Issue Position: Health Care

Issue Position

Building a Working Washington Health Care System:

Bending the Cost Curve, Improving Quality and Increasing Access Health care system improvement in Washington State is a critical element that will drive economic recovery and job creation. Jay Inslee and his administration will bring together stakeholders to implement best practices and adopt innovations that promote efficiencies and quality. Jay's policies will help to bend the cost curve of health care in Washington downward and improve patient outcomes, while helping small businesses better afford coverage for their employees. Specifically, Jay's vision for a Working Washington Health Care System includes:

Fully implementing the benefits of the Affordable Care Act (ACA), which are estimated to accrue savings to state government of between $667 and $988 million from 2014-2019.

The expansion of Medicaid under the ACA that will help eliminate the cost-shift from the uninsured to those with insurance, which on its own increases premiums $1100 per family per year.

Using Medicaid to create new payment models to support innovations in care delivery, like Accountable Care Organizations and Patient Centered Medical Homes, which put the health care patient-provider relationship at the center of care.

Development of a vibrant Health Benefit Exchange that puts more of your premium dollars toward care instead of insurance companies' overhead.

Improving Washington's health care system must build on the support provided by the Affordable Care Act. Hundreds of thousands of Washingtonians have already benefited from the increased coverage of preventive care, the ability to keep their children covered up to age 26 and the elimination of limits on insurance coverage. Millions more will benefit when insurance can no longer be denied or limited because of pre-existing health conditions. It will bring relief to small businesses struggling to find coverage for their employees. In large part due to Jay's efforts, physicians and hospitals have finally seen an increase in our state's Medicare reimbursement rates, which have been underfunded for years.

The true challenge now before us is to bring health care costs closer in line with the inflation rate of the larger economy. Health care inflation is rising unsustainably, squeezing the state's budget and making our private industries less globally competitive. As governor, Jay will move forward on innovative practices that respect the patient-physician relationship and keep Washington at the forefront of this rapidly changing industry.

Jay's policies respond to the challenges facing Washington State and builds on his demonstrated leadership on health care. It is an approach that helps to increase access, improve quality and decrease costs.

1. Extend coverage to hundreds of thousands of Washingtonians by expanding Medicaid while also examining the option of a federal Basic Health Option
The Affordable Care Act is a landmark bill for many reasons -- chief among them is the generous financial support to states for the expansion of Medicaid. The federal government will cover 100 percent of the health care costs for new beneficiaries of an expanded Medicaid program for the first 3 years.

This is among the most transformational elements of the ACA, one that comes with a very limited cost and a tremendous benefit to the state and the citizens of Washington.

While some have questioned whether the state can afford the expansion, Jay understands we can't afford not to expand Medicaid. All of us already pay a hidden tax for uncompensated care for uninsured people over $1,100 per year per family in increased premiums -- a total of $1 billion annually. Families pay even more in state and local taxes to cover uncompensated care.

With expansion of Medicaid, we can also expand personal responsibility for beneficiaries by aligning benefits and financial incentives to encourage the right care in the right setting and reduce overutilization of the system.

If a state doesn't opt for the Medicaid expansion, the planned elimination of some hospital payments under the ACA will still go in effect -- which will be devastating to hospitals, especially in rural communities. The expansion will benefit the state's economy, bringing in more than $2 billion per year and tens of thousands of new jobs. Last, we can't forget that, if we turn down the Medicaid expansion, federal taxes paid by Washingtonians will finance Medicaid expansions in other states. There is no question about paying the taxes to the federal government. There should be no question about reaping the benefits either.

2. Realign the financial incentives in state contracts for Medicaid and public employee health care to pay for care that makes a difference, while supporting similar payment models in the private insurance market that will pay for the right care in the right setting. Instead of paying a fee for each medical service, our system should reward doctors and hospitals for improving health outcomes for their patients. The state is a major purchaser of health care services and should leverage those dollars to encourage innovative models of care that will improve quality while reducing costs. Some of these models could include the patient centered medical home, shared savings arrangements, bundled payments or global capitation to providers or regions.

3. Adopt strategies to improve employee health through incentives for health
improvement and better management of chronic disease. Boeing developed a program to help employees better manage chronic conditions, resulting in reduced time off and increased labor productivity. King County, in partnership with organized labor, developed an incentive-based approach to health benefits that has significantly improved overall employee health. They've seen a 40 percent reduction in cigarette smoking, as well as a loss of 24 tons of weight among their 18,000 employees. Jay will direct his administration to work with state employee labor partners to implement strategies that have been successful elsewhere, and develop programs that improve care and reduce costs for state workers.

