member for the City of Sequim. The importance of sunshine laws is they shine a light on government and ensure the government is not making decisions that the public do not know about or understand. Not having a quorum here is important because this is a presentation to HCFA – WA and it is not an open public meeting. We want to make it clearly understood that there is no action happening for the Commission here tonight. We just want to ensure that we are not doing anything to jeopardize the Commission, so thank you for being understanding and being here tonight.

I hope that many of you can join our meetings, and if you cannot, the meetings are recorded. There is also an opportunity for public comments. The public comments are very important because you have a chance to speak directly to Commission members. Remember the decisions that will be made by the Commission will directly impact you.  

Dr. Weinberg: I enjoyed serving with you on the work group that created the Universal Health Care Commission and put you in charge. I wish you the best of luck as your year goes forward. Our first question is: What is your relationship to universal health care and your commitment to making it a reality?

Vicki Lowe:  Thank you and thank you, Dr. Weinberg. I really enjoyed serving on the Universal Health Care Work Group with you as well, and Ronnie, and many other people.

I have a 25-year background working in the Indian health care delivery system.  I think people wonder what that has to do with universal health care. First, the Indian health care delivery system is universal health care, it's just chronically underfunded. 

I told a little bit about my personal story, of being a pregnant teenager and finding out that my pregnancy was not covered by my dad's insurance because insurance didn't cover the pregnancy of a dependent. That is still a practice of the insurance companies today. My daughter is now 39, so that's been going on for quite some time. I spent all of the money for college on the pregnancy and birth of my child. That greatly impacted my life and the choices I had to make. 

When I went to work for the Jamestown S’Klallam Tribe in 1996, we did not have a clinic, so we bought insurance for our tribal members. If they were eligible for Medicaid, we helped them sign up for it. If they have Medicaid, we helped them use it. If they had Medicare, we helped them use private insurance and bought Washington Basic Health Plan, a state-subsidized health insurance program that was a soft subsidy. As a point, it is similar in concept to today's Universal Health Care Commission. I convinced Physician Services to make a health plan for tribal members, which was really unheard of back then because the insurance companies certainly could not understand that the relationship that a tribe has with their members is greater than the employer to employee relationship. A few years later, the tribe did start a clinic and I helped with the contracting. Since then, I helped the Jamestown Tribe establish self-funded employer insurance.

So I have a lot of experience with helping people use insurance coverage, Medicare and Medicaid, and seeing the barriers and the frustration from those barriers. In my position as the Executive Director of the American Indian Health Commission for Washington State, I work at the state level to get rid of some of those barriers.  So in the last few years, I've actually learned about the legislative process by helping draft and pass legislation.

But the experience I had as a teenager, having this huge financial issue with being pregnant without coverage and the struggle I had is huge. Along with helping our tribal members trying to access care and seeing some of the perceptions that people have about people who are on Medicaid or who are covered through Indian Health that somehow is taking away coverage from some else. It seems really sad to me that health care is about money when it should be about taking care of people.  I fully support universal health care, and when this bill was written, I actually gave testimony in support.  So thank you for getting  the opportunity to share that, Ronnie and Dr. Weinberg.  

Dr. Weinberg: We have the second question now.  What do you view as the charge or purpose of the Commission?

Vicki Lowe: Our purpose is to get to a single payer system, but the law (SB 5399) was written with the opportunity to do so incrementally.   Some mentioned the Affordable Care Act, which I think was a great first step, but it was a pretty sweeping change.  But ACA got a lot of backlash so I think it's really important to when doing this work to bring everybody along and ensure a single payer system for all Washingtonians.   

Dr. Weinberg: So you think it will have to be done incrementally? That we won't be able to put in place a-cover-everybody-plan?   

Vicki Lowe: The goal is universal health care at the end of the time period, 2026. But we can do all this work and make recommendations, but it's still up to the legislature to pass it. So it is a good thing that we have legislators on the Commission like Senator Randall, who sponsored the bill and really helped get it passed. It was written to allow the legislature to make changes between now and then.  

Also I think it's hard to make sweeping changes. I just think we need to be cautious, thoughtful, and think backwards. We need to be careful of our most vulnerable population, because when we make big changes, those changes may have impacts that we do not really see. We also need to recognize that change can make your average person feel uncomfortable, and figure out ways to bring him along. 

Because health care has been so focused on being health insurance, about money, we really have to focus on the perspective of access to care and the most vulnerable populations. But also this happened a lot with the Universal Health Care Work Group, we were talking about how to get to a system that benefits you, bring in the right providers, and the next thing you know we are talking about premiums and co-pays.

Dr. Weinberg: That is a good one. I view it as creating a system, with then the question being, how to sell and implement it. But you're right, part of that is bringing along a wide variety of people. It's good that the commission has people who have a lot more exposure than this octogenarian retired pediatrician.  

Vicki Lowe: What you know about health care is so valuable. At the Universal Health Care Work Group you always got us right back on point.

Dr. Weinberg:  Let me say that as long as I'm still going, I am available as a resource to the commission. We have a final question for you before we introduce the rest of the Commissioners. What do you hope to see as a result of the commission? How do we get from here to there? 

