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October 2020 e.Bulletin

We’re up to Meeting #7 of the Universal Health Care Work Group. Only two more to go. Read the recap!  Send your comments!

Despite the objective of the ACA to eliminate medical debt and bankruptcy, it’s still a big problem in the US and in Washington with far-reaching impacts to people’s lives.  We take a look at the causes, what’s being done about it, and what should be done. (Spoiler alert: publicly funded and administered universal healthcare is what should be done!)

HCFA-WA’s Vice President Ronnie Shure attended the September 2020 State of Reform Conference.  He recaps the highlights in the form of a quiz!  See if you can match the quote to the quoter!  We wonder if Ronnie’s next report will feature him doing an interpretive dance or poetry reading on universal healthcare.  Stay tuned to the e-bulletin to find out!

Shining a Spotlight on Social Determinants of Health, its importance to health equity, reducing health costs, and an example of a traditional health insurer investing in social/community services that support health.

Action Alerts: Did we mention it’s time to vote?  And comment on Meeting #7? 

The Annual Membership Meeting is coming!  Nov 15!  Details are in the Upcoming Events section!

Subscriber Survey! Tell us what you think so we can make the e-bulletin better for you! Thank you!

You must get out there and push and pull and make America what America should be for all of us.”-- Rep. John Lewis

Salutations and election greetings to all our readers!. Did you vote yet?  We know our readers have high civic and political engagement and we thank you for all you do to keep our democratic system operating as it should. It’s on this basis that all our efforts to make health care for all rest.

Actuarial Analyses, Administrative Savings, and Benefits

Needed: Your comments on Work Group Meeting #7

In the midst of Federal uncertainties, a pandemic, a worsening recession, and the struggle for racial justice, it is more important than ever for everybody to have access to affordable, comprehensive, and equitable health care. Read our recap below, watch the meeting, and prepare to share your comments directly to the Work Group. 

Provide public comment, which ends Monday, October 19.

For Main Takeaways from the meeting, click here.


Medical Debt and Bankruptcy: “Even with Insurance”

The US has the highest burden of personal medical debt and medical bankruptcy of the developed nations.  In 2016 Americans had $81 billion in collections for medical reasons. In 2019 it was estimated that 137 million Americans, about 26%, faced medical financial hardship.  62% of these report having health insurance. One fifth of those with medical financial hardship declare bankruptcy.

Since the COVID pandemic, new medical debt has been somewhat suppressed because of deferral of care for elective procedures, for fear of COVID infection, and being newly uninsured.   The CARES Act relief allowed some people to get their outstanding bills paid.  But there have been many reports of staggering medical bills, as well as co-payments charged when they shouldn’t have been and claims erroneously denied by insurance companies, all associated with COVID care despite legislation designed to protect patients.  

To date, only 5 states, Massachusetts,  New Mexico, Idaho, Michigan, and Minnesota, have enacted cost sharing waivers for COVID treatment.  Many cost-sharing waivers established by insurance plans have already expired or are set to expire in December.

The people most adversely impacted by medical debt, BIPOC and people with lower income, often experience aggressive debt collection tactics such as placing liens on patients’ homes and garnishing wages, which add to their financial hardship and stress.  

Even with Insurance:  Rising Deductibles, Co-Payments, Surprise Bills

While the burden of medical debt falls most heavily on the uninsured, having health insurance, whether via the ACA marketplace, or through an employer, is no guarantee of protection from financial hardship from medical bills. Deductibles in job-based health plans have TRIPLED in the last decade. Fourteen percent of working age adults, even with adequate insurance, had problems paying or were unable to pay medical bills in a recent survey.  About 35% of people who were uninsured or underinsured had problems paying or were unable to pay medical bills.  People of color experience this hardship disproportionately.


Quiz Time!  How well do you know your State of Reform-ers?

Health Care Reform Quiz 

 2020 State of Reform Health Policy Conference 

 This conference was planned to take place in Eastern Washington on September 23rd and 24th, but the pandemic changed it to a virtual conference. It brought together a variety of opinions about reforming our healthcare system. Democrats, Republicans, political insiders, healthcare providers, health insurance executives and public employees shared their opinions on the challenges for our healthcare system today. How can these different opinions be used to improve the health of the public? 

There is an African proverb that says: “When spider webs unite, they can halt even a lion.” Let’s review some of the opinions that were shared at this conference in order to take a closer look at what each leader is saying. If we search for the meaning in these quotations, then maybe we can bring these ideas together to form universal health care for all Washingtonians. 

  1.  I still have PTSD from making cuts during the Great Recession in 2009 … I cannot endure another nightmare like that … when we defunded the basic health plan and took it down. I still feel guilty about that. 

  2. Budget cuts impacting the Medicaid population should be a last resort. It’s just my preference that we do not go backwards on Medicaid. I can see that coming and I just, I don’t want to do it. 

