Q&A: Rep. June Robinson on health care in Washington and the House Speaker election

Representative June Robinson represents Washington’s 38th Legislative District in Snohomish County. She serves as both a member of the House Health Care & Wellness Committee as well as Vice Chair of the Appropriations Committee.

In this Q&A, Rep. Robinson discusses health care in the 2019 session, the challenges of writing a state budget, and the upcoming House Speaker election.

 

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Emily Boerger: At our 2019 Washington State of Reform Health Policy Conference, you named your drug transparency bill as one of your top priorities for the 2019 session. Now that the bill has passed, can you tell me about what is included in the legislation and what the process was like to push that bill through?

Rep. June Robinson: “Sure, so we did get a prescription drug transparency bill through this year with bipartisan support in both the House and the Senate after several years of trying. You know, it wasn’t exactly what I had hoped for in that I was really looking for more notification to the public when prices are expected to increase. And that piece, we just couldn’t get.

But what we were able to accomplish was a lot of reporting from pharmaceutical companies, pharmacy benefit managers, and the pharmacy services administrative organization — so throughout the chain of pharmaceuticals — to the Health Care Authority around their costs, price increases, and reasons for price increases. So hopefully, the Health Care Authority will be able to use that information as a large purchaser of pharmaceuticals for the state, and then be able to give aggregate information to the legislature so that we can continue to look at options for both transparency and keeping costs down around pricing.

I expect that this will be a topic that we continue to work on and look at. There is conversation at the federal level as well around drug prices so it will be interesting to see, you know, if Congress gets anything done. We’re all – I think both states and at the federal level – just really concerned about pharmaceutical costs as a driver of health care costs.

But I think the bill that we passed this year is a first step and we hope it will give us information that we can use and we’ll have to just keep looking at seeing where we can continue to push on this issue.”

EB: I’d like to hear about your foundational health services bill as well.

JR: “That bill was really around defining what foundational public health is, meaning, what each local health jurisdiction should provide. So, really defining local public health in the 21st century – what we can expect in every community around the state… Obviously what we really need is funding and so it also included the mechanism for how money gets distributed, or decisions are made about how the money is distributed as it is allocated by the legislature.”

EB: You mentioned the definition needing to reflect the 21st century and what’s needed. How did the definition of foundational public health services change?

JR: “Well, I wouldn’t say anything was added, but this bill came out of a long process that the Department of Health led with local public health leaders just defining what is really foundational. What is needed in every community in order to protect the public’s health?

So, the one thing that usually comes to mind is around communicable disease, outbreak investigation and control, and then all the environmental health things that we sort of take for granted, like water quality and food inspection and things like that. Some of the larger local health jurisdictions have the resources to go much further in the services that they provide, but what the process of this bill really was about was defining what is foundational. What is the package of local public health that every community around the state can expect? So, I wouldn’t say it was anything new, it was more around defining what we really need in each community.”

EB: Any other health care bills that passed this year that you are particularly proud of or excited about?  

JR: “Well, the balance billing bill that Rep. Cody worked on for a long time, we finally got it passed. And that is now an issue that is in the news and in conversation a lot and so I’m really glad to be taking a step forward on that. Again, we’ll see how that actually plays out as it’s implemented, but hopefully that’s a solution in the state around these bills that people get that are unexpected, especially after going through an emergency room.

And then of course our public option bill that we passed that will allow the state Health Care Authority to stand up a public option on the Exchange for people who buy individual policies. This again is a first in the nation [bill] and kind of a big experiment in how we as a state might be able to keep the cost of health care policies lower for those individuals who buy on the individual market. So, those bills I’m excited about. I’m proud that we were able to lead as a state on those issues and anxious to see how they evolve and come to fruition.”

EB: I also wanted to talk about the process of finalize the budget. What was that like?

