Inslee, health care leaders and patients kick off nation’s first public option effort

Governor Jay Inslee
Jun 20 · 7 min read

Stakeholders and industry leaders meet to form partnerships, talk about first steps for Cascade Care in Washington

When 6-year-old Kaiser Whittaker broke his leg last year jumping on a trampoline, his parents’ first priority wasn’t taking him to the emergency room. Instead, it was more important to give him medicine to prevent any possible internal bleeding. Then, they rushed him to the hospital.

Kaiser has hemophilia, which means his blood doesn’t clot easily. Kaiser’s dad, Jed, said what’s most worrisome about this type of medical disorder is something they can’t see: If Kaiser falls and hits his knee hard on the concrete, for example, Jed’s concern immediately centers on the chance of internal bleeding.

The Whittaker family pays $800 in monthly premiums for medical insurance, which includes Kaiser’s expensive but life-saving medicine. Jed and his wife, Jessica, depends on access to an affordable plan through the Washington Health Benefit Exchange for Kaiser’s medicine and care.

Jed started his own marketing business a few years ago, so being self-employed and finding a reasonably-priced health insurance plan was at the top of his priority list. But he worries about what could disrupt the availability of health care plans in Washington and that undermine the Affordable Care Act, which led to creation of the Exchange.

“It’s a stressful reality for me and my wife,” Jed said.

Protecting Washingtonians against that uncertainty is why Gov. Jay Inslee and legislators passed the nation’s first public health care option.

“We should not be cautious and conservative on this,” Inslee said. “We should be bold and energetic.”

Inslee convened health care leaders, legislators, elected leaders and stakeholders in Seattle Wednesday to discuss the first steps of implementing Cascade Care, an effort that will be led by the Exchange.

Inslee convened health care leaders, legislators, elected leaders and stakeholders in Seattle Wednesday to discuss the first steps of implementing Cascade Care, an effort that will be led by the Exchange. (Office of the Governor photo)

“Access to reliable and affordable health care is something every family in Washington needs, and it’s something every family deserves,” Inslee said. “It builds on the work we’ve done to expand and protect health care under the Affordable Care Act. This is one way our state is taking action now to ensure affordable care for more people.”

National health policy expert Larry Levitt said that with national health reform efforts stalled, attention has turned to states such as Washington.

“Washington is the laboratory and it’s going in the right direction using a hybrid approach,” said Levitt, senior vice president for health reform at the Kaiser Family Foundation. “A public option is not easy, and Washington is the first out of the box. It’s an important model for other states.”

During Wednesday’s meeting, Levitt and others noted how costs have skyrocketed under the current federal administration. Some consumers are now paying as much as 16–23 percent of their income on health care premiums and costs.

Insurance Commissioner Mike Kreidler said the state has led the way on innovating health care and that Cascade Care is just another example.

“This has the possibility to help lower costs — which is critical for many consumers — and provide more options, helping to further stabilize our market,” Kreidler said.

Pam MacEwan, CEO of the Washington Health Benefit Exchange said the Exchange created a broad-based stakeholder workgroup that will guide the development of standardized plans before they are introduced to consumers in fall 2020. The group will also work with health insurance carriers who offer plans to consumers through the Exchange to consider technical aspects of standard plan design.

“We are excited to begin work on introducing Cascade Care to our customers,” MacEwan said. “The Exchange is well-positioned to develop and implement innovative plan offerings that lower consumer costs and move Washington toward our goal of universal coverage.”

Healthcare leaders, patients and legislators listen to Gov. Jay Inslee talk about the efforts the state needs behind the recently passed public option bill. (Office of the Governor photo)

One of the biggest problems this policy attempts to solve is improving the scarcity of plans across the state. To date, health care consumers searching for coverage through the Exchange can only get one coverage option in 14 of Washington’s counties. The public option aims to ensure coverage is available throughout the state.

Jed testified in support of the recent public option bill that Inslee signed this legislative session. Right now, the Whittaker’s can stay self-employed and find a reasonable health insurance plan. But as Kaiser gets older (and bigger) the medicine dosage he needs will change. To date, Kaiser’s yearly expenses are somewhere around $100,000 in medical bills related to hemophilia and the cost could get closer to half a million dollars as Kaiser grows. The cost of Kaiser’s medicine reaches his share of the health insurance deductible within the first month of the Whittaker’s new insurance year.

