There’s a lot at stake for consumers in the closing days of the legislative session as Gov. Gary Locke reviews bills to roll back health care reforms and restrict access to the state medical plan for the working poor.
It’s a far cry from 1993, when the state made national headlines for passage of a health care reform law that required employers to pay part of the cost of their employees’ medical benefits, and expand access to the Basic Health Plan.
That bill was mostly repealed in 1995. A bill now before Locke would largely finish the job, even as the proposed budget freezes enrollments in the Basic Health Plan and raises premiums and co-pays for the working poor.
“I think that’s terrible,” said former Rep. Dennis Dellwo, the Spokane Democrat who helped write the 1993 reform act.
“They are backing off all the things they said would remain so reform would still work. If hypocrisy were a crime, they would all be in jail. They are just returning to the way things were before.”
Locke has until Saturday to take action on ESHB 2018, which restricts the current right to health coverage regardless of pre-existing conditions.
The bill leaves a two-month window for open enrollment each year, with a three-month wait for coverage. It also limits the insurance commissioner’s ability to control rates, meaning unhealthy people might be charged a lot more than healthy people when they sign up.
People who don’t apply for coverage during the months of July and August could be out of luck.
They could face a wait for coverage as long as 13 months, if they get coverage at all.
Public sentiment seems to be strongly against the bill. Calls to the legislative hotline as of Wednesday showed 46 people in support, while 1,164 people called to oppose it.
“I call this the insurance relief act. It was authored by the insurance industry and pushed by the industry,” said Insurance Commissioner Deborah Senn.
The Legislature has also passed a budget that freezes enrollment in the Basic Health Plan at current levels, despite a waiting list for coverage of more than 70,000 people.
The budget also doubles Basic Health Plan co-payments for hospitalization, ambulance services and emergency room visits, and triples co-payments for office visits.
The state premium subsidy for the poorest subscribers to the state health plan would also be diminished.
Under changes in the budget adopted by the Legislature, a family of four with two children and a monthly income of about $2,750 would see its premium jump from $94.98 a month to $152.60.
Other changes would make it more than four times as expensive for community clinics and hospitals to provide care for poor people through the health plan.
Under existing law, clinics and hospitals can sponsor Basic Health Plan subscribers by paying $10 to help cover their premiums.
The fee jumps to $45 under the budget adopted by the Legislature. That will make it impossible to help as many people, even if slots were available in the health plan.
More than 6,000 people are waiting for coverage under the plan in Spokane County, said Jamie Rogers of Sacred Heart Medical Center. Another 16,000 already depend on the plan for coverage.
About 48,000 people in the county are without health insurance, including about 14,000 children, according to a 1996 study by Sacred Heart.
The four major hospitals in Spokane write off about $12 million a year in charity care now, and the figure will go higher if people don’t have insurance, Rogers said.
The four hospitals have allocated $300,000 to sponsor additional Basic Health Plan subscribers, but so far the money is going unspent because the state has not added additional slots.
“We have the money. It’s just sitting there. It’s awful,” Rogers said.
Locke had proposed a 20,000-slot expansion of the Basic Health Plan. He vetoed chunks of the Legislature’s budget Wednesday, and appeared at a rally for the plan on Tuesday, hinting he wouldn’t let lawmakers leave Olympia until they add enrollment slots.
Sen. Jim West, R-Spokane, said Republican lawmakers are willing to add more slots to the Basic Health Plan if they can figure out a stable funding source.
“We are trying to prevent a major collapse or catastrophe in the plan,” said West, chairman of the Senate Ways and Means Committee. “It has to be on a stable foundation.”
Locke proposed paying for his expansion with money from a one-time budget surplus. “That’s irresponsible,” West said.
Rep. Phil Dyer, R-Issaquah, chairman of the House Health Care Committee, said he, too, would like to expand the plan and he’s got an idea of how to pay for it.
Dyer will introduce a bill today that would put a business and occupation tax on nonprofit hospitals’ Medicare and Medicaid revenues.
Dyer said the tax would close a loophole in the existing law and raise about $116 million, enough to add thousands of people to the plan.
But Dyer stood up for the bill that rolls back insurance reforms. He said Locke should sign it because it protects consumers, and he argued responsible people are forced to pay higher premiums because of the state’s year-round open enrollment plan.
That has provided an incentive for people to buy coverage only when they need it, Dyer said.
“How many people would like to buy fire insurance the day their house burns down? This is no different,” he said. “This isn’t a bill for the insurance industry. It’s a bill for consumers.”