SPOKANE — Lobbying behind closed doors, Washington’s largest health insurance company persuaded Republicans in the state Senate to gut a widely supported bill that aimed to reveal health care price and quality information to consumers.
The battle pits Premera Blue Cross against a broad coalition representing just about everyone who buys, uses, provides or shapes health care: small and large businesses, consumer advocates, tribes, hospitals, doctors, nurses, the governor, the insurance commissioner, the agency that governs insurance for state employees and the poor, and even Premera’s competitors.
That coalition seeks more than sunlight on the industry’s finances; it also backs a comprehensive new statewide plan to change the way the industry operates.
The battle focuses on House Bill 2572, which passed the state House of Representatives and came up for a hearing Thursday in the Senate Health Care Committee. After some fiery testimony, committee Chairwoman Randi Becker, R-Eatonville, stripped the bill’s most controversial section and passed it on to the Ways and Means Committee for further action. She did so without explanation. A lobbyist for Premera stepped to the microphone and thanked her, but said little about the reasons for his gratitude.
The controversy involves the original bill’s provision to create an “all payer claims database.” Loaded with statewide health insurance claims, the database would allow people to compare what health care actually costs and how well it turns out — procedure by procedure, hospital by hospital. It would answer questions like these: What would a knee replacement or childbirth cost, and who does it best?
So far, 14 states have created such databases, and the systems are operational in at least 10.
Rep. Eileen Cody, D-West Seattle and the bill’s sponsor, said, “My goal is to make sure people can see who are the lowest-cost and highest-quality providers.”
Medical costs for common procedures vary in Washington — by as much as 500 percent from one provider to another. So says the Washington Health Alliance, which has operated a claims database containing information only from insurers who submitted information voluntarily. HB 2572 would have made it mandatory for insurers to submit their data.
Big businesses such as Boeing and Alaska Airlines support creation of the database because they hope it would help them identify a path to cost-effective care for employees. Boeing, for example, rattled Seattle-area hospitals when its health plan began offering to fly cardiac patients to the Cleveland Clinic in Ohio, which is praised for the cost and quality of its care.
Small businesses support a claims database, as well.
At Thursday’s hearing, the fiercest comments came from Patrick Connor of the National Federation of Independent Business. NFIB fought the Affordable Care Act, Connor noted, and often aligns with Republicans. But on this issue, he told Becker, “It is very, very frustrating . each time we come forward asking for more transparency, more access to information, the concerns of the health insurance carriers about not wanting to participate seem to trump those of the consumers who desperately need more good information to help control health care costs.”
His organization checked with insurance carriers in states that operate claims databases, and the carriers “have no complaints,” Connor said.
Referring to objections Premera has raised in its closed-door lobbying with legislators, Connor said: “Not one of these Chicken Little complaints about price setting, price fixing, about … privacy, have come to pass.”
Premera spokesman Eric Earling explained the company’s point of view to The Spokesman-Review: “We support transparency. We’d like to see more of it.” But, he said, price information is not “actionable” for a particular consumer unless it is presented together with information about the consumer’s own coverage details such as deductibles and co-pays.
In addition, it would be “complicated, potentially expensive and time consuming” to create a claims database and comply with its data submission requirements, he said. Meanwhile, he said, his company is busy trying to comply with existing requirements of the federal Affordable Care Act.
