From Cindi Laws, HCFA-WA lobbyist, this breakdown of the important health care bills this session - including ours!
Key Legislative Bill Elements
CORE-4: 3 of our 4 bills passed, but the language of the 4th was included. That's 100% success on our primary legislative objective.
Engrossed Second Substitute House Bill 2662
Summary
Establishes the Total Cost of Insulin Work Group; Caps the total out-of-pocket cost for a 30-day supply of insulin at $100 for two years.
What it means for Health Care for All-Washington
HCFA-WA developed a proposal last summer to have the state cover the cost of insulin and supplies for people with insulin dependent diabetes, using a model based on the very successful Childhood Vaccination Program. Our proposal was picked up, and a lot of legislative and health policy staff work went into what could legally be done in one legislative session. HB 2662 combines two Senate Bills, 6087 (which passed) and 6113.
This bill goes a long way towards government administering health care.
The work group must review and design strategies to reduce the cost of and total expenditures on insulin in this state. Strategies the work group must consider include, but are not limited to, a state agency becoming a licensed drug wholesaler, a state agency becoming a registered pharmacy benefit manager, and a state agency purchasing prescription drugs on behalf of the state directly from other states or in coordination with other states.
This is also significant: if the total cost of insulin work group determines that all or a portion of the strategies may be implemented without statutory changes, the health care authority and the prescription drug purchasing consortium shall begin implementation without further legislative direction. Prescription insulin drugs must be covered without being subject to a deductible, and any cost sharing (co-pays) must be applied toward the enrollee's deductible obligation.
Bill changes during the legislative process
HCFA-WA lobbied, and won, the addition of a diabetes patient advocacy group who also lives with diabetes to the work group. The final bill limited the scope of the work group a bit, but the core elements were left intact.
Vote Notes
Overwhelmingly supported by both Chambers of the legislature (97-1 in the House, 48-0 with 1 excused in the Senate). The bill was originally developed by Rep. Eileen Cody, who graciously passed the bill to Rep. Jacqueline Maycumber, who told her heartbreaking story of her toddler son being hospitalized with Type 1 diabetes. Several other members of the legislature have diabetes or have family members with the disease.
2/26/20 - Rep. Jacqueline Maycumber (R-WA, LD-7) introduces her insulin affordability bill E2SHB2662 in the Senate Health & Long Term Care Committee
2/26/20 - Dr. Sherry Weinberg, HCFA Education Fund president and Physicians for a National Health Program - Western WA president, citizen Marcee Stone-Vekich and HCFA-WA lobbyist Cindi Laws, Senate Health & Long Term Care Committee
Engrossed Second Substitute Senate Bill 6087
Summary
Limits out-of-pocket expenses for a 30-day supply of insulin to $100; Requires the Health Care Authority to monitor the price of insulin.
What it means for Health Care for All-Washington
Most of 6087 is contained within 2662. This is government putting a price cap on private insurance companies, which will “encourage” insurance companies to negotiate prices with Pharma.
Bill changes during the legislative process
Several amendments were added during the bill’s journey, but the “striking amendment” in the House Health & Wellness Committee brought the bill back to its original language.
Vote Notes
Mostly bipartisan in the Senate (34-14 and in the House (66-33). Again, this bill is contained within 2662, which passed unanimously, showing that sometimes weird things are happening behind the scenes.
1/17/20 - HCFA-WA President Marcia Stedman and Vice President Ronnie Shure, and Dr. Sherry Weinberg, President, HCFA Education Fund and Physicians for a National Health Program Western Washington, Senate Health & Long Term Care Committee.
2/25/20 - Lobbyist Cindi Laws, House Health Care & Wellness Committee
Senate Bill 6113 (did not pass but was incorporated into 2662)
Summary
Establishes the Central Insulin Purchasing Work Group. The Work Group must design a purchasing strategy to allow the State Prescription Drug Purchasing Consortium to act as the single purchaser for insulin in the state.
