State Of Washington Will Launch Universally Available Health Care Option
KPBS Midday Edition Segments / May 14, 2019
Washington state will offer a set of tiered health care plans by 2021 that will cover standard services and are expected to be up to 10% cheaper than comparable private insurance. These state plans will be available to all residents regardless of income.
Speaker 1: 00:00 Washington state has a new health care option. On Monday. Governor Jay Inslee signed a universal care plan.
Speaker 2: 00:07 You will improve affordability through standardized plan designs. They're easier to understand and have lower out of pocket costs for consumers. Reimbursement rates would be consistent, was 100% and 160% of Medicare rates. That will help ensure fair payments for providers to reduce costs for people.
Speaker 1: 00:29 The plan is state managed but not state run. Private Insurance will administer the new program called cascade care. It will offer a set of tiered public plans and is expected to cost 10% less than private insurance. California lawmakers have been trying to introduce single payer public health insurance for the state but have been stumped over how to pay for it cause something like this. Washington state public private hybrid B. The answer joining me is Associated Press reporter Tom James based in Seattle, Washington and Tom, welcome to the program.
Speaker 3: 01:05 Hi. Thanks for having me. On.
Speaker 1: 01:07 What does it mean that the state will manage cascade care even though it's administered by private insurers? In other words, who gets to set the terms of the coverage.
Speaker 3: 01:16 So the state is going to essentially make a contract with one or more likely more than one private insurance companies have to offer insurance plans on the state's healthcare exchange. So that means that the state will draw up a contract on, I think will be the state's insurance commissioner and set, you know, a broad set of terms for what the plans will cover. Um, what the, uh, cost share levels will be between the insurance provide her and, uh, you know, the patient and then leave the administration of those plans up to, uh, up to the insurance company to handle things like, you know, enrolling patients, paying out claims, doing customer service, the day to day of running the plan.
Speaker 1: 01:57 And, and it says, these plans will cover a so called standard services. What does that mean?
Speaker 3: 02:02 Standard services are defined in a couple of ways. Is My understanding, uh, there, the, the affordable care act or Obamacare, um, lays out, you know, I said if I think 10 essential services that all health plans have to cover. Um, and then there's also a set of peers in, uh, you know, metal tiers, bronze plans, silver plans, gold plan and platinum plans. Um, and my understanding is that, um, and I should emphasize that, you know, these contracts haven't been drawn up, so I need this could change I think a little bit, but from what I'm seeing in legislation here and the experts that I've talked to, and then the architects of the plan, the plan, the plans will cover, you know, all the same services that a private plan in the same tier would cover. Um, and the question between the tiers is just sort of how much, you know, whether it's 60% or 80%, uh, or you know, more or less, uh, of a cost. Um, uh, the insurer would cover as opposed to, you know, the patient covering and out of pocket.
Speaker 1: 03:01 Yeah. Are Private insurers supportive of this plan?
Speaker 3: 03:05 My understanding is that there was a mixed reception for the plan. Um, some of the insurers I think opposed it, but others as time went along and as law makers kind of, uh, fiddled with the dials of the policy, um, try to find something that was suitable for everybody. Uh, you know, some of them got on board.
Speaker 1: 03:26 When Washington State's plan takes effect in 2021, it will be available to everyone regardless of income. So how has the state making that work?
Speaker 3: 03:35 My understanding is that what you have, is it a fixed, uh, core cost for the plan, which is determined by how much the state essentially decides to pay doctors and hospitals for the services they provide. Um, now, uh, by capping that cost, the state hopes that the plans will be, as you said at the beginning, right in the range of five to 10% cheaper than, um, a comparable private plan. So that savings will be passed straight on to consumers. I think anybody who, who buys the plan, we'll get those, you know, offensively lower rates. Um, although how much lower, again, sounds like it's still a little bit up in the air. Um, and then, you know, there are still other subsidies like federal, uh, for instance, I think the main one is a federal tax subsidy. Um, that, uh, we'll go to, you know, people with lower incomes that won't be available to people with higher incomes the same way they would if you were buying any other plan on the individual market.
Speaker 3: 04:36 Um, and when I've talked to the architects of the plan, they've said that it probably won't be in terms of cost very attractive to somebody who already has, you know, Medicaid where they're paying very little of their own costs. And that's a, a plan for people on relatively low incomes or for people on an employer sponsored healthcare. So, you know, if you already have coverage through your job, this might not necessarily be attractive compared to that. But for the person considering a comparable plan on the individual market, you know, that's where I think most of the savings are going to be. As I've heard it as I've heard it described.
Speaker 1: 05:10 No. As I said, California has been struggling with how to build its own single payer health system. How is that different from Washington's new healthcare plan,
Speaker 3: 05:18 both a single payer and a public option? Our approaches that try to offer, you know, universal healthcare coverage, they tried to get to universal healthcare but via kind of different routes. So single payer offers universal healthcare, paid for by taxes. Um, and public option is more of unapproached to figuring out a way to offer a universally affordable healthcare offering, some kind of basic basic health plan that theoretically everyone will be able to afford for consumers. That probably means a very different experience between the two. On a single payer, you'd likely just go to any doctor and receive care and it would be covered the single payer, which is, you know, the state. Um, on a public option, you'd still have an insurance plan with potentially the same challenges of having to find a doctor that accepts your plan, um, and then figure out how to afford your deductible, you know, depending on what it is. But, but the flip side of course, is it critics think that single payer might be more expensive for taxpayers and ultimately might lead to fewer doctors being available and longer wait times for, for, for care, like a knee replacement or something that's not as critical as, you know, immediate open heart surgery. Again, that's what critics say. It's, that's all quite a ways out in the future since no one has done either of these things.
Speaker 1: 06:35 How have other states to try something like this, this a public private hybrid,
Speaker 3: 06:41 seen more states, uh, get closer to proposing this? Uh, you know, the, a lot of states have toyed with the idea of making some kind of, you know, public option available. Typically what they have leaned toward in the past has been offering a medicaid by it. So Medicaid is a, a program that offers insurance coverage to people on low incomes, but there's an, there's an eligibility limit. If you make over a certain amount of money, you're not eligible. So a lot of states have had toyed around with the idea of offering people essentially the ability to pay and get access to that program. So it's kind of an existing state program and you just expand the eligibility and Bada Bing, Bada boom. You kind of have in the box public option for a variety of reasons. You know, Washington has gone with this, with this public private hybrid model. They're trying to sort of invent a new system.
Speaker 1: 07:33 I've been speaking with Associated Press reporter Tom James, Tom. Thank you.
Speaker 3: 07:37 Hey, thanks so much.
Speaker 1: 07:39 [inaudible].