It was a universally applauded cheerleading speech until health care popped up. Outgoing Gov. Chris Gregoire was more than halfway through her farewell address when she told the state Legislature on Tuesday: "Every Washingtonian deserves an open door to the doctor when they need one."
While Democrats sprang to their feet and clapped, Republicans sat with their hands in their laps.
There was one other visible point of dispute in Gregoire’s Tuesday speech, which focused mainly on Washington’s positive progress. "I'm proud that our gay and lesbian couples became the first in the country to marry because their friends and neighbors stood up at the ballot box and said they should have that right," she remarked.
Again, Democrats and a handful of pro-gay-marriage Republicans stood and clapped, while most Republicans sat silently.
After Gregoire's farewell speech, Sen. Randi Becker, R-Eatonville and the new chairwoman of the Senate Health Care Committee, and House Minority Leader Richard DeBolt, R-Chehalis, said that they are concerned about the costs to the state of increasing health care, especially with education being the Legislature's top budget priority.
"Every Republican wants access to health care. But accessible and affordable are different things," Becker said.
"Health care is the No.1 driver of costs in state government," remarked DeBolt.
The pair pointed to an expanded Medicaid program and the new Washington Health Insurance Exchange as potential points of contention between parties. They worry the federal government might withdraw its share of Medicaid funding in future years, which would increase the state’s obligation.
"We want to be cautious," DeBolt said.
In a recent interview, state Sen. Karen Keiser, D-Kent, said Medicaid expansion could provide health care dollars to single low-income adults who are currently uninsured – without dipping into the state's coffers for a while.
Overall, Washington will provide $9.9 billion in low-income medical care between 2011 and 2013 — slightly more than $5.3 billion of that comes from the feds. The Medicaid portion is included in that figure, though the specific amount of Medicaid funding hasn't yet been calculated.
Currently, about 1.2 million Washingtonians —18 percent of the state's population — are eligible for Medicaid. Depending on whether and by how much the Legislature decides to expand Medicaid, between 62,000 to 343,000 more people could be enrolled.
If that happens the liberal Washington State Budget & Policy Center estimates that the state itself could net some $200 million in savings during the first two years of an expanded program because of a hundred percent subsidy of medicaid enrollments and other costs that will be picked up by the federal government starting in 2014.
DeBolt and Becker also voiced qualms about the new state health exchange, which will act as a clearing house for consumers, allowing them to inspect and select health insurance packages within their budgets. The Legislature passed the measure along party lines last year. (Most Republicans opposed the exchange.) Ultimately, 140,000 to 410,000 low-income Washington residents could participate in the health insurance exchange, according to state estimates.
Becker wonders about whether the new exchange will be operated as inexpensively and efficiently as possible. "Are we telling the people the truth about the exchange?" she asked, referring to the exchange's limited $50 million budget. "We need to see what that $50 million gets us."