5 Things We’re Watching – Washington, April 2013

Push has come to shove.

The deadline has passed for plans to apply to be on the exchange – with mixed levels of interest.  The legislature is in the final stages of the session with (mostly) only the budget remaining.  And the US Senate has become a less friendly place when it comes to health care.

Tension and conflict – those are the watch words for April’s “5 Things.”

1.Two plans in the small group exchange market?

On April 1, plans were required to submit their application materials to market products on the exchange this fall.

Without the subsidies to offset the costs, which exist in the individual exchange market, few plans decided to participate in the small group market. While some might suggest more carriers will be on the SHOP exchange, most Washingtonians may have only one or two plan options from which to choose.

2. Becker: Medicaid an “imperfect solution”

“At the end of the day, Washington will be participating in the Medicaid expansion. It’s an imperfect solution, but it is the best mechanism we have to extend coverage to uninsured individuals in our state.”

Sen. Becker has scored high marks from many insiders for her steady and careful leadership through the legislative session when it comes to health policy.  Read her guest commentary on Medicaid posted this week at www.stateofreform.com.


3. End game on the budget

Discussions between the House and Senate are continuing as their two budgets merge into a final.  Expectations vary about whether the two sides will agree in order to finish on time, though the big questions in health care (ie: Medicaid) are mostly settled.

Remaining are questions about whether to fully fund the exchange or pare it back, whether to shore up rural health clinics in advance of Medicaid expansion, and the details of the hospital safety net assessment.

4. Sebelius gets dressed down by Sen Baucus

While the state is taking the lead on the exchange, it is still noteworthy when the Democratic chair of the US Senate Finance Committee, Max Baucus, lays into the Secretary of HHS over the progress of the federal exchange in a public hearing.

Sen. Baucus to Sec. Sebelius:  “I just see a huge train wreck coming. You and I have discussed this many times and I just don’t see the results yet.”   The fireworks start at the 48:43 mark.


5. Medicaid expansion comes without plan choice for patients

Imagine signing up for Medicaid, but having little to no choice about whether you can continue to see your current physician.  That will be a likely scenario for some beneficiaries next year as newly eligible Medicaid enrollees will have no say in which health plan – and which provider network – they get assigned.

This guest commentary last week highlighted the issue.  Thanks to Molly Firth and Sylvia Gil for the authorship.  As you know, we’re always interested in good ideas and are happy to share them online.