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. You can read their introductions here. 

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.