Senate’s updated BCRA, Providence, Jorge Rivera
I read some of Thomas Paine’s writings over the 4th of July, and I couldn’t help but think this famous quote is a great fit for the state of health policy today: “These are the times that try men’s souls. The summer soldier and the sunshine patriot will, in this crisis, shrink from the service of their country; but he that stands by it now, deserves the love and thanks of man and woman.
Regardless of which side of the political divide one is on, this is a time of choosing in health policy. And, if the politics of the ACA are any guide, we will be debating and discussing this time of health policy for the next decade, if not longer.
1. Latest on the Senate reform bill
The Senate is out with their latest reform bill today. Two Republican Senators have already announced they are no votes (Collins, Paul), meaning no other votes can be lost. That’s a bad sign when conservatives like Mike Lee and Ted Cruz may not have gotten what they wanted (contrary to media reports). Moderates like Lisa Murkowski won some language on reinsurance, but she’s long been oppositional to the idea of ending Medicaid expansion.
If the bill fails, and if Sen. McConnell moves to work with Democrats on “fixes” to the ACA, as he suggested last week, what role should Sen. Murray and Cantwell play? Is this the time for them to come to the table for a bi-partisan set of changes to the ACA? Or should they dig in, and hold to the existing bill? I’m curious about your thoughts as I prepare a post with some suggested bi-partisan changes. The alternative to constructive engagement is a potential full repeal vote without any replacement, something conservatives pushed for in January.
2. Providence added 15,000 jobs in last 2 years
A story out in the Oregonian this week mentioned that Providence Health and Services added 15,000 new jobs over the last two years, and how has a payroll of 110,000 across seven states. That’s a lot of new positions, even with significant growth. Now, however, the story says Providence is facing operating losses of $255m on revenue of $20 billion, forcing some cost cutting and layoffs.
I pulled the 2016 year end financial results for Providence/Swedish hospitals in Washington State to see if Washington State might expect similar layoffs. Comparably, Washington State operations appear to be doing better than Oregon, though this is only a hospital-specific view. The 13 hospitals posted net revenue of $1,343,618. However, four Swedish hospitals reported net losses of $68,663,247.
3. Rep. Riccelli bill on individual market backstop
Rep. Marcus Riccelli is one of the legislature’s rising stars. That’s true in general, but it applies to health care as well. He spent time as an aide in Senate Majority Leader Lisa Brown’s office. He also shepherded the bi-partisan effort on a WSU medical school. So, he knows how to make the legislative process work.
In this interminable legislative session, Riccelli is out with a bill to create an “Apple Health Plus” program. This would allow individuals in counties where no commercial carrier offers a plan to purchase benefits from a Medicaid plan. This is a smart “backstop” in case commercial plans leave the market, and would prevent the collapse of coverage options for beneficiaries. Plans chose not to file in two counties for 2018, though Commissioner Kreidler was later able to recruit plans to fill the gap.
In an interview on KIRO (16:38), Riccelli calls this a “conversation starter.” If the goal is a smart, integrated system, leveraging the purchasing power of the state to bring efficiencies to the market overall, this is probably a good conversation to have.
4. Exec changes at HCA, HMA, Regence
Three noteworthy changes in executive leadership to mention. First, Lou McDermott has been appointed the Interim Administrator at the Health Care Authority. He runs the PEBB program there, and will hold the position while a national search is underway. Lou knows the HCA well and will be a stable presence there. Here’s our interview with him from 18 months ago. The HCA job description is here if you’re interested in applying.
Meanwhile, at Health Management Administrators (HMA), long time CEO David Snodgrass announced he has stepped down. Steve Suter is now the firm’s CEO. Snodgrass launched the firm in 1986, growing into the TPA business to serve employers in the self-funded marketplace. Over time, through mergers and acquisitions which resulted in Cambia acquiring the business, HMA has grown to be one of the largest TPAs in the country. Snodgrass has been a respected figure in the ERISA space for years.
Finally, Regence Blue Shield has announced their new market president. Tim Lieb joined Regence in 2016 as the VP of Sales, coming from Mercer where he previously was the principal for the Pacific NW Employee Health and Benefits practice.
5. Video: Jorge Rivera, Molina Healthcare
Jorge Arturo Rivera is the Director of Community Engagement at Molina Healthcare of Washington. Among his other responsibilities, his team manages outreach for over 1,300 events in the state each year, with a particular focus on cultural and ethnic diversity.
His comments in this edition of “What They’re Watching” are focused on expanding access through the use of technology. He says Molina is excited about “improving access to care to our virtual care because our 700,000 patients today can come to a doctor at three a.m. without leaving their homes. Medicaid has not done that before and I think expanding the access is what managed care organizations are about.”