Health Care Reform Solid Improvements Are Being Realized At State Level But Much Still Remains To Be Done

In “Faces of the Uninsured” (July 31), Spokesman-Review reporters Jeanette White and Diana Dawson brought us seven compelling stories of people in need … stories that remind us why the Washington State Legislature approved a bold but risky health care reform plan in 1993.

While today there is good news to report about the evolution of health care in Washington state, there are also troubling signs that if we do not shift direction during the upcoming legislative sessions, our gains could be lost. Health care reform could become a disaster for the uninsured and for the 5 million Washington citizens who have insurance coverage they enjoy right now.

As you read this, five commissioners (including Spokane’s Dr. George Schneider) are preparing to implement the full measure of reform. Their recommendations, unless rejected by the Legislature and the governor, will be put into place beginning in July 1995. At that time:

There will only be one kind of health provider in Washington - state-approved certified health plans (CHPs).

Health care benefits prescribed by the state in the uniform benefits plan (UBP) must be a component of all health insurance plans.

Employers with 500 or more workers will be required to pay at least half the cost of the lowestpriced premium in their area for their employees. One year later, employers with 101 to 499 employees will face this same requirement and, by 1999, all employers must pay half the premium cost for their employees and those employees’ dependents.

As you can see, major changes in your health care are coming, regardless of what Congress does in the coming days.

On the state level, lawmakers face crucial decisions.

If the reforms already implemented are working to increase access and control costs - without risk to people’s jobs and health care quality - should we stop now? Or do we risk the gains we’ve made by implementing the most radical portions of the 1993 Health Services Act?

Access is improving dramatically. New expansions of the state Medicaid and basic health plan coverage will bring state-subsidized care to tens of thousands of Washington’s low-income families. And the short-term insurance reforms recently implemented have opened a “window” to potential subscribers who cannot be turned away because of pre-existing conditions. Exclusions are disappearing; portability is coming.

The state Health Services Commission is now estimating health care inflation at about 7 percent per year - still too high, but vastly improved from the 16-21 percent increases of recent years.

So we’re done, right? Wrong. Government-controlled access, services and pricing of the sort that President and Mrs. Clinton have proposed are still on the way - unless we change course.

Unless we act, many insurers will pull out of the state (19 underwriters have already left), likely leaving behind a few very large health maintenance organizations (HMOs) that use “gatekeepers” to screen patients seeking permission to see medical specialists, physical therapists, chiropractors, naturopaths and other “specialists.”

Unless we act, you may enjoy less coverage and see your co-pays and premiums rise and your choices and options limited. With premiums estimated to cost between $126 and $406 per month, and employers required to pay at least half the cost, some employers now paying 80-90 percent may reduce their premium contribution, leaving workers to make up the difference.

Worse off will be those employees whose employer must lay off workers in order to provide others with health care coverage.

Maybe it won’t be this bad. The problem is, we just don’t know. It’s not a risk I believe we need to take. I support alternatives including:

Keep what’s working. Continue insurance reforms that will guarantee insurability and portability. Continue expansions of Medicaid and the basic health plan to provide coverage for low-income families.

Offer more options. Allow employers to offer actuarially appropriate medical care savings accounts for their workers. Such plans encourage wellness and allow consumers to go directly to the services they want; for example, chiropractic care.

Create incentives for employers, and no employer mandate. More employers may be encouraged to provide insurance for employees with tax incentives. The greater the level of participation by the employer and the better the package the employer provides, the greater the tax break.

Ensure quality - no premium caps. The current plan requires insurers to compete under a state-mandated price cap, which may put cost-cutting ahead of quality control. Prices have begun to level off and increasing access will slow cost increases further without risking quality.

Don’t play favorites. Legislators and other state employees should be under the same plans offered to the state’s taxpayers. Today, they’re guaranteed no decrease in benefits or increases in employee-paid costs. That must change.

Back up the promise. If these reforms do not result in near-universal coverage by the year 2000, the people of Washington must be asked to vote on an employerbased health care system or other alternatives.

Without change, “reform” might mean paying more to get less.