Once again, the lack of clarity about governance was front and center at the recent March FTAC meeting. Coming the day after Oregon's presentation at our 2WSS session on how they are developing their UHC plan and recapped above, this FTAC meeting was a disappointment.

The Milliman Group compared the costs and benefits of thee current and existing health plans administered by Washington state: Medicaid, the Public Employees Benefit Board Uniform Medical Plan (PEBB UMP), and the Cascade Select silver plan sold on the Health Benefit Exchange. Milliman was not instructed to incorporate the expenses associated with administration and management of these programs, so these costs were not examined. This is unfortunate, given that numerous other analyses have shown that administrative costs are out of control, accounting for 15-30% of health care spending (source). 

This presentation was to be followed by the adoption of a Cost Containment Memo to the Commission, which did not happen.  

Main takeaway:  A lack of direction from the Commission on the Governance structure of the new plan continues to hamper FTAC’s work, as pointed out once again in the public comments and echoed by several Committee members during the course of the meeting.  A proper study of benefits and costs requires an overarching framework.

Takeaway #2: The Milliman study documented what health care reform advocates have long known: as the share of health care costs paid by patients rises, patients seek less care, thus reducing insurer costs. Conversely, as patients’ cost-sharing decreases or disappears altogether, they can afford care, which causes payer costs to rise.  This raises two important questions:

• What is the goal of the Commission: to make the costs of the current system more sustainable, or to improve patient health and well-being? 
• Is it possible to design a health plan that achieves both goals simultaneously?

Until the Commission answers these questions, future actuarial studies will be premature and miss the mark just as this one has.

Takeaway #3: It is not possible to recommend cost containment strategies in a future universal system until the universal plan design is known. Discussion of cost containment options in the current system belongs in the Health Care Authority’s Health Care Cost Transparency Board.

The FTAC convener mentioned that based on the Public Comments, they may revisit Governance at the April 17th Commission meeting. While that would be a welcome development, it would be a first visit, not a re-visit.  

Review the meeting materials, including the Milliman Group report, here. Watch the meeting here.

Save the date and join us at the next meeting of the UHCC on Thursday, April 17th,  from 2–5 p.m.

We encourage you to:

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