Stakeholders debate Washington healthcare cost transparency bill


Shane Ersland


Stakeholders debated a bill that aims to boost the role of the Washington State Health Care Authority’s (HCA) Health Care Cost Transparency Board on Friday.


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Members of the Senate Committee on Health and Long Term Care discussed House Bill 1508 during a public hearing. The bill would direct the transparency board to conduct an annual survey of underinsured residents, and study how state tax preferences affect the calculation of healthcare expenditures.

HB 1508 sponsor Rep. Nicole Macri (D-Seattle) said the price of healthcare outpaces general inflation, which has a detrimental impact on residents and their families.

“I hear from my constituents about rising pressures because of high deductibles and copays,” Macri said. “I also am an employer, and do a lot of work trying to manage healthcare expenses in my workplace. That really competes with wages when we’re looking to make sure folks have adequate coverage. As a policymaker who works on the state operating budget, it’s important for us to know that healthcare is now 20% of the state budget. We are one of largest purchasers of healthcare in the state, so we have a particular interest in managing those costs.”

The transparency board was established when HB 2457 was signed into law in 2020, with the purpose of reducing healthcare cost growth and increasing price transparency.

“That work is underway, and there’s been a lot of great progress,” Macri said. “The board recently set its first cost growth benchmark. This bill seeks to take the next step in that work. (It) builds in some additional analysis, transparency, and accountability measures to ensure all of our healthcare partners are working with us as a state to manage healthcare costs over time. We need to center the patients and our constituents in this work.”

HB 1508 would authorize the transparency board to require that payers or providers who frequently exceed the healthcare cost growth benchmark without a reasonable justification submit a performance improvement plan, or pay a civil fine unless the healthcare provider is composed of 25 or fewer professionals.

Washington State Medical Association (WSMA) Director of Government Affairs Sean Graham said WSMA was not opposed to the creation of the transparency board, but has concerns about HB 1508.

“I think if this legislation was focused on improving the processes and operations of the transparency board, you’d see a different dynamic around it,” Graham said. “But instead of that, this takes the approach of granting the board broad new powers, unspecified ability to mandate data collection for providers, unspecified fines pertaining to that data collection, subjecting providers to performance improvement plans, and levying unspecified fines related to the performance improvement plans.”

In contrast, Erica Hallock, a lobbyist for the Washington State Nurses Association, said the bill takes smart steps to build some accountability guardrails for rising costs. 

“Nurses see the direct impact of high healthcare costs on patients,” Hallock said. “They see the stress patients are facing, and the consequences when patients make the decision to ration their own healthcare due to the cost of care. When patients do things like cutting medication or delaying care, they often end up back in the hospital in worse shape with their illness or a condition that is further exacerbated. This bill asks each part of our healthcare system to think critically about how to manage spending toward the goal of what patients can afford to pay.”

Dr. Mika Sinanan, WSMA board past president, noted that the transparency board is still very early in its work. 

“It has barely started to analyze cost data, and [has] not yet identified any specific opportunities for cost containment,” Sinanan said. “My colleagues and I believe this bill is premature and may be harmful. Physicians and health systems in Washington are paying very close attention to the transparency board work. We all want to bring down the cost of healthcare, but we also want to preserve quality, safety, and access to the systems that we have all worked so hard to build. Healthcare is enormously complex.” 

Mich’l Needham, chief policy officer at the HCA, noted that the transparency board’s cost growth benchmark should pave the way for the agency to begin tracking healthcare increases across the state.

“We believe this work is important to provide some mechanism to influence cost control, and help your constituents with these increasing prices, as well as the state in healthcare purchasing,” Needham said.

MultiCare Health System’s Allison Bailey testified in opposition to HB 1508, noting that she was not clear on what types of additional data the transparency board needs. 

“In its report to the legislature, the board did not identify data deficiencies or identify supplemental data needs,” Bailey said. “Further, we have concerns that the state’s consultants are not adjusting for essential factors in performing the analysis that would be considered best practice for this work. For example, data comparisons between hospitals need to account for the differences between the cases, as well as regional differences in input prices, such as wage differentials. More complex cases require more resources.”

Jim Freeburg, founder and executive director of the Patient Coalition of Washington, said HB 1508 puts the focus on the patient by building proactive and constructive accountability into the healthcare system.

“I’m here today because patients are struggling,” Freeburg said. “They’re delaying care and going broke because they cannot afford the healthcare they need. As we work on addressing the rising cost of care, we need to remember that the healthcare system exists to serve patients. And we need patient-focused solutions.”

Freeburg recommended that lawmakers view the GoFundMe website, as it provides many examples of people who are struggling due to the high costs of healthcare.

“You’ll see real people and real stories from your community who are suffering because we haven’t figured out how to pay for healthcare,” he said. “Families from Vancouver, Everett, Oak Harbor, Spokane, and every corner of our state are trying to pay for critical healthcare through online fundraising efforts. It’s sad to see so many people resorting to such measures, just trying to take care of their health and not go bankrupt.”

The House passed HB 1508 on March 6th. It awaits a vote in the Senate.