Washington lawmakers took another step toward bracing the state for the implementation of Obamacare this week, even though some obstacles still loom before the controversial health care. Gov. Chris Gregoire is scheduled to sign House Bill 2319 Friday, which will help Washington fully implement the federal Affordable Care Act, coloquially known as "Obamacare," by 2014. But the predominately Republican Washington Senate budget does not provide the $2.9 million needed to put that bill into action.
"The Senate budget ignores it. It pretends (the bill) doesn't exist," said Sen. Karen Keiser, D-Kent, on Tuesday. The House has created a budget that does provide the money, but House and Senate leaders are still trying to hammer out a compromise budget.
Meanwhile, oral arguments are expected next Monday in front of the U.S. Supreme Court on whether the federal Affordable Care Act is constitutional.
Gregoire's signing of HB 2319 would mean the creation of a new Washington health insurance exchange board, which would act as a clearing house for consumers, allowing them to inspect and select health insurance packages within their budget. There would likely be a gradual transition of responsibilities from the Washington Health Care Authority to the new board.
The state Legislature recently passed the revised bill along a stark partisan line — 27-22 in the Senate and 55-41 in the House. Democrats mostly supported the bill, while Republicans mostly opposed it.
Ultimately, 140,000 to 410,000 low-income Washington residents could participate in the health insurance exchange, said Molly Voris, project manager for the WHCA Health Benefits Exchange Program. Milliman inc., a Seattle-based consulting and actuarial firm, recently prepared a report on the topic for the Health Care Authority.
Rep. Eileen Cody, D-Seattle, introduced the bill at the request of Gregoire and State Insurance Commissioner Mike Kreidler. A related bill passed by the Legislature last year called for the creation of a state health insurance exchange, but provided few guidelines.
This new law lays out in broad strokes the role that the new state health insurance exchange would play, such as creating criteria for insurance companies to participate — but leaves many of the nitty-gritty details still to be tackled.
"We want something simple from the consumer's perspective," said Emily Brice, an attorney with Northwest Health Law Advocates.
The idea is to get the exchange set up by the time the federal Affordable Care Act goes into effect in 2014 — assuming that the U.S. Supreme Court does not overturn it. Cody said if a state exchange system is not in place by 2014, the federal government would put its own exchange into action for the Evergreen State. That might disqualify the state from receiving federal funds for the program though. A significant amount of federal health insurance aid is tied to the creation of a fledgling state health insurance exchange.
Where the Affordable Care Act is designed to provide health insurance to people who normally cannot afford it, Cody's bill enables Washington to map out how it wants to implement the ACA in 2014. The bill would allow Washington to remodel its health care systems on its own terms — not with a cookie-cutter approach designed by the feds.
"We have a good and effective model in this state," said Roberta Riley, a consultant working with Northwest Health Law Advocates, "Our state will signal to the federal government that we want to do federal health care."
Supporters say the new law would allow Washington state to pool federal funds, making health insurance more affordable to the poor. Individuals and families with incomes up to 400 percent of the federal poverty level — a sliding target linked to the number of people in a family — would qualify.
Families and individuals making up to 133 percent of the federal poverty level qualify for Medicaid, while those making 134 percent to 400 percent of the federal poverty level will receive tax credits to help them afford health insurance. Businesses with 50 or fewer employees will also get tax breaks linked to the exchange.
Washington's Basic Health Plan for the poor — which faces the chopping block annually in the Legislature — would be listed on the state health insurance exchange if it survives to 2014.
Still, not everyone is a fan of the program. Washington Attorney General and gubernatorial candidate Rob McKenna opposes the federal Affordable Care Act and has joined other state attorneys general in a joint lawsuit to overturn it.
Meanwhile, House Minority Leader Richard DeBolt, R-Chehalis, and Senate Minority Leader Mike Hewitt argued in an Olympia hearing Tuesday that Washington should not set up a health insurance exchange until the U.S. Supreme Court rules on whether President Obama's Affordable Health Care Act is constitutional.
"We can't afford to wait," Cody retorted.
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