5 Things Washington: Leanne Berge, Prior authorization, Rep. Eileen Cody

We are in day 30 of the 60 day legislative session. The few notable health bills that are moving this session actually highlight something more interesting: just how big a health care session 2019 was. So, for a host of reasons, this feels like the lull before the next big storm: a 2020-election infused and informed session in 2021, where health care could be back, front and center.



With help from Emily Boerger



1. Pierce, Clark, North Central to face new tax on crisis services

In what appears to be an accident resulting from the complexity of Medicaid policy, Pierce, Clark, and counties in North Central Washington now face a new B&O tax on mental health crisis services. The tax does not apply to King, Spokane, or other counties in the state.

An amended bill to address the issue, HB 1483, passed out of House Finance last year with unanimous and bi-partisan support but stalled in Rules. It didn’t move before cutoff this year, though it could come back if the tax is addressed in the supplemental budget. The tax appears to be the first time Washington State has applied the B&O tax to mental health services, and it’s the only state health care-related tax to target some counties and not others that I can find.

2. Health reform leadership at CHPW

Community Health Plan of Washington has long been an organization willing to take risks when it comes to health reform in Washington State. I had the opportunity to sit down with CHPW CEO Leanne Berge for a one-on-one keynote conversation at the 2020 Washington State of Reform Pre-Conference event.

During our conversation, Berge describes the issues she is spending her mental energy on, what’s working and not working in Washington’s 1115 waiver, and her opinion on the potential influence of Cascade Care. She also outlines CHPW’s legislative agenda for the coming years which includes strengthening the safety net, and being a voice for low-income individuals and under-served communities.


3.  Prior authorization bill on the move

I think Sen. David Frockt’s prior authorization bill, SB 6404, is one of the more ambitious health-related bills moving forward this legislative session. The bill aims to reduce barriers to care by increasing transparency on prior authorization, and establishing a work group to review standards and make recommendations to the legislature.

“Outside of the high cost of premiums and deductibles, the number one complaint is arguing with insurance carriers about necessary procedures,” says Frockt. “Consumers are not being approved and are routinely denied. For commercial carriers, we have no data or transparency at all.” SB 6404 was scheduled for executive session in Ways & Means this morning.

4.  Video: Rep. Eileen Cody

Rep. Eileen Cody represents Washington’s 34th Legislative District and is the Chair of the House Health Care and Wellness Committee. Cody has long been a health policy leader in Washington State’s legislature, and one of the most esteemed health policy legislators in the United States. She’s worked on issues ranging from implementation of the Affordable Care Act to mental health parity, and patient safety improvements. She joins us in this edition of “What They’re Watching” to discuss addressing the total cost of care.

“I would say the biggest issue that I’m concerned about and working on is looking at the total cost of care. And setting up basically a workgroup or board…that would get the data and look at the total cost of care that the state of Washington is spending on health care so that we can start moving forward with the goal of not spending over the rate of inflation.”


5.  Capretta, “Healthy Adult Opportunity,” and being open minded

Some of the biggest health news in recent weeks came from CMS’s release of the “Healthy Adult Opportunity” initiative — or what many are calling a “block grant” model. Our State of Reform columnist Jim Capretta of the AEI breaks down the new proposal. He takes a complex proposal and explains the impact and its component parts.

Often folks can’t get past language in politics. Inheritance tax = good. Death tax = bad. So it is with the idea of a block grant. For the most part, it’s bad. But these things are good: flexibility for benefit design, accountability for a fixed cost trend, no limitation on enrollment, opportunities to integrate SDOH into a risk model. As Washington State starts to think about its next waiver, due to be submitted this time next year, we should try to not get hung up on language or politics. There will be plenty of that this year as it is.