Six policy and political predictions for Washington State health care in 2019

Now that we are firmly planted in 2019, and the new year lays out before us like a blank canvas, I thought I’d offer my token predictions for the year in Washington State health policy.

These may have no bearing in reality come 12 months from now.  That’s the joy of predictions – they are often miserably wrong.  But, from where we sit in early January, 2019, they look strikingly and modestly reasonable.

So here goes.  These are worth what you paid for them.


1. Washington State will have its first woman speaker

Ask a member of the House Democrats and they will tell you about the House Rules Committee chamber.  On the wall are portraits of past Speakers.  Every one of them is a man.

With a more diverse caucus than prior years, and one that is more female than the last decade or so, House Democrats will elect their first woman to be Speaker during the re-organization in April of this year.

The leading candidates are, I’m told, June Robinson, Laurie Jinkins, and Monica Stonier, each of whom are strong, passionate, capable legislators and potential speakers.


2.  Governor Inslee announces his candidacy for president

Someone said this announcement should have come a few years ago.  But, 2019 is the year Inslee will jump in the race for president.  Following a leadership role at the Democratic Governor’s Association, where Democrats picked up 7 seats in the 2018 elections, Inslee has built a network of contacts and relationships that can support a national run.  Moreover, some of Washington State’s big money donors may have enough interest in his campaign to support an independent super PAC to help drive support to his candidacy.

When he does announce, climate change will clearly be a central component. And, as evidenced by the news this week, health care will be a prominent piece of his campaign, too.


3.  Dow Constantine and Bob Ferguson file for governor.  Denny Heck and Lisa Brown think about it.  And, a third candidate gets in the race for the Democratic nomination.

It won’t take long following word that Inslee won’t run for a third term as governor that multiple candidates will get in the race to succeed him.  Two names that are expected to run are King County Executive Dow Constantine and Attorney General Bob Ferguson.  Both would be strong candidates – and both will announce their intentions to run when Inslee lets it be known that he won’t run (though he could run for president and governor both in 2020…).

However, I expect we may see water-testing by US Rep. Denny Heck.  Heck lost a recent race to lead the DCCC, the US House Democrats’ campaign arm. He is also more entrepreneurial than being one member of 435 in Congress might allow.  There are some early signs he is thinking about returning to state politics, so we’ll see.

Likewise, Lisa Brown will likely take a look at this.  If there are a bunch of men in the race, a woman could have some demographic advantage among progressive voters – many of whom are women.  This is particularly true during our era of the #metoo movement.


4.  Premera will make big news.

I admit:  I’m not sure what this news will be.  It could be that they enter the Medicaid market through an acquisition. It could be that they are acquired by a national plan, extending the market consolidation by national players started by Kaiser’s entry.

One of these two items – or both – could be on tap:  either an entry into Medicaid through an acquisition or being acquired by a national player looking to pick up market share in the NW. But, there are a number of subtle signs coming out of the organization that suggest some sort of big move is possible in 2019 – or I could be imagining it all.  It wouldn’t be the first time.


5.  Pramila Jayapal becomes a national player on Medicare for All.

She’s young at 53 – but not young enough to wait around for 20 years to get a committee chair.  In this, her second term, she may be at the apex of her influence in Congress.  She is co-chair of a Congressional Medicare for All Caucus, and is sponsoring national legislation on an issue that is earning a groundswell of support from Democratic voters. Medicare for All feels something like an issue whose time has come for progressives and folks on the left.

Jayapal is more of a policy geek than an administrative workhorse.  But, she’s got a lot going for her politically that would make her a compelling candidate for governor against a handful of white men in a Democratic primary.  That might be one way to parlay the national spotlight shining on her into a promotion.  However, the timing is a little off to file to run this year, something she’d have to abandon Congress for at the height of her relevance.  But, in a Democratic administration, she might make a compelling choice for HHS Secretary in a new Democratic administration.  So, watch as her star rises with the fortunes of a single payer policy proposal.


6.  All meaningful candidates for the Democratic nomination for President will have to have a Medicare for All or similar policy proposal.

I don’t think there is any pathway – particularly in what looks to be a crowded field of Democrats – for a candidate to get through the election without being for a single payer or single payer-like policy proposal. The California Democratic nomination for governor was a perfect example of this.  Of the three leading candidates on the left, it wasn’t until Gavin Newsom fully embraced a single payer policy and the other two tried a half measure that Newsom – at that time Lt. Governor – was able to pull ahead of his competitors.

Now, sure:  California is not like America.  But California Democratic primary voters are much more like Democratic primary and caucus voters in other states than you’d think.  So, the lesson may not apply in a general election, but I’d bet it will certainly apply in the primary. A single payer policy platform may be good politics or bad politics for the 2020 general, but it’s a “must have” in a Democratic primary where as many as 70% of Democrats reportedly support such a policy.