Legislative Update

Many of the more conservative legislators were not sure whether to support expanding Medicaid to cover families whose income is less than 138 percent of the Federal Poverty Level (roughly $14,000/year for an individual). However, the realization the state could increase the number of residents receiving health care benefits, get the federal government to pay the total cost to provide this increased coverage, and then also get the feds to cover payments for people currently receiving Medicaid, has been very persuasive.

A large majority now seem committed to making sure Washington gets the $225 million reduction in state costs for the next biennium created when the federal government makes Medicaid payments the state is currently required to pay. In addition, most legislators want to see the 1 million state residents whose income is below 138% FPL, and who currently do not have health care coverage, also benefit from this coverage. 100 percent of the cost to cover the additional 1 million residents will initially be paid by the federal government.

While the budget has not yet been implemented, and so Medicaid expansion has not yet been put into law, FCWPP made a significant contribution to educating all legislators about the above and helped more conservative members get past objections based on concerns about expanding government services. It appears this program will be part of the final budget for the next biennium.

While many might prefer the single payer structure described below (see HB 1085), it may take a while to build the support needed to create this structure.

The Affordable Care Act provides individuals and groups of less than 50 (small employers) an opportunity to purchase insurance through a Health Benefits Exchange that will provide structure it is hoped will make information needed to comparison shop for health care benefits more accessible and transparent. It is also hoped this structure will force insurers to price their products more competitively and create savings for all involved. In addition, the Exchange provides mechanisms to route federal premium subsidies to people with incomes below 400 percent of the Federal Poverty Level (FPL).

Washington’s Health Benefits Exchange Board estimates the cost of running the exchange to be about $50 million/year. This breaks down to $12.50/participant/month. Exchange Board members fear insurance sold through the Exchange will not be competitively priced if they require people who purchase that insurance to pay the total cost of running the Exchange.

ESHB 1497 would fund the Exchange with that piece of the Business and Occupation Tax paid on all insurance, which is generated by the sale of insurance through the Exchange. This would reduce the additional amount that would have to be added to premiums to $2.50/participant/month. The bill also requires the State Auditor to conduct a performance review of the Health Benefits Exchange and make recommendations based on cost, performance, and adoption of best practices.

Protecting a woman’s right to consult in private, with her physician, to decide whether to have an abortion. EHB 1044 keeps abortion services safe, legal, and accessible by requiring insurers to cover these services in any plan that covers maternity services. This bill exposes some of the basic conflicts and concerns related to exclusionary clauses in insurance plans.

The exclusionary clause people are most familiar with is the current practice of not covering the costs of treating pre-existing conditions. Most of the public has come to understand that without a requirement that everyone purchase insurance, some will wait until after they get sick or injured before paying a premium to purchase a policy. This results in those who have maintained continuous coverage paying a large part of the costs for the care of the person who was without coverage until after he or she got sick.

The Affordable Care Act (ACA) addresses the above issue by requiring everyone to have health care coverage and by requiring all insurance plans cover pre-existing conditions. One complements the other. The ACA also creates hurdles in an effort to appease all parties in how it addresses women’s family planning decisions (see also NARAL).

Many fear federal efforts to prevent discrimination based on provider decisions to provide abortion services, while allowing employers to not purchase insurance that covers these services when it conflicts with their conscious or religious beliefs, and while also ensuring employees and the general public are not denied access to these services (see Abortion Rules) have created a bureaucracy with significant costs which will motivate insurers to create products that do not cover abortion services.

Since support for a woman’s right to choose is not part of the essential health services the ACA requires all insurance plans to cover, insurers are obligated to create the bureaucratic structure referenced above only if they choose to insure these services. The costs associated with the bureaucracy can be avoided by excluding coverage. A few insurers deciding to sell plans that do not support women’s choice could fragment the insurance market, resulting in a refusal of all insurers to cover these services for the same reasons and in the same way they currently refuse to cover treatment of pre-existing conditions.

Washington’s insurers, and their customers, could also be put at a serious disadvantage if 2SSB 5540 becomes law. Each state, through its Office of Insurance Commissioner, regulates the insurance industry. Under 2SSB 5540 out-of-state insurers would not be required to maintain parity with Washington insurers. This creates an imbalance that would increase the cost of policies structured by Washington laws in the same ways mandating coverage of pre-existing conditions while allowing people to not buy insurance creates an imbalance.

