5 Things Washington: House budget, Meg Jones, price variation

It’s the 72nd day of the legislative session.  The House budget is out this week, which includes $1.5m for administering a public option program that caught a number of stakeholders by surprise this year. The Washington Health Alliance is out with interesting new reports that show the scope of price variation within hospitals, as well as among them.

It’s all teed up for you for our March, 2019, edition of 5 Things We’re Watching in health care for Washington State.  Thanks very much for reading our stuff.


DJ 5 Things Signature With help from Emily Boerger.



1. Reviewing the House budget

Yesterday’s release of the House budget starts a clock that will take about 72 hours.  That’s the window between the first release and the final passage off the House floor.  It’s not a process set up for much input unless you know how to pick your opportunities. So, I put this primer together at our sister site, the Washington State Wire, to scope how the budget process really works.

Rep. June Robinson should win praise for her advocacy, with others, to include significant investments in mental health funding in this budget.  But, there are some other interesting nuggets in the HCA’s budget, which I outline here. For example, it’s notable that the House budget increases the HCA’s budget by 13%.  It’s also interesting that some mid-adopter regions (not Pierce?) get some additional crisis funding while early and late adopting regions are cut out from the deal.


2. Price variation and plan performance in WA

The Washington Health Alliance is out with some interesting new reports on negotiated reimbursements from commercial payers. For example, one report shows that for a vaginal delivery, Swedish Medical Center might get paid $7,196, or it might get paid $19,402 depending on the commercial payer.  Another report shows that in the study years of 2015-2016, overall inpatient utilization was down enough ($51.2m) to offset price growth ($21.7m).

In a third report, the Alliance “analyzed how well health plans are meeting the needs of their members and working to improve quality and reduce the cost of health care.” They scored Washington State health plans based on data from 18 employer and union trusts, names like Boeing, Starbucks, and Puget Sound Energy.  It found Kaiser’s HMO product the overall top rated insurance plan, with Regence the top rated PPO plan.  Premera did not participate in the study.

3. Q&A with Meg Jones on the public option

Meg Jones leads the Association of Washington Healthcare Plans, the state’s advocacy arm for carriers. Sara Gentzler interviewed her on the “public option” bill moving through the legislature.  It has a couple of interesting nuggets in it, including that Jones admits the industry was caught a little flat-footed due to how closely the bill was held prior to session.

While Jones says the Association doesn’t have a formal position on the public option bills moving through session, a Milliman study they procured said the legislation could have dramatic consequences: “The individual market grows exponentially, the small-group market collapses. The estimate Milliman gave us in the worst-case scenario is that 60 percent of the market would migrate to the individual market. At that point, the 40 percent that remains goes into what, in the insurance world, is called a ‘death spiral.”

4.  Video: Rep. Eileen Cody

Rep. Eileen Cody is the Chair of the House Health and Wellness Committee.  Of the nine states in which we cover health policy, I put her acumen, political savvy and depth of health care knowledge at the very top.  For example, this video, the latest in our “What They’re Watching” series.

This was recorded in January, but even back then, she lays out all of the topics that we see finalizing in the legislative session.  The public option, the Long Term Care Trust Act, balance billing, opioid legislation, “Tobacco 21,” and mental health.  All of the issues she highlights in January are exactly the issues that have played out this session.


5. Use our stuff. Seriously, go ahead.

We’re excited and honored to be part of a dynamic media ecosystem in Washington State.  Collectively, we’re growing, re-writing the rules of media and information in what we think are smarter, better ways.  We play a small role, like one straw on the camel’s back.  But, it’s one we’re happy to play.

Part of the new logic of journalism today – we think – is that our free content available at StateofReform.com should be shared and used by anyone who would like to.  So, if you ever want to use our stuff, please do so.  Go ahead and use it.  We ask that you follow a few rules, but paying us isn’t one of them.  We’re about community rather than clicks, about quality over quantity.

We’re able to make it in health care journalism today because of the support and engagement from our sponsors and our conference attendees.  So, if you like any of our stuff and want to use it, go ahead.  You can thank our supporters for making it all happen.