Health Care in the 2019 State Legislative Session

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Alex Evans
Senior Account Director

Jan 22, 2019

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On January 10th, nearly 800 providers, payers, conveners, elected officials, policy wonks – and a few communicators – came together in downtown Seattle at the State of Reform to discuss the current health care landscape in Washington state and what to expect this coming year from our government officials as it relates to health care policy.

5 areas we expect to see covered in Washington’s legislative session:


Health care reform – This is top of the agenda and the top voter issue – making it a good area for bipartisan collaboration. Legislators need to address both access to coverage and affordability. This could change and expand options for Washington residents and new negotiated rates for providers.

Public option – Governor Inslee’s proposed public option legislation has Democratic support in the legislature, however Washington state Insurance Commissioner Mike Kreidler anticipates difficulties getting it passed. The proposal would provide a public option that is available across the state through the Washington Health Benefits Exchange with at least one health-insurance carrier, competing against private insurance carriers. Supporters, like Senator Cleveland (D-Vancouver), expect the public option to lower costs and provide access to affordable choices for health care plans. The key questions are the plan’s premium costs and which hospitals and doctors will be in-network, with the plan reimbursing at Medicare rates. If the legislature passes the Governor’s proposal, Washington will be the first state to implement a public option.

Medicaid funding – We are in a funding crisis in Washington state. Low Medicaid reimbursement rates have had a downriver effect – shutting out Medicaid patients, closing facilities and ultimately leading to over-crowded emergency rooms. In the last 17 years, Medicaid reimbursement rates have averaged an increase of only 3.5% – over almost two decades of significant growth in both population and GDP in our state. This is an issue for the legislature to take on this session. Medicaid providers are hoping for sizable rate hikes, but we will see how far the state is willing to go.

Mental health – Not only is this a topic of discussion and expected action at the state level, but it is part of nearly every health care and policy conversation with county and municipal governments, as well as with providers and payers. Fortunately, there is strong bipartisan support for funding and action to address the growing behavioral health crisis in our state. Expect a bill to address the current behavioral health system that includes a shift, in part, to community-based care, as well as bolstering the behavioral health workforce.

Balanced billing – Expect this issue to be addressed in this session, but know that “everyone is going to not like it,” says Carrie Tellefson of Miller, Malone & Tellefson. She expects balanced bills will be banned, and instead we will see “commercially responsible” bills, which providers can dispute. What would be maintained are the incentives for payers and providers to contract with each other.

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