  3. I remember Ron Sims’ fear that a pandemic will hit Seattle first, since we have such close global connections. We need to prepare a pandemic safety net with federal leadership, so that it is not state specific and does not make a political crisis out of a public health crisis. 

  4. It gives me hope that the genie is out of the bottle. This pandemic has increased our awareness of the impact of social disparities, the value of telehealth services, and importance of preparedness. 
  5. If we learned anything from this pandemic, it is that people of color, people of lower income have been affected more. 

  6. It gives me hope that we are taking a wide approach to health equity and anti-racism. 


a. Peter Adler – Molina Health Care, Chief Executive Officer 

b. Paul Harris – State Representative, 17th District Republican 

c. Karen Keiser – State Senator, 33rd District Democrat  

d. Joe Schmick – State Representative, 9th District Republican  

e. Zach Silk – Civic Ventures, President and Chief Trouble Maker 

f. John Wiesman – Washington State Secretary of Health 

Match the quotation and the speaker, then click here to see the answers.

Social Determinants of Health, Health Equity and Upstream Investment

About 80% of our health is shaped not by the health care we receive when sick, but by our social, economic, and physical environments.  These factors define “Social Determinants of Health” (SDOH) and it is now recognized that achieving health equity depends on addressing SDOH, as many marginalized and vulnerable people experience unfavorable SDOH. 

Investing in these “upstream” causes of illness and death is becoming increasingly recognized as key to not only health equity but also reducing the total costs of health care. More and more we are seeing health payers from states to commercial health plans committing resources to integrating health care with community social and economic supports.

One example in Washington is Molina Health Care.  This Accountable Community of Health (ACH) organization contracted by the state to provide coverage to Medicaid enrollees has also become a grant funder for several local social service organizations.  It is providing nearly $1 million in grants to 16 Washington-based organizations that address:

  • housing support, including youth homelessness
  • food insecurity, nutrition education, and medical nutrition therapy
  • integrating substance abuse care with specialty wound care clinic within the Tacoma Needle Exchange.
  • school-based clinics to provide preventive care services, health and safety education, and wellness programs 
  • Integrated behavioral health services with reproductive healthcare delivery at Planned Parenthood

Future Spotlights will explore how SDOH innovations are using community and patient driven models to ensure services are meeting their needs, and how return on investment is being demonstrated.

Call to Action

The Universal HealthCare Work Group needs your voice.

Public comments are an important part of the process. Your health care stories and expression of the urgency of moving our state to universal health care is vital.

Provide public comment, on meeting #7 by 5:00 p.m. on Monday, October 19.  For more information about the meeting, see Marcia Stedman’s recap here.

VOTE now!  It’s up to all of us. It’s recommended to get your ballot in early to ensure it’s postmarked by November 3, (or use a ballot drop box to avoid mail delays) and in case there are any issues with your signature.  Don’t forget to sign your envelope!


Healthcare News & Commentary


  • Policies to Achieve Near-Universal Health Insurance Coverage 
    In this report, the Congressional Budget Office (CBO) examines policy approaches that could achieve near-universal health insurance coverage using some form of automatic coverage through a default plan. The CBO organized existing proposals into four general approaches, ranging from one that would retain existing sources of coverage to one that would almost entirely replace the current system with a government-run program. All four approaches would provide automatic coverage to people who did not enroll in a plan on their own. 


  • The Cascade Care plan (which includes the much lauded “public option” by the state) will be available through the Health Benefit Exchange in 2021 in 19 Washington counties.  While the average premium is 4% higher than the other plans on the Exchange were in 2020, Cascade Care plans offer about $1000 lower deductibles and co-pays, which will be beneficial to people who need to use their health insurance regularly.  Open enrollment begins November 1.

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Upcoming Events

Oct 23, 30

Northwest Health Law Advocates presents a series of webinars

Pandemic response: How do we center health equity?
“Features health policy experts, agency leadership, advocates, and legal experts as we explore the intersectional impacts of COVID, Black Lives Matter, older individuals and persons with disabilities, federal updates, behavioral health, and systemic approaches.”
For more information and to register click here.

Sun, Nov 15

HCFA-WA Annual Meeting via Zoom
2-5 PM

Special Guest Dr. Ben Danielson, Senior Medical Director Odessa Brown Children’s Clinic speaking on “Creating a culture of anti-racism in Healthcare”

- 2020 Wins
- 2021 Plans

Registration Details available soon.   

Did we miss an event, perhaps virtual, coming up in a month or so? Let us know ASAP and we’ll post it on Facebook!

Did you know you can help us achieve our goal — with no additional cost to you — when you shop with Amazon? If you shop at Amazon, simply use our Amazon Smile Link and Amazon will contribute to our education efforts.

The perfect gift for every universal health care supporter, any time of year: Everybody In, and Nobody Out t-shirts, winter scarves, and umbrellas.

 Editor: Elaine Cox ★ Graphics & Communications Specialist: Sydnie Jones
★ Health News: Rich Lague  & Cris Currie  
 Spokane & Video: DW Clark   President: Marcia Stedman ★  

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