Key Design Elements of a UHC System

by Consuelo Echeverria

In the  June session, we got to hear from the Commission members themselves as they discussed Washington’s readiness to implement key design elements of a universal health care system. 

1. What should WA state’s universal health care system key design elements be?

• Public health approach to a WA state universal health care system

  •  Jane Beyer, from the Office of the Insurance Commissioner,  stated there needs to be a universal entry point that includes everyone like a birth certificate 

• •  Nicole Gomez, with the Alliance for a Healthy Washington, suggested that we need to build simple, uncomplicated forms into the enrollment system.

  • Rep. Schmick asked if Medicare and Taft Hartley are out, who is in this plan? Are the bronze, silver, gold and platinum categories really necessary in a unified plan? 

• WA State's universal health care system must be trauma informed 

  • Dr. Johnson, Washington State Office of Equity, shared how the Veterans Administration (VA) was able to cater to the direct needs of veterans by designing a system that included input from families, specifically mothers and wives.  Go to women to get their input so the system is welcoming! The lessons learned in the VA can be transferred for UHCC.

2. Eligibility and enrollment 

• While eligibility and enrollment has a robust system for AppleCare and qualified health plans there is no centralized system. This fragmentation has severe consequences in understanding the true number of  WA state citizens who have insurance and how much it costs. 
• Joan Altman at the Washington Health Benefit Exchange (HBE), shared that HBE is exploring how the Health Plan Finder can integrate DHHS and  the 40 odd other federal  databases into their system, but the various technologies, some of which are 30 years old, make interoperability a challenge. 

3. Cost containment

Fee for service vs value-based payments (VBP)

• Jane Beyer, emphasized with the significant consolidation, both vertical and horizontal, a VBP model disproportionately impacts small practitioners who may not have the ability to take on financial risk. Therefore there should be some sort of protection. 
• Vicki Lowe, UHCC chair, shared the concerns from the American Indian Health Commission for Washington State that VBPs drive out rural practitioners leaving rural communities who are already struggling at further risk.
  
  “Significant differences in health care access between rural and urban areas exist. Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by 

  • a scarcity of services

  • a lack of trained physicians

  • insufficient public transport

  • No or poor internet”
    
    Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015 Jun;129(6):611-20. doi: 10.1016/j.puhe.2015.04.001. Epub 2015 May 27. PMID: 26025176.

4. Infrastructure 

There seemed to be agreement that the commission should focus on what is working well now and then add to it. 

5. Governance  

Sequencing of elements was discussed with  Rep. Schmick very importantly noting that if the public perceives this Commission is operating behind closed doors, it will be harder to convince the public of our conclusions.  Jane  commented that the phased initiatives are outlined badly, we need to clearly articulate a path 

The meeting ended with a call to address the short term and help folks. Do what is easy first in order to help the most vulnerable while figuring out the more difficult questions with ERISA, Medicare  etc..