But we're not calling Jay Inslee's
But we're not calling Jay Inslee's "public option" a public option. People are doing it. But we're not doing it. KAREN DUCEY / GETTY IMAGES

This year the Legislature passed bills that will lower the cost of health care for people on Obamacare, increase transparency in drug pricing, ensure equal reproductive health care access to LGBTQ people, create a new long-term care system, and possibly put the state on the path to developing a single-payer system.

With the rather large exceptions of the long-term health care bill and the hundreds of millions the state has dedicated to fixing up the mental health care system, most of these measures are small but meaningful steps forward toward expanding coverage and lowering health care costs.

But first thing's first: we are not calling Jay Inlsee's Cascade Care plan a "public option" any more. Why? Because the bill, which passed the Legislature but hasn't been signed by the governor, is not a public option. I know it's a little dumb to get too hung up on the terminology, but lauding this legislation as a "public option" is risky.

The measure allows the state to enter into cost-sharing agreements with health insurance companies who want to sell plans on Washington's health care exchange (aka Obamacare). This public-private partnership will lower the price of insurance premiums by 5 to 10% in 2021 for the 266,000 Washingtonians buying on the exchange, according to a representative from the Insurance Commissioner's office. And by 2020, the state and its private partners must develop a plan to make sure people earning up to 500% of the poverty line will spend no more than 10% of their income on premiums. All of that is good! Especially since premiums will go up 14 percent next year.

But, because Cascade Care relies on the private market, it's vulnerable to the caprice of health insurance companies. Those companies might not want to participate in the program in the first place, or they might participate for a while and abandon the field later on.

Last I heard from Insurance Commissioner Mike Kreidler, Kaiser was the only insurance company who was interested in playing ball. Now, according to Jason McGill, senior health advisor at the governor's office, Premera, Regence, and Community Health Plan are also interested. That's four of the top five largest health insurance companies in the state, but that's not everybody. However, McGill says, "it's still very early."

First, the governor has to sign the bill. Then the Health Benefit Exchange has to design the plans while the Health Care Authority designs the contracts. Meanwhile, insurers will need to see if they can gather enough provider networks willing to be reimbursed for services at Medicare rates. (Under the most recent version of the bill, rural hospitals will be reimbursed at 100% of allowable costs, which might help.)

If all that goes smoothly, then we'll have slightly cheaper insurance plans on the state exchange. Not sure if 5 to 10% of a price reduction will coax an estimated 400,000 uninsured Washingtonians to hop aboard the Obamacare train, but it can't hurt.

If this bill were a public option, however, the state would provide a publicly funded health insurance plan for people who are slightly too "rich" for Medicaid but too poor to afford insurance on the exchange. That program would be vulnerable to the caprice of politicians, sure, but removing earned benefits once they've been put in place hasn't exactly been a winning strategy.

But neither is calling something what it's not. We don't want people thinking that the "public option" is just a slightly cheaper but still too expensive health care plan. If they think that, then they'll get disappointed. And if they get disappointed in the public option, then they won't trust the government to administer a truly universal health care system that will save them money on health insurance over time while covering every single person in the state. Speaking of which...

The Pathway to a Truly Universal Health Care System

Bad news: Even with bipartisan support, Sen. Emily Randall's Pathway to Universal Health Care bill didn't pass.

Good news: the substance of the bill was included as a proviso in the budget with $500,000 of funding. The legislation calls for a workgroup to study a broad range of strategies for providing universal health care in Washington state. One of those strategies includes a regional solution, where Washington would partner with Oregon, California, and Hawaii to create a single-payer system.

Recommendations from the workgroup are due November 2020, so the new Legislature starting in 2021 will have a bunch of good ideas for creating a path for universal health care.

"It's a big deal," said Rep. Nicole Macri, who sponsored the bill in the House. "For the first time, we’ll bring all the relevant stakeholders to the same table to work through the options and challenges related to expanding coverage and access, managing cost, and reducing disparities in health outcomes."

Long-Term Health Care Act

Another big deal is the passage of the Long-Term Health Care Act, which imposes a .58% payroll tax on all workers in order to establish a new benefit for people who don't have anyone to take care of them when they're old. After 2022, eligible recipients can tap up to $36,500 to pay for nursing home services, home care services, meals, "dementia supports," transportation, and "respite for family caregivers."

In case you haven't exactly been keeping up, the country is facing a long-term health care crisis.

Even though many of us will need some form of assistance to live after "retirement," the cost of long-term health care insurance is insane, Medicare doesn't cover it, and some old people are draining their entire life savings just so they can be poor enough to enroll into Medicaid, which does cover long-term health care.

Because few people can afford nursing homes or hospice care, according to the language of the bill, "more than 850,000 unpaid family caregivers provided care valued at $11 billion in 2015. Furthermore, family caregivers who leave the workforce to provide unpaid long-term services and supports lose an average of $300,000 in their own income and health and retirement benefits."

This bill will help relieve some of that burden.

Drug Pricing

Rep. June Robinson's drug transparency bill also passed the Legislature. This bill requires companies to explain the reasons why they're charging so much for drugs. As I wrote earlier this year, the bill will hopefully shame the Martin Shkrelis of the world into not being horrible Martin Shkrelis about their drug prices.

Reproductive Health Care Act

According to Washington's 2015 Transgender Survey, 29% of trans people say they've been denied health care only because they were transgender. Since health care providers tag certain medical processes to gender, trans people see automatic denials for routine treatment such as Pap smears and prostate exams. Some health insurers get more crafty with their coverage denial. As I mentioned in my last post on this bill, Sen. Marko Liias heard testimony from a Washington resident who said their insurance company declared their broken arm a transition-related injury, which the company didn't cover. If the patient hadn't transitioned, the company argued, they wouldn't have been playing the sport they were playing when they broke their arm.

Thanks to the passage of this bill, none of that stuff can happen anymore. A section of this bill also covered family planning services for undocumented residents who don't otherwise have health insurance. Those services were taken out of this bill, according to Rep. Macri, but were included as a proviso in the larger budget. So now all eligible residents up to 260% of the federal poverty line will get these services.