News
Basic Health Plan finalizing criteria for who it will cut
Target: 40,000 of the 100,000 currently on its rolls
Saroja Strand currently pays a $30 monthly premium for her state health insurance, Basic Health, and says if she had to, she could pay more.
After 22 years of driving a school bus in Seattle, Saroja Strand had to give it up: The chronic back pain of osteoporosis, a thinning of the bones, made it difficult to steer a bus every day, so, in 2002, Strand decided to go back to school and train as a court reporter.
She signed up that year for the Basic Health Plan, one of the nation’s few state-subsidized insurance plans for the poor. Since then, Strand, 62, has gotten a part-time college job attending lectures with deaf students and typing up what’s said for them on a laptop. But she doesn’t make much — $12,000 last year after taxes, she says — and still qualifies for Basic Health.
The question is for how long?
In April, to fill a $9 billion budget gap, the state legislature cut $242 million, or 42 percent, of Basic Health’s two-year budget, requiring the program to drop roughly 40,000 of the 100,000 people on its rolls by January. But the state’s Health Care Authority, which oversees the 20-year-old program, has never had to make actual cuts before and is now scrambling to figure out how to do it — with the criteria and final number to be cut a moving target that worries health care providers and recipients like Strand.
Among four definite steps that the Health Care Authority plans to take are increasing premiums and co–pays (by how much is still under study) and doubling the number of people each month who have to send in paperwork to certify that they are still low income — a point, says agency spokesperson Dave Wasser, when many people fall off the rolls, either because they have higher incomes or, as providers say, paperwork gets lost.
On June 10, the agency will also mail letters to about 5,600 very low-income people who are “dual eligible” — they are on the federal Medicaid program and Basic Health — telling them that Basic Health will drop them by Aug. 1, the date by which Wasser says his agency must finalize next year’s contracts with the five private insurance plans that actually provide Basic Health’s coverage.
Altogether, that’s expected to cull roughly 20,000 people. After that, the agency is weighing another four proposals, none of which take a person’s medical condition or needs into account, critics say. They include the possibility of cutting longtime recipients like Strand or Basic Health’s newest enrollees, lowering the eligible income level from 200 percent to 125 percent of the federal poverty line (roughly $21,600 versus $13,500 for one person) or — the most controversial proposals — dumping non-citizens or using a lottery to disenroll people randomly.
To get more people off the rolls, the agency might also institute a policy of cutting people if they miss one month’s premium payment. They can currently be cut for missing two consecutive payments or three within a year.
The Health Care Authority’s director, Steve Hill, will make final decisions on those criteria and policies by early next week, Wasser says. The disenrollment target now stands at 36,000, he says, but could get down to 33,000 if the program raises its premiums, which currently range from $17 to $30 a month.
“We’re trying to find a way that impacts the fewest people,” Wasser says. “One of the reasons that increasing rates is attractive is that individual enrollees have a choice in what is going to be their outcome” — that is, they can leave the plan if the new costs are too high.
But if the state were to double the $17 that the lowest-income Basic Health members pay today, “that only takes it to $34 [a month] for a decent package of health benefits that is still an excellent bargain,” Wasser says.
“While people in that income range are going to feel the impact,” he says, “they would feel it even more if they god sick and didn’t have health insurance.”
Strand agrees. She says her premium just went up to $30 a month from $22.50, but she could pay more. “I feel like I could afford a $50 to $60 premium,” she says, “but I can’t afford a $300 premium” for private insurance.
A group of health care and insurance providers who met with Hill and Health care Authority staff May 13 to discuss the proposed criteria, however, say things are moving too fast, with little analysis on the agency’s part of who will be affected and how.
“I don’t see how they can’t go case by case in some instances,” says Bev Spears, legislative director for the Washington Community Action Network. “If someone is on medication that’s necessary to save their lives, there have to be exceptions.”
Spears and other health care advocates sent the Health care Authority a letter on May 22 urging the agency to delay its decisions — in part, says Janet Varon, an attorney with Seattle’s Northwest Health Law Advocates, because 2,000 people a month drop off the Basic Health rolls on their own, which would add up to 14,000 people by year’s end.
