Cascade Care — Washington Leads the Way with Public Option
In 2019 the legislature passed Engrossed Substitute Senate Bill 5526 and Washington became the first state to create a public option for health insurance. In an era of public debate and litigation over the future of the Affordable Care Act following a presidential campaign where “Medicare for All” was a contentious issue, Washington’s incremental foray into a public option for health care represents a cautious but determined step forward.
In May Austin Jenkins, public radio’s government reporter in Olympia, wrote a clear summary of the challenges facing the plan. One issue is whether the plan is truly a public option plan, since the state is not actually directly providing health insurance but rather is “creating more of a hybrid public-private system where the state will contract with private health insurers to administer the plans, but will control the terms to manage costs.” More critically, the plan’s reimbursement cap may result in consumer cost savings of only 5 to 10 percent, but are likely to slow year-over-year premium increases. Finally, the plan faces the same “bare county” problem the state has already experienced with the Washington Health Benefit Exchange plans. The Legislature’s goal is to provide a plan available in all 39 counties, but there is no requirement that contracting insurance companies meet that goal.
The new law creates standard plans and public option plans under a new program called Cascade Care. State agencies and the Washington Health Benefit Exchange are directed to work together with health insurance companies to create “up to three standardized health plans for each of the bronze, silver, and gold levels” which “must be designed to reduce deductibles, make more services available before the deductible, provide predictable cost sharing, maximize subsidies, limit adverse premium impacts, reduce barriers to maintaining and improving health, and encourage choice based on value, while limiting increases in health plan premium rates.” RCW 43.71.095.
The public option plans work within the existing framework of the Affordable Care Act’s health insurance marketplaces to create plans where individuals can sign up for health insurance that is partially subsidized by the state through contractual limits on what providers can charge, capped at 160 percent of the Medicare reimbursement rate. Rather than fully socialized, publicly funded medical care, the Washington State Health Care Authority explains that “the goals of Cascade Care are to increase the availability of quality, affordable health coverage in the individual market, and ensure residents in every Washington county have a choice of qualified health plans.”
In October, the Health Care Authority signed contracts with five health insurance companies to provide the Cascade Select Gold, Silver, and Bronze public options for 2021 in nineteen of Washington’s counties, leaving many counties without a public option plan. Despite the challenges posed by this ambitious endeavor, the plans are successfully being implemented and are enrolling members as of November 1, 2020. Enrollment should be completed by December 15, 2020 to ensure coverage starting on January 1, 2021. Enroll and receive assistance at Washington Health Plan Finder. (RM)
