Commission discusses Washington’s readiness to establish a universal health care system


Shane Ersland


Washington’s Universal Health Care Commission discussed the state’s readiness to establish a single-payer system Thursday.


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The commission was created after Senate Bill 5399 passed during the 2021 legislative session to make health care more accessible and affordable for residents. Health Management Associates (HMA) staff is helping the commission by providing guidance in developing a baseline report for legislators on the feasibility of creating a state universal health care system.

To help with that process, HMA created a report that indicates Washington’s readiness to implement key design components necessary to establish a universal health care system, which HMA Principal Gary Cohen introduced to the commission. The report discussed the feasibility of implementing several key design components, including eligibility and enrollment, benefits and services, financing, provider reimbursement and participation, cost containment elements, infrastructure, and governance.

When discussing the benefits and services component, Cohen asked if commission members felt a universal health care system should provide one set of benefits for everyone, and if so, which benefits should be offered. Commission Chair Vicki Lowe said input from recent meetings has indicated that multiple health care services should join medical in the plan’s offerings. 

“It’s hearing, vision, and behavioral health,” Lowe said. “And I’ve heard that public health should be part of universal health care. Dental is part of health care. [It’s] all connected.”

Cohen also asked about the possibility of offering supplemental options with any proposed universal health care plan, which commission member Dave Iseminger—Director of the Washington State Health Care Authority’s Employees and Retirees Benefits Division—said could create equity issues.

“You may have people who desire [an] enhanced benefit and one can afford it and one can’t,” Iseminger said. “There are a lot of people who would love it but it does raise a very clear equity question.”

Lowe said any type of cost sharing option would raise equity questions as well.

“Cost sharing is an equity issue,” Lowe said. “I have never seen a report that it helped save services needed. It inhibits people who have lower incomes from going to the doctor. I’m totally against cost sharing. I think we need to look at the benefits as benefits.”

Commission member Jane Beyer said she was concerned about the financial effects of supplemental benefits on small health care practices, however.

“I understand all the weaknesses of the fee-for-service system,” Beyer said. “Here’s my concern … We have seen significant consolidation. We’re now starting to see more private equity money coming into health care. From that small practitioner’s perspective, that in and of itself, is going to drive that provider to sell their practice to the big hospital system or a private equity firm. I don’t think we want to create practices to drive people to sell. I think the commission should explicitly involve these discussions.”

No final decisions were made, and commission members will discuss their options again during their July 13th meeting.