1. Healthcare for All – Washington
Washington Health Security Trust:
State-based universal health care
What is it, and how do we get it?
[Show this slide while audience gets seated.]
[Introduce yourself briefly.]
We want to show in this 20-minute presentation that it is very possible to get to universal coverage for all residents in the state of Washington. Beginning in 2017, individual states are allowed to implement their own health coverage plans under the Affordable Care Act.

2. How other countries do it
Other countries regard health insurance as a public good.
They cover all residents.
They have payments & fees supervised by the government.
They have no deductibles, though some have small co-pays.
They have one universal benefit plan.
Supplemental insurance is allowed.
Returning to the idea of the public good, most industrialized countries have developed systems that:
[1] cover everyone,
[2 & 3] control costs,
[4] cover all medically necessary conditions, and
[5] allow for supplemental coverage.
Because it’s a public good, people don’t have to worry about their health care.

3. Useful features of the Affordable Care Act
Young adults eligible for parents’ insurance
No lifetime limits on coverage
Medicare “donut” hole eliminated over 10 years
Preventive care included at no charge
Price discrimination now limited only to age and tobacco usage
States allowed to innovate with better plans
The Affordable Care Act, which Congress passed in 2010, offers some benefits:
[1] expanded coverage for young adults,
[2 & 3] no gaps or limits in coverage,
[4] free preventive care, and
[5] more equitable pricing.
[6] Most importantly, it allows states to develop their own plans that meet or exceed ACA’s coverage requirements and deal with its drawbacks.

4. Problems with the Affordable Care Act
25 million or more uninsured after 2017
Provider continuity not guaranteed
Age discrimination in pricing
Nearly half of the States have chosen not to expand Medicaid
Erratic oversight due to regulation at the state level
Four levels of cost sharing based on premium (platinum, gold, silver, bronze)
The ACA
[1] will leave many people uninsured,
[2] offers no guarantee of continuity,
[3] charges older people up to 3 times as much as younger.
[4 & 5] Also, many states have opted out of offering even the partial benefits of the ACA.
[6] Finally, it offers inadequate benefits to those who can’t afford an expensive plan. The promise of choice is really an illusion of coverage.

5. We can do better! Universal coverage: Everybody in, nobody out
A single agency for health care financing
Publicly financed, but privately delivered
An improved ability to control costs
Continuity of care, regardless of employment status; free choice of provider
Universal coverage means that
[1] everyone is covered.
[2] A single, [3] publicly financed agency will pay for all medically necessary treatments
[4] while implementing cost controls and
[5] ensuring continuous care.

6. Washington Health Security Trust
All Washington residents covered
Simple, easy to understand
Comprehensive health coverage (medical, vision, and mental health) with no deductibles or co-pays
Choice of any licensed provider
Lower cost - much lower administrative costs and negotiated prices
Purchase of supplementary benefits allowed
The Washington Health Security Trust will
[1] cover all Washington residents,
[2] be simple to understand,
[3] offer comprehensive coverage,
[4] eliminate provider networks,
[5] negotiate for lower prices, and
[6] allow residents to buy supplemental coverage if desired.
The WHST will end uninsurance in our state.
[Note: People who have federally protected coverage will be exempt from the WHST, at least in the beginning.]

7. Washington Health Security Trust
Basic Structure
Agency of state government
9 member board of trustees
Initial appointments by the governor
All must have knowledge of health care needs of diverse populations
1 each from lists supplied by both caucuses in both House and Senate
5 selected to improve diversity

8. Washington Health Security Trust
Basic Structure
3 standing committees
Financial advisory committee – to recommend specific budget details
Citizens’ advisory committee – to hold public hearings on priorities
Technical advisory committee – technical recommendations on benefits

9. Washington Health Security Trust
Responsibilities of the board
Establish set of services to be covered
Seek necessary federal & state waivers to allow all funds to come to the WHST
Request any legislation needed to implement funding
Develop state-wide data system for quality improvement
Develop practice guidelines & quality standards

10. Washington Health Security Trust
Responsibilities of the board
Protect confidentiality of patient records
Write eligibility rules & policy for state residents temporarily out of state
Develop or contract for a streamlined claims processing system
Develop an appeals process
Integrate functions with other agencies

11. Washington Health Security Trust
Responsibilities of the board
Balance benefits & provider payments with revenue
Develop cost controls & ways to control unnecessary & excessive costs
Address non-financial barriers to care
Monitor migration into the state to detect any trends related to availability of health care
Develop an annual budget

12. How the WHST is to be financed
Joint Select Committee on Health Care Oversight will:
commission an actuarial study
devise a financing system to raise sufficient funds
Funding sources may include:
an employer assessment on ALL employers
an individual premium for all adult residents
other revenue sources
The WHST is a unified financing system.
[1] A legislative committee, the one that currently oversees the ACA exchange, will work out the details of how the WHST will be funded.
[2] Sources of funding are likely to include employer assessments and individual premiums.

13. Washington Health Security Trust: “What’s in it for me?”
Whether you’re insured, uninsured, retired, in school, or unemployed, the WHST will provide:
Lower-cost, high-quality care with choice of any licensed provider
Continuity of health coverage regardless of student or employment status
Possible Medigap coverage, supplementing Medicare
Relax! You’re covered.
The WHST offers Kids, Families, and Seniors HEALTH SECURITY that they can TRUST, regardless of age, family size, or employment.
[1] The WHST is affordable and sustainable.
[2] The WHST assures continuity.
[3] Seniors may be able to use the WHST for supplemental coverage. [Eventually it’s hoped that Medicare payments and benefits will be folded into the WHST.]
[4] There’s something in the WHST for everyone!

14. Moving ahead – state by state
The Washington Health Security Trust (WHST) bill had a House hearing on Feb. 1, 2013; more than 100 people showed up in support of the bill. In the 2017 session it had 30 co-sponsors in the House & Senate, and several additional supporters.
In addition to Washington, activists in California, Oregon, New York, and many other states are working to implement universal coverage plans. They regularly share information and strategy as part of the group One Payer States.
The best alternative is for Congress to legislate one unified plan that covers everyone: an Improved Medicare for All.
But while we wait for Congress, Washington is one of 23 states working toward universal coverage.
You can follow the progress of bills in each state on our website, by checking our ‘Resources’ page.

15. What you can do…. (1) Talk to your state legislators in Olympia
Ask them to publicly support the Washington Health Security Trust, HB 1026 / SB 5701.
Use the comment link on the official bill website.
Tell them your personal story…in 60 seconds!
Talk to everyone you know about the WHST
Book a speaker for your group from Health Care For All-Washington
[1] Talk to all three of your state legislators. If the legislators say this isn’t the time because of budget deficits, tell them that one of the main reasons for the deficit is skyrocketing health care costs.
[2] Spread the word!
[3] Invite one of us to talk to your group.
[ ear=2015]

16. Washington Health Security Trust
Don’t wait for Congress to act. Universal coverage is possible, state by state!
On our website you’ll find informational resources for each of the issues that we have talked about today – and more.
Are there any questions?