Washington State Holds Off Single-Payer Health Insurance
During the 2019 session, the Washington State legislature again declined to pass a bill imposing single-payer health insurance on the state.
Instead, legislators chose to move the bar incrementally by introducing two bills to create a working group to determine a “pathway” to a single-payer health care plan.
H.B. 1877 and S.B. 5822, which passed March 13, initiate a study to draft recommendations on implementing a “universal,” “publicly funded,” and “privately delivered” health care system in Washington State. The working group would be tasked with creating a “pathway” for universal health care and would include representatives of consumers, businesses, health care providers, health insurers, and legislators.
Governor on Board
The bills coincide with Gov. Jay Inslee’s announcement of his support for a “public option” plan, a slightly less radical approach than single-payer because it is not complete government-run health care. Unlike a single-payer plan, which is a completely government-run health insurance system covering everyone—like Canada’s health care system—the "public option" is a government-run health insurance plan to compete with private insurance companies.
“This public option will ensure consumers in every part of the state will have an option for high-quality, affordable coverage,” Inslee said at the King County Public Health Center in Seattle.
Inslee’s plan would direct the state’s Health Care Authority to contract with health insurers throughout the state, guaranteeing coverage to anyone in the state’s individual insurance market. His plan, which does not include a price tag, would subsidize premiums for people with incomes up to 500 percent of the federal poverty level, which is about $128,000 for a family of four, and make reimbursement rates to providers consistent with those of Medicare.
Unaffordable ‘Free’ Health Care
Single-payer health care bills have come up many times in the Washington legislature but always failed to make it to the floor for a vote because there’s no way to pay for such a plan, says Dr. Roger Stark, a health care policy analyst at the Washington Policy Center and a retired physician.
“The adults in Olympia realize the state can't afford a single-payer system—see Vermont, Colorado, and California,” Stark said. “So, what do politicians do? They form a ‘working committee’ to hold meetings and hearings to waste taxpayer money. This is what is happening with the single-payer issue in Washington State.”
Both chambers passed a “public option” plan separately in March that would be available on the state’s Affordable Care Act exchange. Lawmakers are currently working out differences between the bills.
“Inslee is ready to sign the final bill into law,” Stark said. “Subsidies will be available to anyone earning up to 500 percent of the federal poverty level,” said Stark. “Oh, and no meaningful funding mechanism is, at the present time, included in the legislation.”
Unions in Opposition
One of the Democrats’ natural allies, labor unions, may be playing a role in Washington State’s decision to go slowly on single-payer.
“The unions are not the place where socialized medicine plays well,” said John Dale Dunn, a physician and attorney in Brownwood, Texas. “Unions already have their health care benefits set up and will be unwilling to give up their health benefits packages and go to some kind of government-run program that leads to inferior care than what they’re already receiving. They’re not the people who are going to support single-payer.”
Another factor, of course, is the cost of single-payer, says Dunn.
“As they found out in Vermont—where Democrats were all hot to have single-payer—they couldn’t afford it,” Dunn said. “In Oregon, they had a weird, hybrid system consisting of a gigantic Medicaid system that rated medical problems and had all kinds of medical arrangements to emphasize provided services in this or that area. But once Oregon got their single-payer plan, it ended up being too expensive and irritating to a lot of people because they ranked procedures by priority,” said Dunn.
“What it amounted to was a disguised form of rationing,” said Dunn. “There were certain things they thought were important and were paid for, and there were other things that were not paid for—but that’s what you get when you have government-controlled health care.”
Kenneth Artz (firstname.lastname@example.org) writes from Dallas, Texas.