Mental health coverage is one area that could be particularly hard hit if 2SSB 5540 becomes law. Washington requires more comprehensive mental health coverage than what is required by federal law (ACA). Ifout-of-state insurers are allowed to sell policies in Washington that do not include the more comprehensive mental health coverage insurers in our state are required to provide, premium costs for the out-of-state product will be less. The population over which the cost of comprehensive mental health care is spread (which is how insurance works) would be reduced as people who anticipated they did not need coverage our state requires all plans provide chose to purchase less costly out-of-state insurance instead. Ultimately, we would be forced to amend our laws to allow less comprehensive coverage or risk insurers leaving our state.

People needing mental health care that is no longer covered by insurance would have to pay for it themselves, use public assistance, or do without.

The subsidized Basic Health options created by past legislators and administered by the Health Care Authority are seen as models for efficiently providing low-income residents (between 138% FPL and 200% FPL) with health care coverage. This inspired Affordable Care Act (ACA) drafters to include a “Basic Health Option” (BHO) in federal health reform legislation to provide states with increased ability to build on Washington State’s programmatic success. SHB 5482 attempted to lay a foundation to facilitate future state legislative efforts to benefit from structures the federal government will create to support BHOs. Unfortunately, the federal Department of Health and Human Services has not yet issued rules needed to implement BHOs. This lack of information made it difficult to develop support for the program.

In future legislative sessions we hope to build on the efforts this session that essentially introduced legislators to the idea of our state’s Basic Health plan in the context of federal health care reform (ACA). SHB 5482 did not survive cut-off.

Representative Sherry Appleton sponsored HB 1085 to provide all Washingtonians with access to health care. The bill was patterned on Vermont’s effort to use the ACA, and the Health Benefits Exchange provided for in the ACA, to create a state run, single-payer plan instead of creating patches and jerry-rigging the existing insurance market. HB 1085 was heard by the House Health Care & Wellness Committee, but was never scheduled for a vote.

Health care professionals, advocates, administrators, patients, and potential patients filled the hearing room and filled two additional rooms set up to handle the overflow crowd. The state run, single-payer, health plan established by HB 1085 would have functioned as one insurance plan that all state resident enrolled in to cover the cost of their health care. Choice of providers and facilities would have remained in the control of individuals seeking care; however, payment would have been processed through one plan instead of the many different insurance companies and plan administrators—each making sure to get their cut of the costs of health care. A single-payer plan would dramatically reduce administrative costs while increasing the plan’s ability to negotiate the best possible prices and care from providers and facilities.

We spend moreon health care in the US than any other nation in the world. On a per capita basis, the US spends almost three times what Japan spends, and almost twice the per capita expenditures in Sweden, Belgium, France, and Germany (see Health Care Costs). In addition, these other countries currently cover everyone, even though they spend far less than we do in the US, while millions of Americans continue to live without health care coverage, despite the fact we dramatically outspend nations in the rest of the world.

SSB 5290 expands the definition of an “eligible renewable resource” to include “micro” hydropower in irrigation canals, irrigation pipes, and wastewater pipes. It provides a stronger incentive for a technology with minimal risk to the environment.

E2SB 5802 is Governor Inslee’s request legislation to create a work group and to commission that group to do a comprehensive review and evaluation of programs in others states designed to reduce greenhouse gas emissions. This is a first step to developing proposals on ways the state can better act to reduce greenhouse gas emissions. The bill has passed the Senate and is expected to pass the House.

SB 5805 modified the definition of “projects of statewide significance” to support expedited review of projects like Coal Export Facilities and the proposed Pit-to-Pier gravel pit on Hood Canal. We were concerned this bill would have weakened environmental protections, resulting in external costs that exceeded the value of any increase in jobs or economic activity that might occur. SB 5805 has been cut off from further consideration this session.

HB 1599, and its companion: SB 5623, have been cut off from further consideration this session. These bills would have permitted counties to decide whether to allow in-water net pen aquaculture. Net pens can become breeding grounds for viruses that then spread into the wild population and hybrid farm fish can escape and contaminate the wild gene pool. Currently, the Department of Ecology has claimed jurisdiction and disallowed counties from forbidding the practice.

SB 5029 is patterned on the Bank of North Dakota and would have increased state resources and increased opportunities for state residents by creating a Washington Investment Trust which would hold state deposits after they are received, and before they are needed to cover budgeted expenditures. Instead of depositing all state funds in a commercial bank, some would have been put in the investment trust. This would increase the return the state received on those deposits while also allowing the state to better target investments or loans supported by state resources. The bill received a hearing in the Senate Committee on Financial Institutions, Housing, and Insurance; however, it was not voted on and has been cut off from further consideration this session.

