Washington Policy Center responds to Gov. Inslee on ACA repeal


I am writing in response to a letter sent to you recently by Governor Jay Inslee and Insurance Commissioner Mike Kreidler which expresses their “moral outrage” over proposals in the U.S. House of Representatives to repeal the Affordable Care Act (ACA). The letter contains several flaws and fails to propose a solution to the problems created in our state by the federal health care law.

In their letter the Governor and Insurance Commissioner open with the false assertion that the ACA has improved the health of Washington state residents. There is no data that confirms this. Simply decreasing the officially-reported uninsured rate does not guarantee access to health care and, in the case of Medicaid, it does not correlate with improved health. The Oregon Medicaid study actually found that when people have Medicaid insurance they have no better clinically-measured health outcomes than people who are uninsured.1

The drop in the number of uninsured in Washington state is probably accurate, even so, public officials have placed over 80 percent of the newly-insured in our state on Medicaid, meaning these enrollees do not necessarily have improved access to health care services.

The numbers for uncompensated care do not reference a time frame. The most recent numbers reported by the state Insurance Commissioner are considerably different. The claimed reduction in uncompensated care in our state represents less than one percent of annual hospital revenue. For the vast majority of Washington state residents, the financial and regulatory burdens of the so-called Affordable Care Act have not been worth the price.

The number of new jobs claimed in their letter is questionable. However, even if we accept it and agree they are private-sector jobs, virtually all of them are in the health care area. Research shows these jobs are in low-paying activities such as nursing assistants, aides, and clerical workers. These are not high paying jobs and definitely do not indicate an increase in the number of trained doctors and nurses. Further, funding taxpayer-subsidized jobs, as the ACA does, actually robs money that could be spent efficiently in the private sector. The same government-transfer effect refutes the letter’s alleged increase in state GDP.

The letter also refers to the $350 million that Washington state saved by expanding Medicaid. We have heard the same argument from other officials in our state. What is not said, however, is the fact that the Washington state Health Care Authority expanded traditional Medicaid in 2011 and 2012 in the anticipation of transferring these people into the expanded portion of Medicaid in 2014, when the ACA kicked in and federal taxpayers paid 100 percent of the costs. The people were transferred, and overnight the state “saved” $350 million. This was simply a bookkeeping exercise that shifted people to a more highly-subsidized federal program.

Governor Inslee and Insurance Commissioner Kreidler admit that 1.8 million Washingtonians are now in Medicaid and another 1.2 million are in Medicare. Think about that – officials have put one in four people in our state into the Medicaid entitlement, and over 40 percent of state residents overall are in government health care programs.

Their letter concludes with a veiled threat. It claims Washington state will lose $3 billion in FY2018 and $3.2 billion in FY2019 if the Affordable Care Act is repealed. The authors should have thought of this when they supported the ACA in the first place. The cost of Obamacare has been breathtaking and the law has not slowed the rising health care costs in this country.

The failure of the Affordable Care Act is the responsibility of public officials, like Governor Inslee and Insurance Commissioner Kreidler, who pushed for its passage to begin with, not those who are working today to repeal it and replace it with something better.

Our state-level research has consistently pointed out the policy failings of the ACA and the harmful effects this federal legislation is having on health coverage for the people of our state. We recommend that Congress enact patient-centered solutions, like the policy changes described in our new study on what should come next.2

Our study findings support the innovative ideas reflected in the “A Better Way” plan and the well-crafted reform bill introduced by Representative Tom Price.

The real “moral outrage” is that so many families in our state have been hurt by the effects of the Affordable Care Act, which is bad legislation that was imposed on us by public officials like Governor Inslee and Insurance Commissioner Kreidler. We hope Congress will act quickly to dispense with this unpopular law, and move forward to enact practical reforms that lower the cost of health care. Patient-centered reforms will re-establish the relationship between doctors and patients, for the benefit of the people of Washington and of all states across our country.


Roger Stark, MD, FACS
Director, Center for Health Care Policy
Washington Policy Center



[1] Katherine Baiker, PhD., et al., “The Oregon Experiment – Effect of Medicaid on Clinical Outcomes,” New England Journal of Medicine, May 2, 2013.
[2] Dr. Roger Stark, MD, FACS, “Health Care Reform After the Election, What Congress Should Do to Replace Obamacare,” Policy Notes, Washington Policy Center, January 2017.