The essential provisions of this bill were brought into 2662, establishing the Total Cost of Insulin Work Group, which is charged with designing a state-administered drug purchasing entity.
Vote Notes
This bill enjoyed bi-partisan support in Senate Committees, but unfortunately it died on the House floor.
2/25/20 - Cindi Laws, House Health Care & Wellness Committee
Substitute Senate Bill 6088
Summary
Establishes the prescription drug affordability board, requires the board to identify prescription drugs priced above a certain threshold, and authorizes the board to conduct cost reviews of drugs and set upper payment limits for state purchasers.
What it means for Health Care for All-Washington
This bill is getting government deep into the examination and control of the cost of individual drugs, and, by establishing upper payment limits, putting price caps on the drugs the state purchases.
Vote Notes
This bill was highly partisan in the Senate (28-20), but, once it got out of Appropriations (27-6), was overwhelmingly supported in the House (94-3, one excused).
Second Tier Priorities
Engrossed Substitute House Bill 1608
Summary
If a health care provider is acting in good faith, within the provider's authorized scope of practice and the relevant standard of care, a health care entity may not limit the health care provider's provision of accurate and comprehensive information and resources to a patient regarding the patient's health status, including diagnosis, prognosis, recommended treatment, treatment alternatives, information about available services and where and how to obtain them, and any potential risks to the patient's health or life; or information about Washington's Death with Dignity Act.
What it means for Health Care for All-Washington
Many independent health provider systems have been absorbed into faith-based systems (i.e. Providence, CHI Franciscan). Patients are not always being told the range of health care options that violate the religious tenets, including Death with Dignity and abortion. This bill essentially stops religion-based health systems from limiting patient options and would allow a doctor or other provider to explain all options, without penalty from the health system. For HCFA-WA, we strongly support ensuring that patients know what their options are, both in terms of cost, but especially in terms of treatment – or not.
Bill changes during the legislative process
Weakened language requiring the actual provision of services in these health systems but strengthened language about providing treatment information to patients.
Vote notes
The bill was strongly partisan in the House (65-33, most GOPs opposing), but passed with strong bipartisan support in the Senate (39-7).
Second Substitute House Bill 2457
Summary
Establishes the Health Care Cost Transparency Board to annually calculate the total health care expenditures in Washington and establish a health care cost growth benchmark.
What it means for Health Care for All-Washington
The Board will examine increases in total health expenditures and specifically to the highest cost drivers in the health care system. Importantly, this identifies providers and payers exceeding the health care cost growth benchmarks. This fits with HCFA-WA because we need to know what the total costs of care are in order to properly determine how much funding will be needed to cover health care.
Bill changes during the legislative process
Strengthened significantly by adding the identifier of high cost/price gouging providers, expanded advisory board, added provisions that ensure no conflict of interest or self-dealing.
Vote notes
Bipartisan at every step (75-23 in House, 32-17 in the Senate).
Substitute House Bill 2464
Summary
Limits the maximum amount a purchaser of prescription medication may be required to pay at the point of sale.
What it means for Health Care for All-Washington
This is government limiting the cost that patients pay out of pocket for prescription drugs. More, this is government requiring insurance companies to absorb the cost, which pushes insurance companies to lean harder on Pharma to negotiate lower prices. This is a big step.
Vote notes
The bill was introduced by two rural Republicans, neither of whom are on health care committees, showing that drug costs affect everyone. This bill did not receive any “no” votes throughout its journey.
Rep. Chris Gildon (R, LD 25) introduces his bill; HCFA-WA President Marcia Stedman testifies in the Senate Health & Long Term Care Committee.
Passage of Other Bills of Note
6097: Will help keep insurance premiums more stable and health care more affordable by allowing the Office of the Insurance Commissioner to consider an insurance carrier’s surplus money and profit margins when an insurer applies to raise its premiums.
5601: Creates greater transparency in health care by regulating benefits managers while also providing consumers recourse when they’re having trouble getting benefits to which they are entitled.