Gun Violence was a major issue prior to cutoff. This is a complex issue that defies easy summation. Activists are encouraged to visit our website, FCWPP.org, where we will post a more detailed discussion in the near future. Highlights follow.

(cut off) In terms of preventing additional violence, successfully blocking attempts to limit judicial discretion and mandate juveniles found to illegally possess a firearm do time in detention may have had the greatest impact. Preventing SHB 1096 from coming to the House for a vote will result in judges continuing to have the ability to work with prosecutors, juveniles, and defense to determine whether detention, a community based alternative, or a combination of the two will best support public safety and reduce the potential the offender will again pick up a gun.

(cut off) Sadly, SHB 1588, which would have required background checks on all gun sales, also failed to get a vote on the House floor. The National Rifle Association, and other gun advocates, ran ads in targeted legislative districts and were very successful in getting supporters to contact legislators. Although polling data showed nearly 80 percent of the electorate support mandatory background checks on all gun sales, some legislators reported calls in opposition outnumber those in support by a 20:1 ratio.

(cut off) A little bill, HB 1676, might have done more to reduce gun violence than anything else considered. HB 1676 limited access to firearms through increased use of lockboxes and trigger locks. This bill did not even make it out of committee. Given that five times the number of people who use guns to kill others, instead use guns to kill themselves, restricting access with lock boxes and trigger locks could have a major impact on reducing gun violence.

(still alive) The two gun bills that did make it through the House were SHB 1840, sponsored by Representative Roger Goodman, which brings state law into conformity with federal laws prohibiting possession of a firearm by a person subject to certain protection, no contact, and restraining orders; and 2SHB 1777, sponsored by Representative Tami Green, changes the implementation date to expands the criteria for involuntary civil commitment due to mental health issues from July 1, 2015 to July 1, 2014.

We were thrilled when FCWPP’s former lobbyist, Carol Estes, informed us of Department of Corrections (DOC) request legislation to reverse current law that prohibits expenditure of state resources to support higher education in prisons. Although HB 1429 did not get a vote on the House Floor before cut-off, we hope to help move it forward as a budget proviso.

The Washington State Institute of Public Policy has documented approximately $5,000/prisoner in savings for every $1,000/prisoner spent on education, so a budget proviso seems very appropriate. A major part of these savings are realized by individuals who are not victimized when former prisoners succeed after their release, instead of “recidivating.” In addition, DOC is not requesting additional funding for this program. The bill requires the department to fund the program with resources from its existing budget.

Keeping families together usually creates a great benefit for children; however, there are times when the state needs to intervene because parents are abusing or neglecting their children. SHB 1284 reduces the possibility the state will inappropriately terminate parental rights by providing parents who are incarcerated or in a residential treatment program with the ability to participate in dependency case conferences via teleconference or videoconference.

What happens when the state—through a jury or a judge—makes a mistake and sends an innocent person to prison? People have been released when new evidence persuades authorities of their innocence; however, they are not compensated for pain, suffering, or lost wages. ESHB 1341 allows individuals wrongfully convicted of a felony to file a claim against the state for $50,000 for each year of actual incarceration.

In addition to passing new laws, the legislative process provides a valuable venue through which to explore new or novel public policy initiatives while educating both legislators and the public. Policy committees frequently hold “Work Sessions”, instead of hearings, to support this education and gain media attention for important initiatives.

Last year the Senate Judicial Committee heard a bill to abolish the death penalty. This year the House Judicial Committee scheduled a hearing after the cut-off date to educate legislators and the public about HB 1504 to abolish the death penalty. We did not succeed in packing the hearing room as well as the advocates opposed to gun control had done; however, Tom Ewell contributed to a discussion of the issue that all found very informative. TV stations, radio, and print media all did stories about the hearing and the information shared.

Our apologies to the Eastside Friend whom we heard made the trip to Olympia, but with whom we failed to connect.

The issue will require additional work before we can succeed in changing the law.

There are ombudsmen in Washington to assist Family and Children, with Education, with Long Term Care, to assist Injured Workers, and to support Human Rights. This model supports an outside third-party who assists people with problems or challenges creating obstacles to the individual or societal benefits programs were established to create. SB 5177 would have created an ombuds program for the Department of Corrections to help resolve issues that otherwise might fall through the cracks: sometimes with major negative consequences for the Department, for a prisoner, for a family member or for a victim. Although SB 5177 was voted out of the policy committee that considered the bill, Senate Ways and Means members did not hold a hearing on the bill, and it was cut-off from further consideration this session.