HCHR Members Participate in House Health Care and Wellness Work Session on Primary Care and the Universal Healthcare Report   (Previously published on the  HCHR-WA Website)

On September 23, the House Health Care & Wellness Committee held a virtual Work Session to prepare for the 2025 legislative session. One hour of the Work Session was dedicated to the draft of the Universal Health Care Commission’s report that will be sent to the legislature in November. 

This hour included substantial public comments and Health Care Is a Human Right stood out in its impact on public testimony. A large majority of those who testified were from HCHR member organizations, including Washington CAN, Whole Washington, PSARA, Healthcare for All-WA, and other organizations. We organized our testimony to speak in unison about the need for the Commission to have concrete deadlines, along with a plan to present recommendations to the legislature of what a Universal Healthcare plan should look like. (Read more here) 

HCFA-WA president, Ronnie Shure testified on our 3 studies which will help to develop infrastructure and capacity to unify our healthcare system and meet federal waiver requirements. HCFA-WA board member Consuelo Echeverria highlighted egregiously, none of the actuarial analysis include a single payer mode nor overhead (billing and insurance related matters), such as prior authorization, claims etc.. in the 3 for-profit models they chose.  HCFA-WA board member Marcia Stedman noted that while Commission progress is painfully slow, and the recent progress is not reflected in this Draft. She called for the Executive Summary to include a bulleted list of Commission decisions to date and the increase in Commission staff to set expectations for a more productive Commission in 2025.

Update on the Prescription Drug Affordability Board, Washington Health Care Authority

By Ronnie Shure 

This Board was established by legislation passed in 2022 to review drug prices, and it was improved by legislation passed in 2023 to set upper payment limits. Washington is one of only 5 state Boards with this authority. The Board meets every other month, and their next meeting is November 13th , when they will announce the first drugs to be reviewed.

The Governor recently filled the last position on the Board by appointing Greg Gipson, PharmD, who has worked at UW Medicine since 2013, initially as a clinical pharmacist caring for critically ill patients with a wide variety of health conditions, and now focusing on drug policy and utilization. His current work aims to improve the use of medications to promote safer, more effective, and cost-conscious practices that result in improved health outcomes across the health system.

The Board has appointed a Core Advisory Group to provide input on the first drugs that will be selected for their affordability review, and they will also assist the Board to develop final reports on the excess cost of drugs that are evaluated.

The members of this Core Advisory Group are:

• Jim Freeberg, MPA - Executive Director of the Patient Coalition of Washington
• Ronnie Shure, Pharmacist - President of Health Care for All-Washington
• Laura Berry, MBA - CEO of Soundview Medical Supply
• Tim Lynch, PharmD - Senior Vice President and Chief Administrative Officer of MultiCare
• Dharia McGrew PhD - Director of State Policy for the Pharmaceutical Research and Manufacturers of America (PhRMA)

They will meet every other month alternating with the Board. Their next meeting is December 10th.

2nd Wednesday Speaker Series October Recap: How Washington State is putting the 'affordable' into affordable health care: The OIC's Final Report

By Ron Lovell 

In 2023, the WA legislature directed the Office of the Insurance Commissioner and the Office of the Attorney General to evaluate policy options that could improve overall affordability for consumers, employers and taxpayers. Two reports were delivered: The Preliminary Report on December 1, 2023 and the Final Report on August 1, 2024. 

The preliminary report revealed significant vertical integration and horizontal consolidation among providers and facilities. In terms of consolidation, 40 of Washington’s 101 hospitals are a part of the 5 largest hospital systems. Nearly 80% of all licensed hospitals are part of  these multi-hospital systems. As for vertical integration, about 50% of Washington’s physicians are employed by hospitals and most of those are in multi-hospital systems.

The final report analyzed the policy implications of 5 different policy changes in the healthcare system: (1) establish a reinsurance program for individual and small group markets, (2) increase the medical loss ratio standard for health insurers, (3) use reference-based pricing for provider services, (4) use hospital global budgeting to control cost of services and (5) meeting the Health Care Cost Transparency Board targets.

In summary, each option can provide improved health care affordability, but each option has advantages and disadvantages. The report is aimed at the Legislature and policy makers with Washington-specific data as they consider changes to improve health care affordability.

Nico Janssen’s presentation gives a good overview of the report, its background, and its data-based outlines of policy changes.

