In a move that clearly has nothing to do with his presidential ambitions, this morning Governor Jay Inslee will throw his weight behind one of the many health care proposals lawmakers are brewing up in Olympia this session. In an advisory note from his office, staff says he'll announce support "for increased public health care options in Washington through the state’s Health Benefit Exchange." That language sounds a lot like he wants to support a public option at the state level.
Lucky for him, Rep. Eileen Cody is working on just such a bill, according to health care advocate Bevin McLeod of the Alliance for a Healthy Washington. Cody's office hasn't released the language of her soon-to-be-introduced "Cascade Care" plan, but, judging from what McLeod has seen, the bill appears to be a public option, which would mandate that current providers offer a basic health plan on the exchange. Cody's staff didn't deny they were working on a public option, but they also didn't send along a draft. A representative for Inslee's office hasn't responded to a request for comment.
If the bill really is just that—and we'll know more for sure soon—the proposal will continue to line the pockets of private insurance companies rather than weaning us away from a private system. It won't solve the structural issues promoting high costs of health insurance, and it won't be a launching pad for a state-based system.
However, if passed—which is eminently possible with a majority of Democrats in the state house and senate!—Washington would be one of the first states to have something like a public option, which would likely cover more people and save more lives.
Politically, it would be a big win for a governor who suffered a big loss with the defeat of the carbon fee initiative last fall. Being able to prove he can deliver on health care—an issue that defined so many successful midterm campaigns for Democrats—might help him drum up support for his presidential run, which is, of course, purely speculative at this point. His support for the bill, however, could prove to be its downfall if Republicans and conservative Democrats don't want to associate themselves with an Inslee-backed bill.
Passing a public option would also obviously show other states that passing a public option is possible, which might spur copycats. Plus, tacking on a public option to the state exchanges might not completely stymie progress towards overhauling the health care system, whereas trying to implement a single-payer system in a hostile environment with a high risk of failure could be a fatal setback.
After all, there's a lot of technical problems standing between us and the state-based single payer system here in Washington. Without the ability to apply for federal Affordable Care Act waivers, which would allow states to use Obamacare money to fund state-based systems, “Medicare for All” at a state level isn’t exactly finically feasible. (Last year Rep. Pramila Jayapal introduced a bill that would allow states to apply for those waivers, but it’s not expected to pass this session because nothing is expected to pass this session.) States can't run deficits to fund such programs like the federal government can, and it's even harder to think about funding a single-payer system in a state that doesn't have an income tax.
This is all to say: maybe a public option is kinda good, and maybe in some roundabout way it could lead us on the path to universal access and coverage in Washington?
But there are as many paths toward universal health care coverage as there are Democrats, it seems. This session lawmakers are planning to introduce several bills that will address the health care industry in some way. They run the gamut from a reintroduction of the state-based single payer bill (aka the Washington Health Security Trust Bill, which has been floating around for a while) to Rep. Cody's Cascade Care to a few bills tackling cost transparency.
Sen. David Frockt and Rep. Nicole Macri are working on a bill that would serve as a “bridge to universal care,” Macri said over the phone in late December. Nothing is set in stone yet, but the bill aims to expand coverage through the Washington Health Authority to Washingtonians who don't currently receive it. Macri hopes to target people hovering between 400 and 600 percent of the poverty line (i.e. people too rich for Medicaid but too poor for the Silver Plan on the exchange), and also DACA recipients, who are currently ineligible for coverage.
The Frockt/Macri bill would also "probably create a workgroup" that studies a just transition model to single-payer in Washington state, laying down the oversight infrastructure for state-based Medicare for All, "with the overall goal being to provide publicly financed, privately delivered health care that all Washingtonians have access to that’s affordable and sustainable," Macri said. She would want the workgroup to figure out how to pay for a single-payer model in the state, and also work on solutions to other problems such as managing the cost of health care inflation.
Sherry Appleton might introduce the Washington Health Security Trust bill in the House, again.
Though it has a very slight chance of getting a hearing, and an even slighter chance of ever being passed, I do have some dream of making that state-based single-payer bill into a trigger law. A trigger law is a law that would go into effect automatically if certain conditions are met at the federal level—a handful of conservative state legislatures, for instance, have trigger laws that will automatically ban abortion in the state if Roe v Wade is overturned. Since we can't pass state-based single payer until the feds get their act together and give us a waiver, then why not pass the WHST as a trigger law and move on with our lives? Macri said she's heard people "talking about that strategy," so maybe it's possible.
According to McLeod, state house representative
Vandana Slatter June Robinson is picking up a bill related to transparency in drug pricing, which would require companies to explain the reasons why they're charging the amount of money for the drugs they're selling. The bill would hopefully shame the Martin Shkrelis of the world into not being horrible Martin Shkrelis about their drug prices.
In addition to the public option, Rep Cody prefiled a bill would end "surprise medical billing" in Washington. You know that thing where you go to a doctor in your network, but then you get a bill showing that the anesthesiologist you saw as part of some necessary procedure wasn't in your network, which means you suddenly have to pay tons of money? Cody wants to make that illegal.
It’s official, from Inslee: “We are proposing to the state legislature...a public option that is available throughout the state.”
— Rich Smith 🥀 (@richsssmith) January 8, 2019