HMA staff provide guidance to help Washington commission establish universal health care system


Shane Ersland


Staff from Health Management Associates (HMA) provided data for stakeholders trying to establish a universal health care system in Washington on Thursday.


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HMA Senior Consultant Liz Arjun and Principal Gary Cohen discussed various aspects of the state’s health care coverage landscape during a Universal Health Care Commission meeting. The commission was created after Senate Bill 5399 passed during the 2021 legislative session to establish a universal health care system for all residents.

As of Nov. 27, 2021, the state’s estimated uninsured rate was at its lowest at 4.7 percent, Arjun said. The estimated uninsured rate was at 5.6 percent on Feb. 27, 2021, and at 11.8 percent on May 30, 2020.

“While the uninsured rate is low, we have significant disparities,” Arjun said.

While the uninsured gap between those in rural and urban counties shrunk between 2014-19, the rate remains higher in rural counties, Arjun said. Those who identify as White, Asian, mixed-race, and Black all saw declines in their respective uninsured rates during that time frame. 

Not all populations saw a decline; the uninsured rate in 2019 for the American Indian/Alaskan Native, Hawaiian, Pacific Islander, and unspecified race populations exceeded their 2014 rates. The uninsured rate for the Hispanic population declined from 29.8 percent in 2014 to 16.9 percent in 2019.

The total number of practicing physicians per 100,000 people increased from 269 in 2020, to 275 in 2021. But there were disparities in their locations, compared to how many people they served.

“The rate of physicians is going up, but it’s not uniform across the state,” Arjun said.

Chelan County had more physicians per 100,000 residents in 2021 than any other county at 532, Arjun said. King County had 383, Yakima County had 221, Stevens County had 81, and Skamania County had the lowest recorded number at 31.

Several health care positions are projected to see staff shortages as well, Arjun said.

“Two areas where we have significant shortages are behavioral health and nurses across all levels,” she said. “The job openings in some of these professions are pretty staggering.”

The projected annual growth of openings between 2024-29 for registered nurses is 780. But the projected annual job openings for that time frame for registered nurses is 4,700.

Cohen discussed eligibility and enrollment factors. Establishing a universal health care system will require stakeholders to identify how to cover currently uninsured populations, and identify which segments of the existing insured population will be included in the system.

“The purpose is to identify core functions, and raise questions about how to move toward universal coverage,” Cohen said. “If the goal is to get everyone into one system, there are some people who have entitlements under federal law.”

Several financial questions will need to be answered, including how the new system will be funded. Options to consider include federal funds–including Medicaid, Medicare, and Affordable Care Act subsidies—state funds, and consumers.

“Certain benefits are provided by Medicaid,” Cohen said. “Is the idea to provide services to everybody? If the goal is to take all the money being spent, put it in a pool, stop collecting premiums, and get other sources of funding, could you do that with Medicare and Medicaid funding? It’s a really key issue; there are some legal challenges there.”

Determining governance of the system, and solving infrastructure questions will be key as well, Cohen said. 

“A lot of people believe we need to move away from fee-for-service, and more to value-based payment models,” he said. “In designing this new system, who will do that, and how will it be done? How will providers be reimbursed? We’re going to need to invest in administrative and operational capabilities necessary to implement a cohesive model.”