State Health Insurance Rules Require Emergency Treatment

Washington state’s 1993 health care reform package was a balanced approach to the individual and group health insurance market. When Republicans repealed most of that reform, many of the remaining pieces could not stand alone. The damage was done and we are now paying the price.

In the last year, suppliers of insurance either stopped or radically limited individual insurance sales in Washington state. Today, there are no new individual plans available in Eastern or Central Washington. What limited and expensive plans are still available might also cease being sold when the current legislative session ends, if nothing is done.

The Legislature and governor can help but doing so will not be easy. Any fix will be stopgap and will only ease the crisis. Major state and federal action is needed to correct the problem. The immediate crisis, where people have lost the opportunity to buy their own insurance, gives the Legislature and governor a chance to explore a new era of bipartisan cooperation in relation to health care reform issues.

There are three major issues in the individual market: the law setting a three-month waiting period for coverage of pre-existing medical conditions; the existing Washington state high-risk insurance pool; and the guarantee that policies issued will be affordable and portable.

Many will resist any modification of the pre-existing condition waiting period, as they should, but some change will be needed. One idea is to require enrollees to maintain their insurance for some minimum length of time and not, as is the current dilemma, maintain coverage only for the period they are receiving specific medical care.

Another idea would be to apply the three-month waiting period - or no waiting period at all - during an open-enrollment “window” that would occur every year or so. During the window period, individuals would be guaranteed issuance of health insurance coverage. Individuals buying insurance outside the window period would pay a higher premium until the window reopens.

There are several variations that could be considered if there are appropriate trade-offs.

The long established high-risk health insurance pool also needs an overhaul. This pool was established to provide coverage when an individual was denied health insurance. Six years ago the law was changed so that no one could be denied. This meant these insurance companies wouldn’t have to pay into the pool because no one would be eligible for pool coverage.

It was not expected that all the insurance companies that offer individual coverage would withdraw their individual plans from the market. Now, though, the high-risk pool must be modified to allow anyone into the pool when insurers are not selling insurance, so that individuals have an opportunity to purchase health insurance.

A deal can be made here. The legislature must act now. The rubble from the Legislature’s aborted health care reform must be cleared and new changes considered. This can only be done if the goals are clear. Insurance for the individual is the critical part of any effort. Neither the state nor the individual can afford the present system. Individuals are cared for in the least efficient and caring manner. Solve the critical problems this session and then work on a reform of the whole system in next year’s long legislative session.