While Jed feels grateful to be insured through the Washington Health Benefit Exchange, staying financially stable while owning a small business and caring for his son’s medical issues weighs heavily on his mind.

Parents Jed and Jessica Whittaker stand with their children Kaiser, six, and Rori, three, in Oahu. (Photo courtesy of Jed Whittaker)

“The biggest challenge is that we have to choose insurance before any other expenses so that our kid stays healthy,” Jed said.

As part of their research, the Exchange is meeting with teams in other states to see how they’ve established standardized health care plans to their consumers. A recent trip to Covered California’s executive offices provided insights on issues that include plan design and certification, active purchasing position, policy considerations impacting high-value services and value, and quality requirements for delivery reform. Exchange representatives will also travel to MassHealth at the end of July to examine how Massachusetts designed and implemented these standard plans.

Stakeholders learns about the first steps the state needs to take to implement Cascade Care. The Exchange created a broad-based stakeholder workgroup that will guide the development of standardized plans before they are introduced to consumers in fall 2020. (Office of the Governor photo)

Research collected from those visits will aid the workgroup with their efforts when they meet later in the month. The finalized workgroup is comprised of individuals who represent a broad spectrum of industry perspectives. They include consumer advocates, insurance carriers and health care providers. Members will discuss their concerns and questions, consider policy options of standard plan design choices and provide feedback on proposed standard plan designs.

How the Exchange will implement Cascade Care follows MacEwan’s recent testimony to the United States House Ways and Means Committee. MacEwan provided insight on the successful implementation of the Affordable Care Act in Washington state, noting the 800,000 new residents who now have access to coverage as a result of the ACA. She also discussed the 60 percent drop in the uninsured rate.

“I hope Congress can look to Washington state as an example of how progress can be made when lawmakers, advocates, carriers and delivery system partners work together on data-driven, actionable solutions,” MacEwan said.

Kaiser gets his annual checkup tomorrow at the Seattle Children’s Hospital for his pre-existing condition. When Jed has walked down the hospital hallways with his son, he always thinks about the other patients and their financial situations.

“There’s nothing more polarizing than when you’re at the children’s hospital and you see so many sick kids that need care,” Jed said. “You realize that every single child in this state should be able to receive care regardless of their financial situation.”

Kaiser speaks with President Barack Obama for a few minutes at Mid Pacific Country Club in Kailua, Oahu. Kaiser has wanted to be president ever since he was three years old. (Photo courtesy of Jed Whittaker)

Jed considers himself a middle-class working American, and he feels lucky that his family has an insurance option. But he knows other families don’t. The public option bill is a step in the right direction, he said.

“We would obviously do anything for our son, but this bill will help families like ours,” Jed said. “We can pursue our professional endeavors and also have health plans that are reasonable and transparent.”

Beginning in fall 2020, consumers can get standard plans and Cascade Care plans through the Exchange for health insurance coverage year 2021. You can find more information on the Cascade Care implementation on the Exchange website.

Reminders: Enrollment is offered year-round to individuals and families through Washington Apple Health (Medicaid). Customers enrolled in Apple Health will receive a 60-day notice before the month they enrolled in or renewed their coverage last year.

About Washington Healthplanfinder

Washington Healthplanfinder is an online marketplace for individuals and families in Washington to compare and enroll in health insurance coverage and gain access to tax credits, reduced cost sharing and public programs such as Medicaid. The upcoming open enrollment period for Washington Healthplanfinder is Nov. 1 ends Dec. 15, 2019.

About Washington Apple Health

In Washington, Medicaid is called Washington Apple Health. Free or low-cost coverage is available year-round for those who qualify. Since the Affordable Care Act launched in October 2013, more people have access to preventive care, like cancer screenings, treatment for diabetes and high blood pressure, and many other health care services they need to stay healthy. Apple Health clients enroll and renew online using Washington Healthplanfinder. Apple Health is administered by the Washington State Health Care Authority:

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