Providence & Times |  PEBB & HCA | Three things from DC

Since January 1st, we’ve held 8 convenings of various sizes in Washington, Hawaii, Texas, Oregon and California. It’s been very cool to hear the conversations taking place across the country during this time of transition – but exhausting. Luckily, things slow down for us for a bit, and we can focus on the moving parts in Washington State health care.


1.  Providence stories in Seattle Times

The Seattle Times just printed two of the most powerfully damning stories I’ve ever read about the health care system with Providence and Swedish as central figures in the stories.  You should read them both (one, two).  They are part of a new investigative series by the Times on how the financial incentives in health care can corrupt a system – from care delivery to administration. This comes on the heels of unrelated but similarly awkward reporting from the Anchorage daily on margins there.

I think it’s reasonable to see the Times coverage as the problem of one physician focused on “getting rich,” rather than system-wide problems at Providence.  Much of the internal documentation highlights physicians acting appropriately, and administrators like Ralph Pascualy acting with integrity.  Swedish CEO Tony Armada released a statement this week.  However, I think this presents Providence (which I hope it takes) with an opportunity for a more comprehensive dialog between Providence and the communities it serves.


2.  Moving PEBB out of HCA

Sen. Becker has a bill (SB 5653) that would carve out public employee health benefits (PEBB) from the HCA and move it to the Dept. of Retirement Services (DRS). DRS is a well-respected agency by both sides of the aisle in Olympia. Becker’s logic is to move PEBB to DRS in the hopes that the culture and operational success at DRS might improve what she sees as a PEBB program that is not achieving the efficiencies that the HCA has promised over recent years.

There is irony here.  In 2011, the legislature moved Medicaid (MAA) from DSHS to the HCA so that the culture and operational success at PEBB at the time would improve the performance of Medicaid.  It’s notable that Steve Hill was the administrator at the HCA during the previous move.  Hill moved to DRS after the HCA, where he since retired.

3.  Three things out of Washington DC

You know that individual mandate thing? Don’t worry about it. The IRS just quietly made the reporting of your coverage optional rather than a requirement on your tax form.

The Freedom Caucus of the House Republicans (a 40-member conservative bloc borne from the Tea Party movement) voted Monday night to not accept any replacement without a full repeal of the ACA, including Medicaid expansion. Moderate Republicans in the Senate reportedly disagree.  The pathway for replacement gets more difficult as things drag on.

Interestingly, I learned during our Texas event last week that the block grant conversation in DC is specific to traditional Medicaid. The expansion population is not part of the policy discussion, which further puts expansion at risk as part of a replacement package.


4.  Video: Alison Carl White on disruption

Alison Carl White is the Executive Director of Better Health Together, the accountable community of health (ACH) in seven northeastern counties in Washington State.  She’s also one of the coolest people in Washington state health care, and someone that is working at the nexus of Medicaid transformation in a smart, authentic way.

In this episode of “What They’re Watching,” she talks through the disruption caused by the election of Donald Trump and how that has had a chilling effect on innovation in health care.  We caught up with her at our recent 2017 Washington State of Reform Health Policy Conference. Hers is one of more than 250 interviews we’ve done now as part of this series.


5.  Arguing over the Medicaid budget

Some legislators have raised reasonable concerns about the responsiveness of the HCA to their questions regarding budgeting for Medicaid. In the 2005-2007 budget, the state general fund amount (GF-S) spent on Medicaid was $3.7b. The 2017-2019 budget is 19% higher than that amount at a projected $4.4b, a significant increase according to some budget writers.

However, put another way, the GF-S portion of the 2005-2007 total budget was 12.5%. That share has actually decreased so the GF-S share of the overall 2015-2017 budget is now 10.4% of the total state spend – in spite of the 19% dollar amount increase.  As the budget writing begins to take shape, we’ll see if Senate Republicans push through any significant cuts to the Medicaid program based on their concerns.