5 Things Washington: When Amazon enters health care | David Postman | CHIP Re-Auth

We host our 2017 Inland NW State of Reform Health Policy Conference tomorrow.  If you haven’t scanned the Topical Agenda yet, you can still do so.  And, you’ve still got time to register to be with us, if you can swing it.

Our SeaTac conference is coming up on January 4th, with events in Anchorage, Portland and San Diego before that. So, if we don’t see you in Spokane, we’ve got more chances to connect you with folks from across the health care spectrum in the weeks ahead!

DJ 5 Things Signature

1.  When Amazon enters health care

The news that Amazon will be looking for a second HQ spurred me to thinking last week about what it would look like if Amazon entered health care. It would likely come with an announcement as quick and straightforward as the HQ2 announcement, and with just as many implications for Washington State.

I lay out an 8-step strategy for Amazon that I think – while certainly a big deal – is probably not nearly as hard for the giant corporation as entering the brick-and-mortar grocery space.  Which, as you know, they’ve done.  Amazon is already a health care giant, which I put at the 6th largest carrier in Washington State based on its employee count.  I recognize it’s not an apples-to-apples comparison. Nevertheless, that’s about 425,000 employees for which it already purchases care – soon to be 500,000.

2.  Podcast interview with David Postman

I recently interviewed David Postman for our podcast series at our sister site, www.washingtonstatewire.com.  If you don’t know his name, that’s probably a good thing. As Chief of Staff to Governor Jay Inslee, Postman is the most senior operative in state government, a role that is generally more behind the scenes than in front of it. He was formerly one of Olympia’s top reporters among a then-vibrant capital press corps.

What does he know now that he didn’t know as a reporter?  “Friends are as difficult in this business as your enemies. You’ve got to bring along a vast array of Democrats. There’s a lot of political spectrum here.  I once said about the Seattle City Council that it represents the political spectrum all the way from A to B… I thought, yeah, give me that. It just doesn’t work that way (in Olympia).”

3.  Exchange board to certify plans for 2018

This week’s Exchange Board meeting will certify the plans prepared to sell on the exchange when “open enrollment” begins on November 1st. Seven carriers will offer 42 qualified health plans (QHPs), down from 9 issuers with 98 QHPs this year. Regence and CHPW both withdrew from the exchange.  Nine counties will have only one issuer.

In some context, on the one hand, Washington’s individual insurance market is having a bit of a tough time in 2017 retaining plans in the market, relative to other states. Premiums for the lowest cost plan are up 36% for 2017.

On the other hand, it’s certainly not as bad as some states, and for that Commissioner Mike Kreidler deserves a lot of credit. He’s worked successfully this summer to shore up counties with no carrier. Moreover, the Exchange as an organization has put its operational and financial issues behind it, a testament to Pam MacEwan’s leadership there.

4.  David Axelrod interviews Inslee, Murray

Speaking of podcasts, David Axelrod is creating a historic cannon of podcast interviews with some of the leading figures in US politics today. He released his 171st episode this week. His guests have included names ranging from Grover Norquist, Corey Lewandowksi, and John Kasich to Rahm Emmanuel, Bernie Sanders, and Barack Obama. They run about an hour, and I can’t recommend them highly enough to you.

His latest episode is with Gov. Jay Inslee, with an interview that ranges from his initial foray into electoral politics to his role as governor during a time of President Trump.  He also interviews Senator Patty Murray. That interview offers in Sen. Murray’s own words what it was like to grow up in a family with her father, a veteran, disabled by MS. That time for her family, where her mother and the kids all needed to work to support the family, Murray says, was a foundational time for her as a policy maker today.  Both interviews are great listens.


5.  CHIP re-authorization due by end of month

Congress must re-authorize funding for the Children’s Health Insurance Program (CHIP) by the end of the month or risk a program shut down. There is bi-partisan support for the program, including an announcement last week that a 5-year extension is likely acceptable to everyone.  When Pres. Trump agreed with Democrats to raise the debt ceiling, it took away the primary legislative vehicle Congressional Republicans had in mind. By moving that legislation forward before the CHIP re-auth was ready, it means the re-auth has to be matched with something else.

That vehicle could be the Senate health reform package, but the House has their own ideas there.  The CHIP re-auth could go in December with some other re-authorizations. But that would mean the program would be in budget jeopardy in October and November while things are sorted out. It could move with the Continuing Resolution (CR) to keep the government funded, which must pass before Oct. 1.  That CR is likely to have other riders on it, each of which make passage more complicated for both parties. The Freedom Caucus doesn’t want a large price tag on the CR. Democrats don’t want to fund the Wall.