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A significant, historic victory on health plan standards


Health care consumers scored a significant, historic victory with last week’s Senate passage of HB 2319, which implements the Affordable Care Act in Washington state. The House concurred with Senate changes on Saturday, so the bill now heads to the desk of Gov. Chris Gregoire, who requested it and is expected to sign it into law.

This critically important legislation, sponsored by Rep. Eileen Cody (D-Seattle) and Sen. Karen Keiser (D-Kent), will set some minimum standards for health plans and coverage offered in 2014 when much of the federal Affordable Care Act takes effect. That’s the year that Washington’s Health Benefits Exchange market place will be established, offering consumers a menu of private and federally subsidized plans from which to choose. Without defined standards, bare-bones cut-rate coverage will continue to be offered on the open private insurance market — which will operate outside the realm of the Exchange — and would cream the healthiest customers from the market, prohibitively driving up the costs of the plans within the Exchange.

Although HB 2319 was strongly supported by Gov. Gregoire and Insurance Commissioner Mike Kreidler, its passage was very much in doubt in the weeks leading up to the Senate vote finally held on March 1. An aggressive campaign against the bill conducted by some of the larger insurance companies failed to kill it in the House, where HB 2319 passed 52-43, but it got held up before it hit the  Senate floor were  insurance lobbyists who opposed the bill were lobbying hard to hold the bill back to water it down further and further.

The industry lobbyists who opposed the bill — including Premera, Regence, the Association of Washington Business,  and others — lobbied in a pack that went from office to office to spread fear and misinformation about what HB 2319 would do.  They made dire predictions of increased costs and the demise of the insurance market.

The Healthy Washington Coalition (HWC) showed its strength and its commitment to improving access to quality, affordable care.  HWC brought a strong voice of the consumers of health care from disease groups like Cancer,  MS and HIV/AIDS, who lobbied next to community groups and unions like WA Community Action Network, SEIU, Children’s Alliance, NoHLA, AARP, WA State Nurses Association, UFCW, NOW, and Community Health Centers. Coalition members provided expert testimony, daily lobbying, and brought the voices of mothers, small business owners, those insurance carriers committed to reform — including key state-based carriers, like Community Health Plan and Group Health Cooperative, and regional plans like Molina and Kaiser — to counter the disinformation campaign from the big insurers and the large corporations that opposed it.

Ultimately, there were many key individuals in the Senate who expressed strong support for the bill and worked to overcome this misinformation campaign by the opposition and ensure its 27-22 passage on March 1:

— Our deepest thanks and appreciation go to Sen. Karen Keiser. After decades of working to reform health care and improve access to high-quality health care for all, Keiser relentlessly worked to improve the Exchange bill. Though it didn’t make it in the final bill, she insisted on language guaranteeing consumer access to coverage by including the possibility of a public option if the Exchange did not offer sufficient plan options.

—  Fighting alongside Keiser, Rep. Eileen Cody was a champion for creating a Basic Health-like option for individuals below 200% of the federal poverty level to ensure their care is affordable and accessible. This option was repeatedly attacked and ultimately took a hit at the end, requiring additional legislative action in 2013 to allow its full implementation, but the design and development of the systems to prepare for the Basic Health program are permitted in HB 2319 — now we just need funding in the final budget to do so this year.

Sen. Jim Hargrove (D-Hoquiam) was instrumental in advocating for the bill internally among different voices within the Democratic caucus. He worked very hard for days to find a path for the bill to get out of the Senate, listening and responding to insurers’ concerns. When insurance lobbyists opposed to the bill kept returning for more and more concessions, it became clear that their primary goal was to scuttle the bill. That’s when Hargrove’s strong advocacy helped convince his colleagues it was time to vote on the legislation.

Sen. Cheryl Pflug (R-Maple Valley), the sole Republican to vote “yes,” bravely spoke about how she was not going to be intimidated by the threatening messages she was receiving. She said she was committed to improving access to health care because it is the right thing to do.

“I am concerned about some of the notes already starting to arrive,” Pflug said, waving a slip of paper during her floor speech. “Frankly, I’m a little bit appalled at the suggestion of consequences to a senator for how one might vote. Appalled, but not intimidated.”

—  The Office of the Insurance Commissioner showed they stay true to their directive: to protect health care consumers. The bill was forcefully championed and continually improved by the suggestions and expert analysis from Commissioner Kreidler and his staff.

The most significant policy win included in HB 2319 will prevent insurance companies from trying to cherry pick and syphon the most healthy and young populations out of the exchange. The bill requires the insurance carriers who offer coverage outside the exchange in the lower-value “bronze” plans to also offer higher-value “silver” and “gold” plans as well. HB 2319 also includes a quality rating system allowing individuals, families and small businesses to rate the quality of care, access, services, and outcomes so all can benefit and hold the industry accountable.

Every word in HB 2319 was a hard-fought battle. In many ways, the debate over the implementation of health care reform in 2012 mirrored the gut-wrenching debate over health reform at the federal level in 2010.

And this battle is not over. We must come back next year to make additional steps toward realizing the goal of health care for all, and we will need your voice and active support then just as we did this year. But with passage of HB 2319, the State of Washington has taken an important step closer toward the goal of improving access to quality affordable health care for the uninsured and underinsured.

Teresa Mosqueda, who serves as Chair of the Healthy Washington Coalition, is Legislative and Policy Director for the Washington State Labor Council.

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