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Universal Health Care Work Group Final Meeting: Where There’s a Will, There’s a Model A

By Elaine Cox, HCFA-WA e.Bulletin editor

The final December Universal Health Care Work Group meeting brought more clearly into focus the work that lies ahead for advocates of state-based publicly-funded universal health care.  While many of the challenges, excuses and resistance are familiar to those of us who have been in this effort for years, we are seeing greater consensus on the urgency to provide affordable healthcare to all, which is illuminated so tragically by the COVID-19 pandemic.

This final meeting had significant discussion around Model C* (see detail at the end for a reminder of the features of the 3 models)  possibly being a short-term remedy to address the urgency of people in need of affordable coverage right now, many because of the COVID pandemic.  Model C was discussed as a transitional step, as a means to continue building the feasibility- the political will, financing mechanisms, price controls, and administrative and regulatory infrastructures that would be necessary to implement Model A (such as funding the Prescription Drug Affordability Board).  

This is our opportunity to show our legislators, the state, the country: in no uncertain terms, the time is now, we have the will, and we must pave the way. 


Public Comments

The meeting had more observers than the 37 group members. 99 Zoom attendees were noted (with fluctuations), including 15 Commenters who were each given 1:30 minutes.  57 individuals had pre-registered to attend and provide their comments.  Nearly every commenter supported various strengths of Model A, including being comprehensive, affordable, and equitable while saving the most in total health spending.

 HCFA-WA’s Kevin Wren, Marcia Stedman and Cindi Laws had some really great comments:

  • Marcia reminded the work group that Model A fits 6 of the 7 needed criteria.  We already have a roadmap to universal health care, the Washington Health Security Trust,  which includes a plan for retraining and a just transition for displaced health workers.
  • Kevin: Patients are at the heart of health care, so it's important their voices are heard when discussing health care policy. We are working to make sure all voices are heard because equity demands it. Who you are shouldn't determine your quality of care.
  • Cindi: Model A will produce cost savings of $5.6 billion in year 2 and onward.  Cascade Care is just a bandaid.  The skin under it dies if left on too long. We’ve done so many things with so much less urgency: building baseball stadiums, bailing out Boeing.

We were moved by several commenters who shared their stories of medical financial hardship, some brought by the pandemic: 

  • Due to a layoff, we lost health insurance. COBRA offerings are burdensome and buying is challenging
  • Medical bills totalled $260K for end-of-life care for a family member this year.
  • Job changed to new health insurance, which refused to pay for my medication.  I nearly died from the covered medication. 
  • I looked forward to Cascade Care but it is a disappointment- my premiums went up by $200 and my husband is remaining working overseas because we can’t afford his health insurance if he comes home.
  • Kelly Powers, a work group member, spoke about being on the state Exchange: we just signed up for a Cascade Care plan  for 2021 - $27K/year in premiums - that’s  30% of our annual income. It is crushingly unaffordable.  We need insurance for our insurance. We are using retirement savings, and this keeps our income bracket higher and at an unsubsidized level.  

Other notable quotes from commenters and work group members:

  • Feasibility is not a barrier, (to Model A),  it’s a self-fulfilling prophecy.
  • Equity requires us to eliminate private insurance.
  • This work group is the strength of our democracy. 
  • Washington is setting the stage for the rest of the US. We can lead the way on universal health care. We could be the Saskatchewan of UHC in the US.
  • Health care costs have exploded since profiteering was allowed.  Insurance executive bonuses are a waste of health care dollars.
  • Universal health care is a powerful tool for maximizing human potential.

Model C: End State, or Transitional?

New information from the Cascade Care work group was presented to the group. The relevance of this information is that it provides more clarity on where there would still be insurance coverage gaps and affordability issues that would impact Model C design.  The group was presented with some menu options such as relief for cost-sharing in people who have high health care needs and/or low income, Medicaid expansion, and constraining costs on providers such as with global budgeting and value-based care.  Questions remain on how many of the 560K currently uninsured people would benefit from Cascade Care. 

Most of the group members emphasized they see Model C as a stop gap and as a stepping stone, possibly with a 1-2 year time limit, to be followed by Model A or B.  It could be a way to get urgently needed coverage to all Washingtonians, but coverage expansions using private health insurance are not economically sustainable.   Only Model A can deliver the price controls and administrative savings needed to build a more efficient system.   Some group members expressed concern about Model A having unexpected costs,  being seen by the public as risky,  and generating resistance from large employers and unions that are happy with the status quo.  Those with these concerns prefer Model B which is seen as less disruptive, although it is the more expensive  alternative. 

The group did not appear to come to a consensus on what Model C should look like, and whether it should be presented as an end-goal or stepping stone/stop gap with Model A or B the preferred end goal. 

We look forward to seeing how the consultant incorporates the various voices and perspectives into the final report, which is due to the legislature on January 8, 2021. Work group members will have time to review and edit from December 18-22, and you can be sure Model A champions will push our case for its urgency and feasibility in the report. As Work Group member Aaron Katz explained, we need the legislature to commit first to the goal. 

This is where YOU come in!

Everyone recognizes that Model A is going to need a TON of support from all of us, the public, not just the people who are in regular contact with their legislators and not just the Work Group’s written report.  It is going to take many, many people pushing to get this rock over the crest of the political-will hill. But the momentum is building, and we believe Model A can address several of our legislature’s expected priorities, including advancing racial equity, addressing COVID concerns, and dealing with the economy. The COVID crisis has opened many eyes to the failures of our system. Crises make bold steps necessary, but also possible.  

So here is your to-do list, as a state Universal Health Care  advocate:

1) Send your comments in support of Model A to the work group by December 21.  

2) Stay tuned and be ready to act with us as we go into the January legislative session.  HCFA-WA will be sending action alerts for you to contact your legislators to act on the work group’s report.  

3) Tell your friends.  Share our posts on social media and encourage friends to get on our mailing list for action alerts!

*Three Proposed UHC Models--

  1. Universal care managed, administered, and funded by state government 
  2. Universal care with the benefit plan set by the state, but administered by private insurers
  3. Fill-in-the-gaps care with standard benefit plan that is administered by private insurers, much as it is today

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