Last fall, at Governor Gary Locke's behest, the Department of Social and Health Services (DSHS) drafted a proposal that might knock off top-tier Medicaid recipients and allow an enrollment freeze--all this, critics say, without a legislative vote or public input.
Not true, Locke and DSHS argue. They say they're all ears, and they've set up a series of town hall meetings across the state, like the one hosted Thursday, June 6, at Shoreline Community College. Feedback from these meetings will be factored into the redrafting of the proposal, they say. However, the proposal is due to the feds this July, giving the redraft just a two-week turnaround time.
Without a legislative vote (compounded by the fact that the state didn't advertise the town meetings to Medicaid recipients like Kaufmann), it appears that the town meetings are a charade--a rubber stamp for a done deal.
"It's a sham," says State Representative Shay Schual-Berke (D-Normandy Park), vice chair of the health-care committee, about the 10 town hall meetings. "I think they've written enough to know [what they will draft]," she adds. "We need to have a process and make decisions on how to spend Medicaid money."
"No one accountable to the public is making these decisions," says Bill Monto, associate director of the health-care watchdog group Washington Citizen Action (WCA).
To solve the problem, WCA and Schual-Berke proposed a sunshine bill that would give the legislature a say about reducing or restructuring Medicaid. The WCA sunshine bill failed.
Monto accused Budget Appropriations Chair Rep. Helen Sommers (D-Ballard) of snatching the bill and sitting on it. Sommers, who supports Locke and DSHS' Medicaid reform, says, "We have overextended our expenditures." Medicaid is inflating at a rate of 11 percent annually, she added, explaining that the Medicaid changes will help to relieve the state deficit. (Medicaid's Doug Porter estimates that $50-$60 million will be saved by the reform.)
Locke and DSHS say the sunshine bill is irrelevant--the Medicaid proposal does not disregard the legislative process. "The legislature will have their say when the budget is presented in January," Porter says.
But Porter and Locke's idea of legislative involvement is dubious. Instead of being considered in its own right, the proposal will be placed within the entire budget for a vote. "The budget is a huge document," Schual-Berke says. "Things get put in there until the 11th hour.... You can't just reject the entire budget."
Porter points out that past Medicaid proposals didn't go to the legislature. (In the past, however, those Medicaid proposals have been about expanding the program, not cutting into its funds. "This [Medicaid proposal] is unprecedented," Schual-Berke says.)
All eyes will be on Washington State this year as the redrafted proposal goes to the feds for approval. It's the first move by any state to threaten Medicaid rolls with monthly premiums and enrollment freezes. If it passes, other states (looking to save some dough) are likely to follow suit. Hopefully, they won't follow our bad example by mimicking Washington State's undemocratic process.
