5 Things We’re Watching – Washington, September 2013

While October 1st is getting a lot of headlines, close observers of health care today might point to non-ACA reform efforts as being just as impactful to Washington State.

Acronyms like SIM, FBHP, and RSN are a few of the 5 Things We’re Watching this month.

DJ Wilson - Host, State of Reform

1. HCA:  State Innovation Model planning

Working through a $1m CMS planning grant, the HCA is building a transformation plan that will serve as the foundation for non-ACA reform efforts in Washington State through at least the first Inslee term.

One of the primary areas of focus is the development of integrated regional funding and delivery systems.  Building out these regional approaches could be the most important item to come from the SIM planning effort.

This concept paper from southwest Washington lays out a vision for what they are calling a Regional Health Alliance (RHA).  Watch counties like Spokane, Chelan/Douglas, and Whatcom where some of the most interesting work is taking place towards a regional approach.

2. RSN system redesign is not as smooth as it might be

This issue, which we (proudly) were the first to report in July, is admittedly a tricky one – mostly because of politics, not policy.  So, the relative lack of stakeholdering by DSHS sets up the possibility for a difficult legislative discussion on whatever corrective action plan is offered to fulfill the CMS mandate for change.

At our Spokane conference, and a recent conference on co-occuring disorders, the buzz and feedback was clear:  the state should be ambitious when it comes to change and integration.  That’s what the ACA pushes, it’s where Medicaid is going, and the rationale for carving out mental health probably no longer exists (and is undermined by recent data).


3.  Federal BHP rule is finally out

Sen. Cantwell will be happy.  She went to the mat to get a federal Basic Health Plan option in the ACA in 2009-2010 and stayed at it through this year.  It’s taken the Obama administration since then to figure out how to write the guidance for states to implement it.

It’s taken too long, I’m sure Sen. Cantwell would say, but at least now there are proposed rules to guide the discussion in states that may wish to implement it.  It’s likely this will be on the table in Washington State – for a number of reasons, mostly political – in the coming legislative session.

4. “Woman up, stand your ground, and fight like a girl!”

Will the US House Republicans’ insistence on defunding Obamacare lead to a shutdown of government next week?  It looks likely, and with Sarah Palin’s op-ed as Exhibit #1 (it’s her quote in the headline), I would argue this is politics at its worst.

Especially since the last constructive idea on health care from Congressional Republicans looked a lot like Obamacare.

When the government shut down in 1995, I was living abroad.  The closure of the consulate in my town was a stark reminder of how important the services provided by the federal government are to folks.  Closing down government for political points – especially when it’s clear this will have no impact on funding Obamacare – is not helpful to anyone.


5. Oct 1 is dead!  Long live Oct 1!

With states like Oregon having even greater difficulty getting their Exchange ready for Oct 1, and the federal marketplaces quietly missing deadlines in September, many are wondering what will break in the Washington effort.

So far, there are no signs of missing the mark in Washington State.  I’ve argued privately that expectations should be lowered about the exchange and Oct 1.  After all, if things aren’t ready Oct 1, it means folks still have 91 days to buy coverage before Jan 1 benefits arrive.

But, even with that relative lack of importance of Oct 1, “all systems appear to be go for launch.”  I’ll save the kudos till after the 1st, but if we make it and the wheels haven’t come off, Richard Onizuka should be named “CEO of the Year.”