5 Things Washington: Medicaid budget cuts, Sen. Maureen Walsh, Shawn West

This edition of 5 Things spends a lot of time covering the final points of disagreement in the legislative session. It points to a great deal of independent, original reporting done primarily by two rock star reporters at State of Reform.  Emily Boerger and Sara Gentzler do great work for this edition, part of our growing team at State of Reform focused on bridging the gap between the worlds of health care and health policy.

So, thanks to Emily and Sara for their work, and to you for reading our stuff!


With help from Emily Boerger
and Sara Gentzler.


1. Health care community criticizes Medicaid cut

In a series of letters sent to legislators, members of Washington’s health care community have come together to oppose cuts to the HCA in the House and Senate operating budget proposals. The budget cuts — $351.5 million in total funds — rely on MCOs not achieving proposed savings goals, and thus not recouping a new 3% premium withhold. It’s a budget item banking on the failure of “program integrity activity recoveries.”

Letters from the HCA, the five MCO CEOs, and a broad coalition of provider associations, ACHs, health plans, and patient groups all call on lawmakers to amend the budget. It’s a striking level of unanimity among a diverse set of stakeholders.  “The Health Care Authority, health care providers, managed care organizations, and advocates for Medicaid recipients adamantly disagree that such savings can be made without serious cuts to eligibility, benefits, or both,” reads one letter. “Washington cannot achieve such spectacular Medicaid savings without sacrifice.”

2. Continued work on the public option

The latest status update on the public option bill (SB 5526) is that the Senate “refuses to concur in House amendments,” prompting a conference committee. This morning, Sen. David Frockt said he wouldn’t take the non-concurrence as “a hostile act by the Senate;” rather, he confirmed it as a way to extend “workshopping” on the bill and to “get things lined up.”

Frockt said increasing reimbursement rates “a little bit” is being discussed, along with some technical changes. The version that passed out of the House includes reimbursement rates pegged at no greater than 150% of Medicare and sets a floor for primary rates at no less than 135% of Medicare. After these changes, Premera Blue Cross, Regence Blue Shield, and CHPW expressed their support for that reimbursement mechanism in a letter. Raising the rate more, Frockt said, should “create more interest.”

3. Sen. Walsh’s comments, backlash, & apology

Sen. Maureen Walsh’s comment on the Senate floor that nurses at critical access hospitals “probably play cards for a considerable amount of the day” and should be excluded from a bill requiring hospitals to give them rest breaks, has made the rounds online. Jennifer Muhm at the Washington State Nurses Association said traffic to a related blog post crashed the association’s website for hours. WSNA.org got over 1m hits in 24 hours after posting Walsh’s comments.

Walsh has since apologized, saying in part that, while the comments were taken out of context, she was tired and crossed the line. Incidentally, that being tired can lead to mistakes, Muhm said, is “the point of this bill.” The amendment excluding critical access hospital workers from the bill ultimately passed, and so did an amendment prohibiting employees covered by the bill from working more than eight hours per day. Now, Sen. Karen Keiser says the bill “needs to be put back together after it was blown to bits on the Senate floor.”

4. Video: Shawn West, Premera Blue Cross

Shawn West is the Medical Director of Premera Blue Cross. He joins us in this edition of “What They’re Watching” to discuss behavioral health.

“Behavioral health is a huge issue. The incidence and prevalence of mood disorders and addiction continue to go up significantly, and I think people are starting to realize not only is this a huge burden for people suffering, but it really drives medical cost in terms of inpatient and ER utilization and poor management of chronic diseases. And in terms of the employers its lost productivity and issues with presenteeism and absenteeism.”


5. Opioid bill amendments spark debate

Last week, the House passed a comprehensive bill aimed at addressing the statewide opioid epidemic from multiple angles. After passing unanimously in the Senate, the bill passed on a 96-2 vote in the House, with Democratic Reps. Nicole Macri and Noel Frame voting against the measure. While the two lawmakers say they support the underlying bill, their no votes are a result of amendments added during floor debate.

The adopted amendments prohibit the HCA from promoting, or partnering with agencies that oversee, supervised injection sites. “I think the inclusion of the amendments was bad public policy, so I voted no,” said Frame after the vote. On Friday, the Senate refused to concur in House amendments, and asked the House for conference.