You can view/listen to the presentation here:
Video

Slides from Nico Janssen’s Presentation – PDF with details from the OIC Report

OIC page that gives the full reports from 2023 and 2024

Two-page fact sheet for The Final Report

October 2024 Universal Health Care Commission Meeting: Health Care in Washington: all about the money

By Marcia Stedman

Haunted by the specter of looming budget shortfalls, the Universal Health Care Commission continues to delay the creation of the universal system that would achieve significant savings for the state and at the same time deliver comprehensive health care to all residents.

E2SSB 5399, the enabling legislation that established the Commission in 2021, clearly states that “Multiple economic analyses show that a universal system is less expensive, more equitable, and will produce billions in savings per year.”  Yet despite this common knowledge, the Commission refuses to act on the findings of the Universal Health Care Work Group that proved this very point.

In contrast to recent meetings, this October 2024 meeting was well attended with 10 of the 14 current members present, resulting in robust and thoughtful discussions, and the ability to take votes on two matters, both of which passed:

• recommend continued funding for the Apple Health (Medicaid) Expansion
• approve the Commission’s 2024 Annual Report to the Legislature

Main Topics and Takeaways:

Cost-sharing Principles:  

Some patient cost-sharing is assumed, but to do dynamic modeling of zero cost-sharing, more funding is needed.  

Regrettably, the nearly $500,000 for dedicated support staff and actuarial expertise for 2024 was won by the advocate community in 2023 but was misapplied by the Health Care Authority, causing a significant delay in the Commission’s work.

Apple Health Expansion:  

The motion passed, but the two Legislators present abstained, citing responsibilities to advocate for social programs other than the Commission, and the need to spend the money on helping the currently enrolled rather than continuing to expand the program.

Prior Authorization Discussion:

• Takeaway #1: Standardizing the forms is difficult when you have so many payers (insurers) with a variety of criteria, leading to treatment delays and administrative burden
• Takeaway #2:  Managed care plans are the ones most often requiring Prior Authorization, which increases the administrative burden on providers

 State Agency Report Outs : There were no printed reports but the verbal reports are viewable on the meeting video at 1 hr:03 min.

• Dept. of Health - access the J-1 program for 5-yr visas for foreign medical professionals
• Health Benefit Exchange - Auto-enroll those losing Medicaid coverage to the Qualified Health Plans on the Exchange*
• Health Care Authority – consolidate purchasing for the PEBB/SEBB program*   
• Dept. of Social & Health Services - expand access to Medicaid for low-income Medicare beneficiaries*

*Health Care for All-Washington secured the funding for the studies that investigated these transitional solutions that were identified by the Commission last year. We hope that the Reports, due by December 2024, should result in 2025 Legislation.

The Insurance Commissioner’s Final Report on Healthcare Affordability

Main Takeaway: greater affordability leads to greater access and savings to the entire state

• Establish a reinsurance program for individual and small group markets
• Increase the share of premiums that insurers must spend on medical care for their enrollees
• Use reference-based pricing
• Use hospital global budgeting
• Meet the Health Care Cost Transparency Board targets

The video begins at 1hr:45min. See page 116 of the Meeting Materials for more information on these options to make health care in Washington more affordable:

Join us as we track the next meeting of the UHCC on Thursday, December 5, 2024, 2-5 p.m.  

The next FTAC meeting will be held on Thursday, November 14, 2024, 2-4:30 p.m.

We encourage you to:

• Sign up to provide public comment by 5 p.m. the day before the meeting occurs.
• We urge our members to push for a single payer plan in their public comments.
• Read our take on past UHCC and FTAC meetings

Subscribe to Health Care Authority (HCA) for updates. 

Defend Washington from 4 Bad Initiatives:  "Skullduggery Be Damned"

A Weird Billionaire Wants to Keep Washington from Having What We Need:​

✔︎ A Healthy Climate
✔︎ Funding for Schools
✔︎ Taxes on the Uber Rich
✔︎ Long Term Health Care
✔︎ Well Paid Union Jobs​

Vote NO on His Ballot Initiatives:
I-2066
I-2109
I-2117
I-2124

Click here to watch PSARA’s webinar on why you should vote NO on the initiatives.
(Note: Webinar begins at 57 seconds into recording)