Watch your email and HCFA-WA’s social media for upcoming opportunities to take action!

Senate and House Budgets Fund Immigrant Health and Universal Health Care Commission (UHCC)!

HCFA-WA’s top-tier legislative actions depend heavily on the budget. HCFA-WA has been advocating strongly for appropriations for immigrant health and the UHCC. 

Immigrant Health 

Both the Senate and House budgets proposed significant appropriations (appears to be about  $20 million from the Senate and $95 million from the House) for a statewide Medicaid-like health insurance program that would cover uninsured  adults regardless of immigration status. The amount and sources of funding, eligibility requirements and other program features will continue to be negotiated and amended through the legislative cycle. 

Estimates show that approximately 30,000 uninsured immigrant residents in Washington would be eligible for health insurance through this program, beginning in January 2024. Caseload forecasting anticipates an initial enrollment of 1500, increasing to 7000 after four years.

Finance Technical Advisory Committee (FTAC) of the UHCC

Both the Senate Ways and Means and House Appropriations committees endorsed the following funding, matching HCFA-WA’s proposals:

• $132,000 for 2024 and $125,000 for 2025 for additional staff dedicated to the work of the FTAC 
• $250,000 for 2024 and $250,000 for 2025 for consultant services, dedicated actuarial support, and economic modeling
  

This additional funding would expedite FTAC work, we hope through enabling more frequent small group meetings that would require additional administrative coordination and support.

Expert dedicated actuarial support and economic modeling can demonstrate how a publicly funded system will achieve substantial savings over the current system, while ensuring that all Washingtonians are covered.

What is the FTAC? This UHCC committee provides subject matter expertise and advises the UHCC on developing a financially feasible, publicly funded model. Roger Gantz, who serves on the HCFA-WA Policy committee, is a member of the FTAC. Through his work on the FTAC, he represents our vision of how publicly funded universal care can be achieved. Roger was Policy Director for Washington Apple Health (Medicaid) and has worked with lawmakers on health care reform for low-income individuals.

HCFA-WA has been meeting regularly with individual members of the UHCC and FTAC to create dialogue, and offer resources and experienced perspectives from our members who have worked for decades on UHC legislation and advocacy.

SJM 8006 This Joint Memorial bill is a formal request from the legislature to the federal government.  It requests to either create a universal health care program or, absent federal action, partner with the state to implement a single-payer health system. To allow the state to implement a single-payer health system, Congress could pass House Resolution 3775 or grant the state the appropriate waivers.  The bill has passed the Senate and now the House Health and Wellness Committee.

SB 5729 - No Expiration Date for Insulin Price Cap! 

The expiration date of January 2024 was removed for limiting out-of-pocket expenses to $35 for a 30-day supply of insulin. This bill sailed through both houses, with great bipartisan support.

For more information about this and other  legislation that we’re supporting this session, visit the Current Legislation page on our website.

Spotlight On: FTAC
by: Marcia Stedman, Immediate Past President, HCFA-WA Board

Transitional Solutions, Medicare Questions, and Lessons from the Indian Health Care Delivery System

If the devil is in the details when it comes to funding universal health care, members of the FTAC (the 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. and at the upcoming UHCC meeting on Tuesday, April 11, 2-4 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:

• View the meeting materials (March 9)

• Watch the meeting

Mark your calendar for these upcoming meetings:

• Universal Health Care Commission
  UHCC – Tuesday, April 11, 2-4 p.m.

• Finance Technical Advisory Committee
  FTAC – Thursday, May 11, 3-5 p.m.

Get Engaged!

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

HCFA-WA March 8th 2nd Wednesday Speaker Series: Legislative Update: Making sausage before our very eyes

There was substantial interest in our 2nd Wednesday Speaker Series presentation on March 8. During this informative session, HCFA-WA Policy team volunteers and our lobbyist, Lonnie Johns-Brown, provided a legislative update on how things stood 60 days into the 105-day session. Lonnie provided a great bird’s eye view of the current legislative landscape and the importance of the upcoming budget for our legislative priorities. Great background on the bills was provided by members of the HCFA-WA Policy team.

Watch the video here

Health Care Cost Transparency Board February Meeting Highlights

The HCA Health Care Cost Transparency Board (HCCTB) meets monthly. The Board is charged with setting benchmarks for the state’s health care cost growth and making costs more transparent to payers and the public. Here are some February 2023 meeting highlights.

Consumer Experience in the Public Option

This month’s meeting featured a presentation of the HCCTB plan to prepare a July 2023 report on the consumer experience of benefits, premiums, and cost sharing for enrollees in the Cascade Select plan. Cascade Select is Washington’s public option plan offered under Cascade Care. This plan tripled its enrollment, to 27,000 enrollees in the last year. 

Adjust for Inflation?
The Board spent considerable time discussing how and whether the benchmark cost growth figure should be adjusted to account for inflation. The challenges in getting timely data on different types of inflation were raised. Later adjustment to account for inflation data lag time might be necessary. The Board voted not to adjust for inflation. Instead, they would continue to study the matter when more data is available.

Cost Growth Driver Analyses: Prices Up in Pharmacy and Hospital Spending
The high-level analysis is that from 2017 to 2021, hospital and pharmacy prices drove overall health care spending growth. The Board considered a drill-down analysis to develop strategies to mitigate this, and identified areas for staff to gather further data.

• Newsom announces $50 million contract to make California’s own brand of insulin

• A survey showing that Majority in U.S. Still Say Gov't Should Ensure Healthcare

• The role of venture capitalists and insurance companies: Dr. Venture Capital: Insurance companies are supposed to cover high-quality care for patients. What happens when they dabble in investing?

• Silicon Valley Bank was a major lender and partner for venture-backed start-up healthcare companies: Fall of SVB hits healthcare sector as federal regulators step in

• Mission and Money Clash in Nonprofit Hospitals’ Venture Capital Ambitions

• They are even in our nursing homes: Private Equity Companies Continue Buying Nursing Facilities

• Podcast: The effects of health care consolidation on prices, quality, and access- New England Journal of Medicine   

Washington State Health News

The COVID-19 Public Health Emergency period has ended, and Medicaid enrollees could lose coverage: Apple Health (Medicaid) eligibility was extended during the pandemic, which helped Washington to achieve record-low rates of people uninsured during the pandemic.

As many as 300,000 Washingtonians may lose coverage after their present term. Eligibility criteria are detailed on the HCA website. 

Updates on other states’ single payer healthcare initiatives

• Oregon: Oregon Lawmakers Consider Next Step Toward Universal Health Care

• Colorado: Bill Would Study Universal Health Care for Colorado

• New York: Lawmakers, Unions, Negotiating Single Health Care Payer Bill