The federal Affordable Care Act triggered sweeping changes to the U.S. health-care system, and that in turn has inspired proposals at the state level. Lawmakers in Olympia currently are debating these measures, some of which could make bold changes to the state’s health-care system, while others are more modest.
It’s a tough situation for those pushing for significant overhauls: The Legislature is split with a Republican majority in the Senate and the House is led by Democrats.
And as the clock ticks down to March 13 — the scheduled end of the legislative session — tensions are rising as some bills languish and others have a shot at becoming law.
Here’s a roundup of some of the measures that caught our attention.
Scrapping the OIC
Senate Bill 6458 would abolish the Office of the Insurance Commissioner — an elected position created in 1907 — and replace it with a state insurance board. The board would have 10 members, mostly selected by the governor. The candidates would include nominees by lawmakers from both parties.
The bill is sponsored by Republican Randi Becker, chair of the Senate’s Health Care Committee, which voted to pass the measure. The legislation moves to the full Senate, but has slim support. Those testifying in favor of the bill at a committee meeting included only Becker and another person who gave no affiliation. Those against were lobbyists from unions, a physicians group, AARP and health-care organizations.
Reviving dead plans
Senate Bill 6464 also takes a swipe at state Insurance Commissioner Mike Kreidler. The measure would allow insurance companies to temporarily revive policies canceled at the end of 2013 and permit out-of-state insurers to sell plans here.
After the public uproar this fall over discontinued insurance plans, President Obama offered to allow companies to revive the plans, which don’t meet new, more comprehensive requirements for insurance policies. Kreidler rejected Obama’s offer and opted not to bring the plans back.
The bill, sponsored by Sen. Steve O’Ban, a Republican from Pierce County, would reverse Kreidler’s decision. The measure passed its committee vote and waits for Senate action.
Medical cost transparency
Two proposals to bring transparency to health-care costs and quality are also still in play. Many people don’t realize it, but depending on where they get a hip replacement or an MRI, the cost for the treatment can be three or four times higher at one location than another. Yet patients rarely know what their care will cost until they open their bill.
The goal of the measures is to provide the public with information about the huge cost differences in medical procedures to help them make informed choices as patients and consumers.
House Bill 2572 is the more ambitious of the two transparency measures. Sponsored by Rep. Eileen Cody of Seattle and requested by Gov. Jay Inslee, this law would create a public, statewide database for making price comparisons for surgeries, medical tests and other treatments. The All-Payer Claims Database would use cost data provided by insurance companies and others. It would also include information measuring the quality of hospitals, clinics and doctors.
Lawmakers passed the bill out of House committees. According to the legislative schedule, the measure has until 5 p.m. Tuesday to make it out of the full House.
The bill has wide-ranging support, including the Washington State Hospital Association, Washington State Medical Association, Seattle Metropolitan Chamber of Commerce and the National Federation of Independent Business.
But it also has powerful detractors: Premera Blue Cross and Regence Blue Shield. Lobbyists with the state’s two largest insurance companies testified against the legislation, citing worries that they could lose a competitive advantage if they share information on what they are paying for medical procedures.
The more modest transparency bill, Senate Bill 6228, would require insurance companies to offer online cost- and quality-comparison tools for their customers, and it describes what features the tools must include. The bill’s prime sponsor is Sen. Mark Mullet, D-Issaquah. It has passed out of committee and is ready for the Senate to consider.
Engrossed Substitute Senate Bill 6016 tackles the challenge of people who get insurance coverage, but stop paying their insurance premiums.
The Affordable Care Act includes a 90-day grace period for people with government-subsidized coverage purchased through the state’s insurance exchange. Currently, an insurance company is responsible for medical bills in the first month someone misses a premium payment, but the hospital or doctor must cover the costs in the second and third months. The patient loses their coverage after the grace period, outstanding premiums aren’t paid.
The bill clearly establishes the insurance company’s obligations for people who fall behind on insurance bills. The measures says that if a hospital or doctor asks for coverage information, the insurance company must say if someone is in the grace period.
The original version of the bill went much further, seeking to make the insurance company cover the medical bills for all three months of the grace period. Insurers turned out in force to testify in opposition. After lawmakers deleted the payment piece, the Senate unanimously passed the bill. House lawmakers may try to reintroduce the cost issue.
One of the more controversial health measures is House Bill 2148, also called the Reproductive Parity Act. This proposed law would require insurance plans to cover abortion costs. While most plans in Washington do include abortion coverage, they don’t have to and new federal rules require insurance companies to follow stricter standards when they do cover these services. As a result, some health companies say it’s too confusing to comply with the new regulations, and have instead opted to drop abortion coverage.
Under the Affordable Care Act’s 10 essential benefits, maternity coverage is already a requirement.
“The Reproductive Parity Act is a common sense bill that ensures that a woman, not her boss, her insurance plan or her legislator, can make her own medical decisions,” Kreidler said in a recent press release.
A nearly identical version of the bill passed the House last year, but did not get a Senate vote. The new version of the bill has again passed the House, and awaits a hearing in the Senate’s Health Care Committee. The measure has until Feb. 28 to be voted out of committee, but it appears to be a long shot.
Extreme exchange makeover
This year’s legislative casualties already include House Bill 2340. This bill would have turned Washington’s health-insurance exchange, which runs the Healthplanfinder insurance marketplace, from a public-private partnership to a state agency.
Insurance companies and members of the exchange’s board argued against the measure, as reported here by State of Reform, a health-care information group. It hasn’t made it out of committee.