Public Comments Lead the Way
by Marcia Stedman
September 27, 2022
At Meeting #7, the Commissioners grappled with key elements that must be included in their Nov. 1 Report to the Legislature.
Takeway #1 - Need for a clear articulated plan
Having received significant pushback from Commissioners and the public, the consultants agreed to re-orient their 3-phase Strategy and place governance first. Below are selected comments.
Deana Knutsen, WACAN Chair, Commissioner of Public Hospital No. 2 in Snohomish County:
“I've always understood that you were to consider your plan, and then implement that plan. I'm hoping that there will be a very clear articulated plan and vision for the community to get behind as we move into universal healthcare. The law establishing the Commission states the November report must include an inventory of the key design elements of a universal healthcare system with a unified financing system including, but not limited to, a single-payer system as in Model A of the Universal Health Care Work Group.
Maureen Brinck-Lund, co-chair of the Health Care is a Human Right Subcommittee on the UHCC:
“Model A was shown to far outstrip the other options in savings both to the overall health care system and the users of the system, while at the same time providing universal healthcare coverage to all residents of Washington State. I urge the Commission to look for Finance Advisory Committee people who have experience working within, or even being on the ground floor of, creating a single-payer system, so their unique expertise can help us to assess the path forward.”
Aaron Katz, Principal Lecturer Emeritus, UW School of Public Health:
“…. In the presentation slide #16, Governance is listed as number 3. I would suggest making that number one, because there's nothing that will affect public acceptance and support for the system that you design more than its governance and the public's faith that it will be transparent and responsive.”
Commissioner Jane Beyer referred to Mr. Katz’s comments in saying, “… we would want to think about the governance structure before we talk about how we're going to operationalize and implement the system. We want … a governance structure that's transparent, [with] no conflicts of interest. I think it's worth having that discussion before we start talking about … enrollment systems [and] contract[ing] this out.”
Takeaway #2 - Increasing Medicaid provider reimbursement rates to 80% of Medicare rates, as required by the law (SB 5399) that created the UHCC, would increase provider participation and therefore access to care. However, the estimated $864 million annual price tag was thought to be too costly for the State, even though it would be offset by a $593 million federal match, leaving the State’s share at $271 Million. The Consultants proposed limiting the rate increase to only adult primary and behavioral care, leaving those $593 million Federal dollars on the table.
Public comments strongly supported the need for the reimbursement rate increase to apply to all Medicaid services including specialty care, and suggested that the current practice of contracting with managed care companies for Medicaid administration be evaluated.
Gary Renville, Exec. Director of Project Access Northwest, a non-profit that provides donated specialty medical care across Washington:
“In 2020/21, more than 785,000 people in Washington were living in poverty, and 428,000 with health insurance. Low Medicaid reimbursement rates means that those most vulnerable are experiencing yet another in a long list of barriers to their health care and makes our communities weaker as providers struggle to keep their doors open in the face of low Medicaid reimbursement rates.”
Aaron Katz, Principal Lecturer Emeritus, UW School of Public Health:
“Increasing Medicaid provider rates is an important strategy to improve access to care but finding the estimated $271 million needed in State funds in 2023 will be no small order. The State has contracted with managed care companies for more than 40 years, and it’s well past time to evaluate whether this model is producing what we need and want: efficient, effective, quality, people-centered care in which the State retains financial responsibility. I urge the Commission to push for such an analysis, as well as an analysis of whether the State should continue to use the current expensive value-based payment model”
Andrea Caupain Sanderson, CEO of Byrd Barr Place:
Providers and hospitals routinely treat patients differently, based on their insurance type or lack of insurance. Our healthcare system has been this inequitable two-tier system: Medicare with a significantly higher reimbursement rate than Medicaid, the program for low- and modest-income people, and highly utilized by black Washingtonians. In 2019, Medicaid reimbursement rates in Washington State were 23% less than the rate for similar Medicare services leading many doctors to turn Medicaid patients away.
Roi Martin Brown, board member of WA CAN: “Providers often lose money when they serve Medicaid patients as a result of low reimbursement rates. This has severe negative consequences for healthcare access and BIPOC communities were simultaneously at greater risk due to environmental lead toxicity. Washington needs a truly single payer healthcare system that is more transparent with consistent fee schedules for providers and healthcare budgets that eliminate the extensive administrative costs of managed care. In fact, when Connecticut eliminated capitated managed care from its Medicaid program in 2012, the very next year the State saw a marked increase in provider participation and a decrease in emergency department business.”
Takeaway #3 – The Financial Technical Advisory Committee (FTAC) was established by vote of the Commissioners, for the purpose of providing financial guidance and options to the Commission on a broad range of system design topics: benefits, provider reimbursement, administrative costs, workforce needs, tax structure, Federal funding, etc. HCFA-WA’s system-design framework outlined in our Washington Health Security Trust bill could help the FTAC organize its overwhelming scope of work into manageable segments.
Takeaway #4 – Measures supporting progress toward universal coverage while the actual system is being designed include:
- Align State-run programs, public programs, Medicaid Exchange, Public Employees Benefit Board and State Employees Benefit Board to the greatest extent possible with respect to benefits, quality standards, networks, and payment structures.
- Increase affordability and access to the Exchange’s Qualified Health Plans to expand them to the currently uninsured, a step toward achieving health equity
- Implement an integrated eligibility and enrollment system
- Initiate Federal discussions on options
The complete record of Meeting #7 can be found when you:
At their Oct. 13th meeting, the Commissioners will review and approve the Full Report with the changes that have been made throughout the past 7 meetings.
Got comments for that Oct. 13th meeting? Sign up here by 5 p.m. on Oct. 12th. Written comments can be submitted anytime, but if you want them to be included in the Agenda Packet for Oct. 13th, email them to the Commission here by 5 p.m. on Sept. 29th.