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Rewritten Health Reform Law Relies On Strategies That Failed Previously

Washington lawmakers’ rewrite of the state’s 1993 health care reform act hopes to achieve maximum coverage by beefing up an existing subsidized program for the poor.

A section of the 2-yearold reform act that mandated all employers to cover their workers was effectively blocked by failure of Congress to grant authority last session.

Within the past few days, both houses of the Legislature have passed a Republican bill that wipes out the employer mandate altogether. And resigned to this outcome, Gov. Mike Lowry appears certain to sign the measure into law.

“To take up the slack,” says Spokane physician and state Sen. John Moyer, “legislators on both sides of the aisle agreed on expanding the Basic Health Plan to increase coverage and improve access.”

A limited pilot project the past few years, the state-subsidized Basic Health Plan for the low-income would be extended to 200,000 adults and 125,000 children.

“The children would be picked up largely through Medicaid,” Moyer says. “For adults at 125 percent of the poverty level, coverage would be paid entirely by the state, except a monthly premium of say $10 and some form of copay per visit.”

The subsidy would decline on a sliding scale up to 200 percent of poverty, where it would cut off entirely.

A Republican who crossed over to the Democratic side and cast the deciding vote for the landmark health act two years ago, the doctor from Spokane continues a key player in redefining reform.

Another player is Don Brunell, president of the powerful Association of Washington Business lobby.

“Basically what they’ve done,” Brunell says of lawmakers from both camps, “is take the existing act’s uniform benefits package, which hasn’t been implemented, and reduce it to the level of the Basic Health Plan. And they have made this basic package a lot more flexible.

“So,” says the business advocate, “if you are a small employer and you haven’t been providing workers health care insurance, hopefully you can get a policy for $50 or $60 a month and cover your people now.

“The emphasis is to try and encourage employers through pricing to cover their employees.”

Many won’t.

Therefore, as revised, anyone could purchase the new Basic Health Plan for themselves - including workers still uncovered, the self-employed, and all who continue to go bare for one reason or another.

And rather than the state mandating employers to offer it, as required at present, the rewrite would mandate insurers to offer it.

It would be, Moyers says, a “template” for what constitutes minium health insurance coverage in this state.

But is it workable?

Not so far.

Right now, the existing Basic Health Plan for the poor goes begging for recipients. State officials estimate over half a million people in the state are without insurance. There are sufficient funds already budgeted to put 126,000 uninsured needy on the plan.

But fewer than 60,000 are taking advantage of that opportunity.

Critics and even some advocates say the state has done a disgracefully poor job of making the existence of this help known to the poor. Especially the working poor.

Unlike experienced welfare recipients, few working poor have the time, the inclination, or the know-how to scout out and avail themselves of such help. They’re not part of the welfare bureaucracy’s established service loop. So many of the most deserving go without.

As to a pricing incentive for small businesses to cover employees, that hasn’t worked either.

A few years ago, in an effort to stave off mandated coverage by employers, the business establishment touted and got passed a law calling for so-called affordable insurance packages for small businesses.

State regulators hounded underwriters to develop bare-bones, affordable packages, which some carriers did, offering cut-rate coverage for as little as $60, as I recall.

Small businesses ignored the offer.

How is this version of that experiment going to work out better?

Well, says Brunell, “My sense is, if you are an employer and you are not offering health care insurance now, and you have the opportunity to insure your people now at $60 a month for example, you are crazy as the Dickens if you don’t.”


So, are we back to square one again?

How about passing a law that says you can put a state-sanctioned official sign up in the window of your restaurant telling customers you pay a fair share of your employee’s health care insurance costs, and allowing you to post the name of competitors who don’t?

Would that help?

Bet on it.


The following fields overflowed: CREDIT = Frank Bartel The Spokesman-Review

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