By then, she and Spears say, Congress might have passed some national health plan that people could hope to transfer to. The coalition is also calling on health care providers and the insurance plans behind Basic Health to save as many slots as possible by agreeing to take lower fees in the short term — a so-called “shared sacrifice” proposal that would soften the blow on struggling community clinics, which will still see the same patients for free, the two say.
“If they lose Basic Health, it’s not like they have other options,” says Rebecca Kavoussi, assistant vice president of government affairs for the Community Health Network of Washington and its 140 clinics, which charge based on income. With so many people getting laid off and turning to community clinics for free health care, she says, “You don’t have to be a rocket scientist to see the math gets more and more difficult.”
The Health Care Authority’s director has said he would be willing to look at “shared sacrifice.” But Wasser says that delaying disenrollment only spends money the agency doesn’t have and makes it impossible for the insurance plans, which are currently putting bids together for next year’s Basic Health contracts, to know what number of members to bid on.
“People have suggested take your time. That would be all well and good if we didn’t have these contracts that we had to come up and didn’t have the budgetary situation we do,” Wasser says. “If we push it out to March or May, we’ll wind up with not enough money to be at 60,000 [slots] by the end of biennium. We’ll be down to 40,000.”
“Hopefully,” he says, “we’re making the right decision and minimizing the impact on the people who can least afford [it].”
Strand says she doesn’t see how that’s possible. She has recently developed a heart condition and fears the worst if she should be one of the unlucky ones. “I feel like everyone should be able to have coverage to go to a doctor,” she says. “I guess I’m just against them even having to cut this.”
Comments
MILO’S PROPOSAL FOR THE COMMON GOOD
I contacted the HCA Administrator Steve Hill directly (on May 31, 2009), stating the following:
“May I suggest that a combination of lowering the
income cutoff in addition to raising the premium
payments for the current subsidized enrollees would
clearly be the most equitable approach for you to
take in your upcoming decision regarding what to do!”
and
“Further, in terms of public relations, such a
combination approach (as I propose herein) actually
can be shown to make demonstrably common sense,
as opposed to wielding the ‘blunt’ and ‘devastating’
instruments that ‘lotteries’, or ‘first-in’, or ‘last-in’
would constitute!”
.
HCA ADMINISTRATOR STEVE HILL’S RESPONSE TO MILO
Milo:
“Your email is thoughtful and you do a great job of making the case for a combination of protecting lower income members and raising premiums. I also agree with you that the clear legislative intent of this program is for low income working people.”
.
GOVERNOR GREGOIRE’S RESPONSE TO MILO
Dear Milo -
I received a copy of the e-mail message you sent to Health Care Authority Administrator Steve Hill. I want you to know Steve personally read your message to me as well as others at a meeting this afternoon. Before reading your e-mail, Steve introduced it as thoughtful and insightful. It was both thoughtful and insightful, and helpful. Thanks for sharing. Rest assured we will do the best we can to meet the criteria outlined in your message.
Take care. Chris
.
MILO’S INTERPRETATION OF GOVERNOR GREGOIRE’S STATEMENT
I interpret the Governor’s pledge (below) as an official statement
of Gubernatorial policy regarding her recommendations to Steve Hill
(as the sole decision maker) in the matter of refraining from the
disenrollment of current eligible subsidized enrollees in BHP by:
(1) Lottery; or
(2) “First-in” length of enrollment; or
(3) “Last-in” length of enrollment.
.
Will Steve Hill adhere to Basic Health’s core intended mission and purpose in the process of implementing these budget cuts that, ultimately, bear our own names as the governed constituents, as well as bearing the names of our elected and appointed officials?
A failure in the decision making process to recognize the unfairness of the three proposed arbitrary disenrollment methods (regardless of any current eligible BHP enrollee’s income level, or medical condition) would constitute a failure on the part of all of our consciences (the governed as well as the governors).
“Just as the titles of winners are worthless unless they are visible to others, there is a kind of anti-title that attaches to invisibility. To the degree that we are invisible we have a past that has condemned us to oblivion. It is as though we have somehow been overlooked, even forgotten, by our chosen audience. If it is the winners who are presently visible, it is the losers who are invisibly past.”
.
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