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With just days to go in a session where state lawmakers are facing a $2.8 billion deficit but can’t agree on which taxes to raise, nothing is certain. Unless a drastic cut is proposed at the last minute to resolve the differences between the House and Senate, however, the Basic Health Plan, a state-subsidized insurance program for low-income households, looks like it’s going to make it intact – at least until the end of next year’s session.

In her first “all-cuts” operating budget for fiscal 2011, the governor called for cutting Basic Health and its 71,000 enrollees altogether, just one year after the Legislature slashed the program 43 percent, or $255 million, in its original 2009-2011 budget. More than 30,000 people lost coverage in that cut, which the state accomplished over the fall and winter through a combination of dropping Medicaid patients, stepping up income verification and raising the portion of premiums that enrollees pay based on their income, from an average of $34.20 to $60.46 a month starting in December.

Rosemary Richter, a Vancouver retiree living on a pension of $1,300 a month, says her premium went up from $151 to $287. “If it goes up any more,” she says, “I won’t be able to afford it.”

The governor’s second budget, along with the House’s and Senate’s, forestalls that by raising taxes to maintain Basic Health and certain other social programs. Gov. Gregoire and the Senate both allocate $160 million to subsidize Basic Health’s current enrollees through the end of the fiscal year in mid-2011, with the Senate calling for more than half the money — nearly $86 million — to come from a $1-a-pack tax increase on cigarettes.

The House plan, however, has a caveat that health care supporters say is worrisome: It reduces Basic Health funding by $56 million on the assumption that, starting in January, new federal Medicaid dollars will be available to make up for the cut. But the money won’t materialize unless the U.S. House and Senate agree on a final version of national health-care reform legislation that is now stalled.

The bill passed by the U.S. Senate, in particular, would let states pay for programs like Basic Health with newly expanded Medicaid funding that would start in 2013 or 2014 and match state dollars one for one. In the meantime, says Rebecca Kavoussi, assistant vice president of government affairs for a consortium of clinics called the Community Health Network of Washington, the state plans to apply for a federal waiver from the Centers for Medicare & Medicaid Services so it can start using the new Medicaid funding in 2011 not only to pay for Basic Health, but for medical coverage the state provides to 18,000 temporarily disabled people under its General Assistance-Unemployable program.

If the expanded Medicaid funding doesn’t make it through Congress, however, Basic Health would run out of money under the House budget and cease to operate on April 1, 2011 – a wager of sorts that Gregoire health policy advisor Jonathan Seib says is a great concern to the governor.

“Clearly we are as interested as legislators in the availability of that [funding],” Seib says, “but the governor is not comfortable assuming it can be spent until we’re sure we get that.”

That surety slipped away in January, when Democrats lost the Massachusetts Senate seat long held by Edward Kennedy and, with it, a super majority of votes. When members of the state House first crafted their budget, “health-care reform at the federal level was moving forward and we had encouragement from D.C. that we could get this waiver,” says Rep. Eileen Cody (D-Seattle), chair of the House’s Health Care & Wellness Committee. “At this point, that hope is fading and the House will probably move to the Senate level.”

How to get there is another question. In order not to cut the $56 million and fund Basic Health at its current level, “we will have to make cuts in other areas where [the Senate is] lower than we are,” Cody says.

With a full 90-day legislative session scheduled to start in January 2011, there will be another chance, Seib says, for lawmakers to address Basic Health funding should it run short. But that, health-care advocates say, does nothing for the 93,000 Washingtonians on the program’s wait list – more now than are actually covered by Basic Health.

Funding Basic Health with a new cigarette tax is more reliable than counting on the federal funding, Kavoussi says, but there are other things in the Senate budget – namely, a temporary three-tenths of a percent sales tax increase that isn’t in the House version – that face strong opposition.

“Basic Health is only OK to the extent that legislators are able to agree on and pass something,” Kavoussi says. “I think it’s fairly well positioned, but I think the differences between the House and the Senate will come down to the wire and come down to individual legislators saying whether they will or won’t vote on specific revenue sources.

“In the conference budget, the leadership will try to sort out these major differences. Then,” she says, “they’ve got to get their caucuses and members to take these votes during an election year.” 

©Olympia Newswire: http://www.olympianews.org.

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