Washington Gov. Mike Lowry is expected to sign three bills that repeal much of the state's landmark 1993 Health Services Act, once hailed by first lady Hillary Rodham Clinton as a model for achieving universal coverage.
The bills are the result of an agreement between Lowry, a Democrat, and House Republicans. May 16 is the deadline for the governor to take action on the bills, which passed the House and Senate in mid-April.
Because much of the 1993 law depended on the state receiving an exemption from the federal Employee Retirement Income Security Act-which was not granted by federal officials-the bills repeal the employer mandate to offer health benefits and pay at least 50% of the cost.
The new legislation also repeals the requirement that insurers offer a minimum benefit package and that all healthcare be delivered through managed-care plans.
But despite the uncertainty about the future of the 1993 law, HMOs have experienced rapid growth in the state as a result of marketplace reform (Dec. 19/26, 1994, p. 54).
Under the new bills, the state Health Services Commission, which has rulemaking authority, would be replaced by a policy board with only advisory duties.
Key elements of the 1993 act remain in the new legislation. The state-subsidized Basic Health Plan would be expanded to cover 200,000 low-income people in the next two years, up from the current 60,000. The state has been contracting primarily with managed-care plans to provide this basic coverage, said Sheryl Hutchison, legislative director of the Health Services Commission.
Medicaid coverage also would be expanded to cover 130,000 children under age 18, up from the current 12,000.
Funding for this expansion has yet to be worked out, she said.
Insurance reforms also survived the cuts. No one can be turned down for private insurance except for nonpayment of premiums, and the waiting period for coverage of a pre-existing medical condition is limited to a one-time delay of three months.
Also preserved are plans to develop projects to gather information on healthcare quality as well as quality-improvement standards.