Sen. Annette Cleveland, D-Vancouver, keeps a quote on her desk at home from Daniel Patrick Moynihan, a longtime U.S. senator from New York: “If you don’t have 30 years to devote to social policy, don’t get involved.”
It’s quote she’s kept in mind as she’s worked on one of her central priorities during the current legislative session: health care.
Despite the often incremental nature of health care reform, Democrats have used their expanded majorities in Olympia to advance a range of bills intended to bring greater transparency to prescription drug pricing, set a new framework for public health funding, establish a long-term care program, tighten vaccination requirements and raise the smoking age to 21, among others.
A former congressional staffer who worked in health care nonprofits, Cleveland has had a key role in health care legislation during this session as the chair of the Senate Health and Long Term Care Committee. She’s signed on to many bills and been the lead sponsor on others seeking to preserve and expand patient protections, address the opioid crisis and overhaul the state’s mental health system.
“We were productive this year,” said Cleveland. “We moved some policies that have stymied us in past years.” But she’s had to balance competing interests in the health care industry. “None of them were easy. Health care is very complicated,” she added.
Earlier this week, the Senate passed a bill on a 47-0 vote that’s intended to address “balance billing,” a situation when a patient is unexpectedly saddled with often expensive costs from an out-of-network provider or facility that isn’t fully reimbursed by their insurance company.
State Insurance Commissioner Mike Kreidler said that this is his fourth year advocating for the bill and that Cleveland played a key role juggling the concerns of insurance companies, providers, hospitals and doctors.
“The challenge was coming up with the right recipe for where everybody felt the pain equally, and this time I think we achieved this,” said Kreidler.
While lawmakers have already passed some key legislation, there remains work to be done before the Legislature is scheduled to adjourn later this month. Some industry groups and others have concerns about how some the legislation will play out, which has also drawn criticism from Republican lawmakers.
Affordable Care Act
One of the biggest concerns for Cleveland and similar-minded lawmakers occurred late last year in a courthouse 2,000 miles away. In December, a federal judge in Texas struck down the entire Affordable Care Act (popularly known as Obamacare.) The law has remained in effect pending appeal, but the Trump administration has renewed its efforts to undo the landmark law. In 2017, Trump signed a federal tax cut bill that removed penalties for individuals not carrying insurance, a cornerstone of the Affordable Care Act.
“I am very worried about that,” said Cleveland. “As a policymaker, it would be irresponsible of me to not be doing everything possible as a state to bring as many patient protections in state statute.”
Earlier this week, lawmakers passed House Bill 1870 (Cleveland was the lead sponsor on the Senate version) that would put many of the provisions of the Affordable Care Act into state law — including requirements that insurers cover pre-existing conditions, offer essential coverage while limiting out-of-pocket expenses and annual lifetime benefits.
Kreidler said that the legislation will help prevent “potential chaos” that would follow the Affordable Care Act being struck down without a replacement.
During the Senate debate for the legislation, Sen. Ann Rivers, R-La Center, spoke against the bill, characterizing it as “another stab at the president” that could prevent the state from correcting shortcomings in its health care system.
“This bill just basically bogs us down in the same little place,” said Rivers.
Meg Jones, the executive director of the Association of Washington Healthcare Plans, said that while her group didn’t object to the bill, the legislation doesn’t protect the state from other changes to the Affordable Care Act, specifically federal subsidies that help individuals buy insurance.
She also said that a bill to establish a mandate that individuals purchase insurance in Washington failed, partly due to the state’s lack of an income tax, which was used at the federal level to enforce the requirement.
Cleveland was the lead sponsor on a bill intended to address the state’s opioid crisis by bringing greater oversight to how medications are prescribed while also making prevention and treatment more accessible.
“The opioid crisis claimed more than 700 lives here in the state of Washington last year, and it’s now the leading cause of accidental death in almost every part of our state,” said Cleveland, speaking on the Senate floor last month where it passed 47-0.
However, the Washington Association of Sheriffs and Police Chiefs expressed concern that the bill would present unfunded mandates to provide treatment in jails. Kathryn Kolan, senior director of government affairs and policy for the Washington State Medical Association, said her group was concerned about IT costs from the bill’s requirements that prescribers connect to a prescription monitoring network.
The bill is currently before the House but hasn’t been scheduled for a vote. Rivers said in an email she was particularly encouraged by the bill and optimistic it’ll pass.
Training new psychiatrists
A big focus of the legislative session has been on revamping the state’s mental health care system. Cleveland is the lead sponsor on a key bill that would establish a behavioral health campus at the University of Washington School of Medicine that would help address the shortage of mental health care workers in the state.
“This is a big one,” said Kolan, of the Washington State Medical Association. She added, “The best predictor of where a physician practices medicine is where she does her medical residency and we know that in Washington we don’t have enough psychiatrists.”
One of the most significant bills introduced this session would make Washington the first state to offer a public health care option. On Wednesday, the House passed Senate Bill 5526 on a 54-38 vote after it passed the Senate last month on a 36-13 vote.
The idea was first considered as part of the federal Affordable Care Act but was taken out in the face of opposition by moderate Democrats. It was revived after the bill was requested by Gov. Jay Inslee, who is currently running for president, and Cleveland expressed optimism about its prospects prior to the session.
The legislation would direct the state Health Care Authority to contract with a health care provider to offer a set of plans, called “Cascade Care,” on the exchange where consumers can shop for insurance.
A report from the Washington State Office of Financial Management shows that the percentage of the state’s uninsured dropped after the passage of the Affordable Care Act to 5.4 percent as of 2016. But the report stated that some rural counties saw rises in their uninsured rate. Last year, the Office of the Insurance Commissioner announced that health insurers would seek a 19 percent average rate increase in the state’s individual market.
The legislation was introduced as a way to lower premiums and deductibles for consumers. Cleveland said that the bill was also introduced to ensure the state doesn’t have any “bare counties” where insurers don’t offer plans. She also said it would benefit individuals who earn too much to qualify for a subsidy, which accounts for 12 percent of people enrolled on the exchange.
“It’s critical to have that option,” said Cleveland.
Rep. Vicki Kraft, R-Vancouver, said that she’s worried that the bill will reduce access to providers, increase premiums and cause doctors to leave the state.
“I don’t think it will accomplish its objective without hurting consumers along the way,” she said.
Groups representing the health care industry had raised concerns earlier in the session about the bill’s provision that wouldn’t allow payment rates to exceed Medicare rates. The bill was later amended to remove that provision.