Washington Gov. Jay Inslee’s proposal for a limited public health care option cleared the state House of Representatives Friday, advancing what he has called the most practical option for expanding health coverage — and bringing to his state a national debate over what universal health care means.
The proposal would create a state insurance option with capped costs and likely competitive premiums. It would also require officials to plan expanded state subsidies for private insurance.
The bill calls for state plans by 2021, but rather than providing them directly to consumers, the state would contract with one or more private companies to offer at least two plans. The state would determine the outlines of each, while the company would handle the work of enrolling customers and paying out claims.
That plunges the state into a national debate over the future of health care, and especially the meaning of universal health care, a phrase used by many of the Democratic hopefuls in the 2020 presidential election. Inslee declared his candidacy in that race March 1.
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Broadly, conservatives have resisted calls to involve state or federal governments in providing health care, while moderates have called for making private health care more affordable. Some further to the left have advocated removing private insurers from the equation entirely.
“The left thinks it doesn’t go far enough, but the right thinks it’s socialized medicine,” said Rep. Eileen Cody, the Seattle Democrat who sponsored the House version of the bill at Inslee’s request.
Speaking at a news conference the day before the vote, Inslee called the bill an achievable goal, but he did not elaborate on the role of private insurers or the government.
Although available to all residents, the cost of the public option — dubbed Cascade Care — would be based on sliding subsidies.
Residents would buy Cascade Care on the state’s health plan website, just like any other plan.
The plan doesn’t set exact premium costs, but rates paid to doctors and hospitals as well as administrative costs are capped, which Cody said would likely put Cascade Care premiums lower than those on a private-market individual plan, potentially by 20 percent or more.
The expanded subsidies — which would be planned but not implemented — would also be tied to income, increasing an existing threshold to include individuals making up to about $62,000.
In the state Capitol, the bill has provoked argument that mirrors the national debate.
On the House floor Friday, Republican lawmakers warned that government intervention would destabilize the state’s health care market, and especially that the payment rates proposed for doctors treating Cascade Care patients were too low.
“This is an illusion of care,” said Colfax Rep. Joe Schmick, ranking Republican on the House Health Care and Wellness committee.
As it stands, he said, providers often take a mix of Medicaid or Medicare patients and patients with private insurance, with the higher-paying private plans balancing out the lower-paying public ones. Letting more people shift to lower-paying public plans would throw off that balance, and the lower rates could ultimately lead to fewer available doctors, he said.
Meanwhile, a Democratic lawmaker had introduced an alternative plan on the other end of the spectrum: Single-payer health care, run by the state, an idea Cody and others have noted has some backers.
After Friday’s vote, however, Cody resisted both arguments.
Unbalancing the market shouldn’t be a problem, she said, because Cascade Care targets only people not already covered by employers’ plans or low-income subsidies, who instead buy individual insurance themselves, directly from insurers. Cody put that group at only about 4 percent of the state.
At the same time, Cody also said she saw good reason not to shoot for a completely government-run plan right away.
While plans run by private insurers — including a state-contracted plan — qualify for federal subsidies, a plan run by the state would not, which would mean the state would have to pay a much larger share of the costs.
“It’s too much money,” Cody said.