Opinion: Kreidler Strikes the Right Balance On Exchange

Mike Kreidler announced last week that Washington Medicaid is second rate insurance.  Ok, so he didn’t say exactly that, but he certainly said the Emperor was wearing clothes as see through as a pair of Lululemon yoga pants.  It was an awkward moment, particularly in such a heavily Democratic state.

Curiously, responses to the announcement seem to have completely missed the point.

Fifteen years ago, network adequacy standards for Medicaid and commercial products were the same.  But somewhere on the road between budget surplus and deficit, the Health Care Authority began to look the other way.

Grossly inadequate provider networks by any standard, were now deemed “adequate”.  Repeated complaints from providers, patients, and legislators were ignored.  Accountability for patient access became a thing of the past.

When provider networks are inadequate, patients aren’t able to get needed care.  Its particularly problematic in rural areas, where the nearest provider is often already a long way away.

Unfortunately, the easiest way for insurance companies to make a profit is to collect premiums, while creating barriers to care, such as excessive pre-authorizations and inadequate provider networks.  It’s a great deal for insurance companies, but a pretty poor deal for taxpayers and patients, who aren’t getting what they are paying for, and can’t access care when they need it.

The check and balance is for regulators and agencies to hold them accountable.  We are grateful to Mike Kreidler. That’s what he just did.

Cindy Robertson is the CEO of Northshore Medical Group and the President of the Rural Health Clinic Association of Washington.