Washington’s public-option health plan demonstrates the complexities of American health care, which often poorly serves patients and providers. Lawmakers must continue to evaluate the first-in-the-nation system to ensure that it is working as promised.
In 2019, the Legislature approved a plan for the state to contract with private insurers and offer insurance plans under specified guidelines with cost limitations. The idea was to make health insurance accessible while Republicans in Congress were trying overturn the federal Affordable Care Act without a plan to replace it.
Unlike various proposals promoting Medicare for All, Washington’s system does not eliminate private insurance. It creates a public-private partnership designed to make insurance affordable and available for those who otherwise would not have coverage. For example, it protects coverage for people with pre-existing conditions, which Republicans have spent years seeking to overturn.
But as the Washington plan grows roots, a public option is available in only 19 of the state’s 39 counties, according to a report from Crosscut. Clark County is one of the regions without a public-option provider. And as of May, fewer than 2,000 Washington residents had enrolled in the system.
“It’s starting to take hold,” Michael Marchand of the state Health Benefit Exchange told Crosscut. “It just takes a while … for new products to take hold.”
State Sen. David Frockt, D-Seattle, who was the prime legislative sponsor of the plan, said: “It’s still early. We’re still kind of at the leading edge of this, if we can make this work.”
Making it work will involve drawing an increased number of hospitals into the system. Insurers offering public-option plans are limited to paying hospitals and providers 160 percent of what is paid by Medicare. That limit is calculated across an entire network, meaning that some providers can be paid more if others are paid less.
State Rep. Eileen Cody, D-West Seattle, said the Legislature may have to revisit that “soft cap” in the future if the public option is not offering the savings expected by lawmakers.
Confusing? Welcome to American health care.
Nationally, more than 30 million Americans have secured health insurance through the exchanges offered by the Affordable Care Act. But nearly 50 percent of the population is insured through employer-provided plans, and polls show that most consumers are pleased with their coverage. Because of that, an overhaul of the health care system is a political non-starter, despite support of Medicare for All by some Democratic leaders.
Washington’s public-option system was designed to fill in the gaps for those who do not have employer-provided care and cannot afford individual insurance. Lawmakers in Nevada and Colorado have since passed similar systems that are not yet up and running, and Sen. Patty Murray is working on a public-option system at the federal level. They can learn from Washington’s experience, even as the state works to tweak its system.
For now, the immediate concern is incentivizing a public option in the 20 counties where it is not available. Notably, that includes both high-population and low-population counties.
Frockt said: “This is the first time we have tried to do this in the country. We really didn’t know how it was going to play out.”
In the process, lawmakers may have done little more than add to the confusion of American health care.