JR: “Well, it’s always challenging. There’s just so many more needs than we will ever have the resources to fill. And there are a lot of pressures from all different areas of both the community and just state government as a whole. Our state agencies and our state institutions really have never recovered from the cuts that we imposed during the recession, and have not had the resources to, sort of, make them whole. So, we’re seeing the effects of that in places like Western State Hospital and our RHCs – the facilities for people with developmental disabilities — and our prison system… all those places where the state is responsible for people’s lives. It’s just really challenging to keep up with the growing demands and costs. So, all of that is challenging.

And then, on top of that, of course, is over the last few years we’ve had the McCleary issue and K-12 funding, so a lot of energy has gone into that. And that certainly will never completely finish. So, you know, it’s hard to write a state budget and we had the pressures of what’s called the bow wave, the kind of, going-forward costs of K-12 funding that we had put in place in previous years.

And then we had set up the new SEBB — the school employees’ health care system which required significant state funding. It was also a year for collective bargaining agreements with state employees.

So, all of those were big cost drivers in the budget, and then you just had all of this other demand which we talked about with funding for a wide variety of issues. One that I track pretty closely is in the world of caring for people in our communities with developmental disabilities… Supportive living, adult family homes, and those community agencies are all struggling with finding employees and paying employees appropriately for the work that they’re doing… They just can’t take on more clients because they can’t find or afford the staff to care for them. So, we knew we needed to make investments there and we did, probably not as much as was actually needed to completely solve the problem.

And then of course mental health has been a big issue for a long time, largely driven by costs and quality issues at our state institutions – Western and Eastern State Hospitals – and so this is the year when we really came together and felt like we really needed to make big changes there. And we did, you know, again we invested a lot of money to create more capacity throughout the state. So, lots of demands. It was hard to piece everything together and it’s kind of amazing that it did come together at the very end between the House and the Senate and we were able to finish by the deadline.”

EB: It seems like with the budget you never can quite cross anything off the list. Even though you might take care of something for the near term, there’s always more to it.

JR: “That’s exactly right. The state is growing, the expectations and demands of our constituents are growing, and yeah, it just keeps going.”

EB: So, where does the conversation on health policy in Washington State head next? What else is on the horizon?

JR: “Well, I’m sure we’ll continue to work on just how do we keep costs down? Both for people who are buying insurance, as well as for the state as a large purchaser with Medicaid and the public employees and now school employees. I don’t have specific policy issues that I can point to right now, but the conversation is just going to continue around costs and quality. How do you maintain quality and make sure people have access?

And part of access is just being able to afford health care. So, we’ll certainly watch closely as the public option gets stood up on the Exchange – not in 2020, but in time for 2021 — and what that does both to costs and the market in general. And I’m sure there’ll be continued issues along those lines.

We’re also part way through our Medicaid transformation waiver as a state and we need to continue to look at what’s coming out of that. What are we learning? What can we use that’s coming out of, sort of, the experiment both to drive statewide in terms of Medicaid, but also what can we transfer from Medicaid to the private insurance market?”

EB: The last few questions I have for you are about the House Speaker election. What pushed you to vie for that position?

JR: “Well, it’s one of those things where there’s just times in your life where you feel like you need to step forward and move into a space where leadership is needed. I feel like I have a lot of support in the caucus and I have good relationships with members of the caucus. I care a lot about what happens both to our caucus, to our legislature, and to our state in the future and chose to put my name forward to see what happens.”

EB: What’s your vision for caucus leadership or how might you lead differently from Speaker Chopp?

JR: “Well, Speaker Chopp is sort of a legend and has been there a long time and has certainly cultivated his own style of leadership. Anybody that steps in after him is going to do things differently and have a lot of challenges as we transition to new leadership, because both inside and outside, people are used to his style. But I think, you know, our caucus is very healthy right now. We have a more diverse caucus than we’ve ever had and people are anxious for a little bit more leadership opportunities or abilities to participate more fully in the conversations in the caucus. And I think if I become the Speaker, one challenge will be to find ways to include more voices as we make decisions going forward.”

 

This Q&A has been edited for length and clarity.