Vicki Lowe:  I think that is that incremental change management. We really have to sometimes ensure that our way towards big change does not overwhelm people. It is good to be cautious, to make sure that the changes we make are not having adverse effects on the most vulnerable. There are going to be a lot of moving parts. 

But I told my kids that I really want to see them not have to worry about having insurance coverage by 2026. It is a big task, but there is purpose and hope.  

To learn more about other Commissioners and a brief perspective of their particular interest and what they each bring to the team, please click here.

Here are some selected questions from the audience for Vicki Lowe. 

Emil Chang: What are the ways that this organization can help the Universal Health Care Commission in this process? Please be specific.

Vicki Lowe: Doing just what you are doing tonight is supporting the commission. Sharing information about us, how to access the meetings and the notes.   

It's really important that people understand change as it's happening, and most importantly to feel like you're a part of what's happening.  I think coming from working with American Indians and Alaska Natives, when you don't have a lot of resources, health care is something that happens to you. So when there is change, there's a lot of fear.  Because even though it might not be the best situation, at least you know what it is. So there is always the fear that it could get worse. 

So helping us keep people informed about what is going to happen is really important.   

Paul and Nancy OldenKamp: I believe the legislature has set a deadline of November 2022 for a baseline report that is required to cover a large number of topics. How will this report be accomplished? How will all the work needed to create an operational universal health care system be accomplished?

Vicki Lowe: You know the legislature funded the Health Care Authority to help staff the Commission so it's not us all volunteering our time. They are really the worker bees, they set the agendas and do the invites but they'll also be doing the work in between.  They are actually looking to hire a consulting firm to help with some of that work, like we had with the Universal Health Care Work Group.  

Paul and Nancy: What are the short term and intermediate schedules? Does the short term schedule cover the work and production of the baseline report and then the intermediate schedule would cover the rest? 

Vicki Lowe: If I am  understanding the questions, yes. We will meet every two months, through next year I think all those meetings are scheduled out.  If there's things that happened in between that we need to deal with, we have to follow the Open Public Meetings Act rules to give adequate notice and all those things. 

I think as we move through we will know better what's going to happen in the next year, but I imagine it will be a lot the same because we want to keep up that pace and keep the changes happening.

Cris Curry and David Loud both asked questions about Model A from the Work Group: How are you planning to handle the two models of the UHC discussion Work Group, since the Work Group did not officially recommend Option A.  Option A was the publicly funded, option B farmed out the administration to private risk bearing entities. 

Vicki Lowe: I remember the conversation and we did make sure that our voices were all heard.  We made sure that each of us were able to say which option and why we chose it.   

I think there were some differences of opinion if the work group was advisory or were supposed to make a recommendation to the legislature.  So I think the Commission is a little bit different because we are working to make recommendations.   

I remember most people picked A, but there should be steps to that path 

Diana and Dale   Do you have any thoughts about the relevance of the original health reform plan that former Gov. Kitzhaber from Oregon created? The Coordinated Care Organization for the Medicaid population was intended to expand the state employees and then private businesses.  Is that model at all relevant to what we're going to be doing this year? 

Vicki Lowe: I only really understand from those two Coordinated Care Organizations from the tribal perspective and how the tribes have worked with them.   

However, I do think that it's important to look at what's been done and other states and really see what's worked, and think about how that can be incorporated into what we're doing here.   Again, that's the importance of having the HCA staff and consultants really bring those resources in so we can look at and think about what other states are doing.  

Bill of the Month 

NICU Bill Installment Plan: That’ll Be $45,843 a Month for 12 Months, 

After baby Dorian arrived two months early and spent more than 50 days in NICU, his parents received a bill of more than $550,000 — despite having insurance.

Healthcare News

HCFA-WA in the news on Medicaid disenrollments

Following a federal emergency declaration in March 2020, millions of Americans enrolled under Medicaid due to job loss and continuous coverage requirements. In Washington State, the number could be in the hundreds of thousands. Our own Marcia Stedman shares how a universal health care plan would eliminate the churn and dislocation of patients from their trusted health care providers. 

Click here to read Rep Jayapal and Dr. Susan Roger’s Opinion Piece on Direct Contracting Entities in the Hill. 

“Direct Contracting is a pilot program, it can and should be stopped in its tracks by the Biden administration while we have the chance.  As a physician and a member of Congress, we’ve never heard a senior ask for their health care to be more complicated, or to have their choice of Traditional Medicare taken away. But that’s exactly what Direct Contracting would do.”

Pramila Jayapal represents Washington’s 7th District in the U.S. House of Representatives and Susan Rogers, M.D., president of Physicians for a National Health Program

A New Ban on Surprise Medical Bills Starts Today. For years, millions of Americans with medical emergencies could receive another nasty surprise: a bill from a doctor they did not choose and who did not accept their insurance. A law that goes into effect Saturday will make many such bills illegal.

Doctors sue Envision Healthcare, say private equity-backed firm shouldn’t run California ERs

The suit says California law bars corporations from practicing medicine. Many states have similar laws but haven’t invoked them. 

Martin Shkreli, the former drug firm executive who ordered dramatic price hikes of a life-saving medicine, has been ordered to repay $64.6m in profits. In 2015 he raised the price of Daraprim used to treat protozoal infections such as Malaria as well as given to people living with HIV, by around 4,000% - overnight.