4. Provide consumers with clear and timely information on costs and the quality of care by health care providers and insurance companies. A key component of Washington's new Health Benefit Exchange is a scorecard that will allow consumers to compare health plans based on price and service. Jay will direct his administration to expand on the work of the Puget Sound Health Alliance and require the publication of cost data and quality outcomes in order to better inform consumers.

5. Reduce litigation in health care by supporting quality care and open communication between providers and patients Virginia Mason (VM) has been a leader in reducing errors in care by developing systems that allow for fewer mistakes. As a result, VM's malpractice premiums have fallen for several years in a row. Likewise, studies have shown that an open conversation between a provider and an injured patient, along with efforts to learn from mistakes and address the patient's needs, reduces malpractice cases. Jay will direct his administration to encourage and support these practices across the state, reducing litigation and strengthening the quality of care.

6. Implement a state health care exchange to decrease costs and allow Washingtonians to draw federal support to gain access to insurance coverage. By implementing the Exchange, originally a Republican idea, Jay will direct his administration to bring increased transparency to the insurance marketplace, allowing consumers the ability to compare plans based on price and service. Thanks to the Exchange, more of our health care dollars will be used to buy quality care instead of more insurance company overhead. The Exchange will include tax credits to make insurance affordable for Washington families.

7. Foster collaboration between patients, providers, plans, payers and public agencies, to encourage community-based models of care. Many counties are moving forward on their own, ahead of the state, to achieve goals similar to those in this plan. Some areas, such as Clark, Whatcom and Spokane counties, are moving toward community-based models of care, or the regional health alliance (RHA) model. Oregon is engaged in a similar effort, one from which our state can learn a great deal about locally led reform efforts. The state should not be an obstacle to innovation due to a lack of creativity or vision. Jay will direct his administration to provide resources to support and galvanize community-based efforts.

8. Continue to improve efforts that allow seniors and family members with disabilities to receive home care, through home- and community-based services
Washington has gained national recognition for reducing costs and improving care by serving seniors and people with disabilities in home- and community-based settings, as opposed to more costly nursing homes and institutions. We are currently second in the country in offering seniors a choice and host of options for long-term care -- something we should continue to do. This successful reform is cost effective, saving an estimated $3.34 billion from 1996 to today.xiii Jay will direct his administration to carry on this commitment to our seniors and people with disabilities by continuing to invest in and strengthen Washington's home- and community-based long-term care system.

9. Make Washington a healthier state with a focus on childhood obesity
Partnering with parents, schools, public health and local government, Jay will direct his administration to set benchmarks for improving the health of Washingtonians. In particular, Jay's administration will focus on childhood obesity, developing standards for schools to measure, track and improve obesity rates for kids in Washington. This goal would ensure Washingtonians have access to healthy options by improving food served in our school cafeterias, increasing access to healthy drinks, expanding programs that fund sidewalk construction near schools, and improving funding for physical education. Jay will also ensure that every Washingtonian is protected by a minimum level of critical public health services that ensure our drinking water and food are safe, that the air we breathe is clear, and that contagious diseases are prevented and contained.

10. Stabilize rural emergency services and primary care funding
Washington is a national leader in agriculture production, creating $16 billion in total economic impact and over 130,000 jobs. Basic emergency and primary care services are needed to care for the growers, farmers, distributors and processors who live there. Changes in the payments to rural primary care providers threaten the viability of the rural health care system and hurt economic development in counties across the state. Jay will direct his administration to work with these health care partners to determine how best to meet their communities' needs -- particularly in advance of Medicaid expansion.

11. Meet the need for an expanded health care workforce by implementing reforms that will support the training of more providers, while helping all providers deliver the best care possible.

Targeted investment in workforce development coupled with payment and health delivery reform can ensure quality and safe patient care by empowering front line caregivers to prevent costlier medical interventions, reduce medical errors, and help meet the growing demand for our aging population.

Conclusion

The Inslee administration will bring laser-like focus to strengthening the economic recovery in Washington State. Everything that can be done will be done to drive job creation across existing sectors, like aerospace manufacturing, as well as newer sectors, like energy.

Key to achieving this goal will be investing in education and containing the spiraling cost of health care for employees, while improving their health. Likewise, in the public sector, our task is to build on the Affordable Care Act to expand coverage while also improving quality.

Jay's approach includes multiple strategies to increase access, improve quality and bends the cost curve. It will employ innovations that have proven to work, and will implement them across the public and private sectors.

Jay relies on good, smart ideas -- whether those are Democratic or Republican ideas -- because that is exactly what Washington citizens expect, and deserve, from their next governor.

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