5 Things Washington: Post-ACA healthcare system, Inslee admin, Marcy Shimada

“I’m just happy to be here.” It’s part of a great scene from the 1988 movie “Bull Durham” normally intended as a meaningless cliche.

But, after spending 6 hours on an 18″ ledge, 50-feet above a surprise tide, I can tell you I’m just happy to be here.  Thanks to the NAS Whidbey Island Search and Rescue for saving my kids and me. I have a new understanding of the word ‘terrifying.’  Here’s the KING5 story.

Now, on to 5 Things We’re Watching in Washington State health care.

DJ 5 Things Signature





1.  Turnover in health policy staff in Inslee admin

Recent news that Gov. Inslee had appointed Cheryl Strange as the Secretary of DSHS was both good and bad news for health policy. On the one hand, Strange is respected, charismatic, and is likely a good fit for the challenges facing DSHS in 2017.

On the other, it highlighted the broad vacancies in the Inslee administration which remain.  Dorothy Teeter’s departure from the head of the HCA was complemented by recent news that Nathan Johnson would also be leaving the agency on August 11th.  Johnson served as the Chief Policy Officer, and has been one of the primary thought leaders at the HCA.  He will be joining Premera as Vice President of Strategic Development. Likewise, Dr. Bob Crittenden has retired from his role as Sr. Advisor to Gov. Inslee. He handled health policy, integration efforts, and paid extra attention to county concerns related to reform on behalf of Gov. Inslee.

Able staff is stepping in on an interim basis, like Lou McDermott for Teeter and Rick Weaver (part-time) for Crittenden.  But, this is a precarious time for the Inslee administration to have such a deep level of turnover on health policy. Candidly, I think it puts at some risk the momentum related to the 1115 waiver, specifically the portion of the $1.5 billion directly related to performance.

2.  Oregon Health Authority in combat mode with managed care entity

Washington State may take 193 days to conclude a legislative session, but Oregon health care stakeholders may have it worse. An 8% budget deficit this year, a failed revenue package at the ballot, and now a referendum to repeal provider and premium taxes passed during the session.

Now, news reports suggest the Oregon Health Authority is raising issues about one of it’s managed care organizations: “…the health authority sought to highlight by finding an HIV patient or other Oregon Health Plan member with “high cost medical issues” to complain to the media about lack of care at FamilyCare.”

FamilyCare has been suing the state agency on multiple fronts for the last few years, which must get tiring for the OHA. They told me the communication plan featured in the story “was never finalized or implemented, and quite frankly, never seriously vetted or reviewed.” All this to say, things could be worse in Washington State health policy and politics.

3.  The post-ACA health care system

It’s likely the ACA is going to change. “Repeal and replace” may have had a set back (don’t assume that’s over), but now the legislative process is at work. Sen. Patty Murray is the lead Democrat, working with Sen. Lamar Alexander from Tennessee to craft a compromise bill that will offer substantive changes to the ACA. Hearings are scheduled after Labor Day. And, even if that fails, Secretary Tom Price could still make significant changes through rule making or state waivers.

Luckily, we’ve got a break out session focused on this very topic at our 2017 Inland NW State of Reform Health Policy Conference!  You can check out the Topical Agenda for the full run down. Sue Lani Madsen is a conservative thought leader and writer. She’ll be on the panel and will be joined by the Director of Medicaid, MaryAnne Lindeblad, and Pam MacEwan, the CEO of the Washington Health Benefit Exchange.

4.  Marcy Shimada and 265 other voices

Marcy Shimada is the CEO of Puget Sound Family Physicians, one of the largest independent physician organizations in the region.  She’s a very savvy operator and well regarded.  In this edition of “What They’re Watching,” Shimada highlights the challenge of the growing bureaucracy in health care, particularly among regulators. “I think whether it’s Washington or whether it’s federal our sort of guiding principle for folks shaping policy would be to cut back on their bureaucracy and to simplify a bit.”

As an aside, Shimada is the 266th entry in our series “What They’re Watching.” The series is an effort to give voice to a wide range of senior health care executives and health policy leaders from across our six states. The idea is, like this email, podcast, and online content, to help the spread of smart ideas among health policy leaders in our local communities where health care is both provided and regulated.

5.  “Insurance company bailout”

Sen. Marco Rubio started using the language of “bailouts” during the 2016 Republican presidential primary. That was in reference to the ACA’s risk mitigation measures to health plans, which Congress ultimately chose not to fully fund. That language has resurfaced from Sen. Mitch McConnell.

McConnell used the language on the floor of the Senate following the failure of the “skinny repeal” language  in the Senate: “Bailing out insurance companies with no thought of any kind of reform is not something I want to be a part of.” He used the language again this weekend: ” If the Democrats are willing to support some real reforms rather than just an insurance company bailout, I would be willing to take a look at it.”

This is a powerfully negative framing of the subsidies of insurance for lower income individuals.  And, while I recognize the failure of reform in the Senate is still raw, it will be very difficult to find any common ground on reform if this is the language used to describe subsidies for insurance.