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Washington State Sen. Keiser on health-care reform: 'This is a monumental step'

State Sen. Karen Keiser, D-Kent - Courtesy Washington State Legislature
State Sen. Karen Keiser, D-Kent
— image credit: Courtesy Washington State Legislature

State Sen. Karen Keiser, D-Kent, shared her feelings Monday about the Legislature's recent passage of major health-care reform legislation. Keiser is chair of the Senate Health & Long-Term Care Committee, a part of the White House Working Group of State Legislators, which has been working closely with the White House to coordinate grassroots support for health-care reform.

The following are Keiser's statements on the health-care reform legislation passed by the state Legislature:

"The health-reform foundation pieces are already in place in Washington thanks to our legislative efforts. We have seen this coming for years.

"Our state has already come a long way in creating a more balanced and fair insurance system. It’s currently illegal to discriminate based on gender in Washington. We’ve also passed legislation allowing state workers to keep children up to 26 years of age on their policies. And the high risk pool and Health Insurance Partnership are already in place. Having federal reforms gives us an opportunity to make even more substantive changes to our system.

"States, like Washington, are struggling under the weight of skyrocketing insurance costs. We need a strong federal partner to enact reforms that- over time- will drive down costs and make the system work for everyone. This is a very good day for our state and our nation.

"Insurance companies have been allowed to call the shots for decades at the expense of hard-working Americans. This bill aims to level the playing field for Washington residents.

"This is a monumental step toward transforming our nation’s very expensive, very inefficient health-care system. It establishes that health care is a right and not a privilege. This is very good news for the citizens of Washington.

"Demand for health services in our state continues to skyrocket in large part because employer-based coverage is dropping. As companies drop coverage because of the expense, more and more people are getting covered through the state's programs.

"Our budget can’t accommodate the growing demand for health services without federal legislation to control costs and help states to better serve those who need government services the most.

"The medical assistance caseload was over 900,000 in 2007. As of January 2010, it has grown to well over 1 million. We don’t have the funding to maintain that type of growth without help from the federal government and the protections this legislation provides.

"We now see a viable path for preserving the Basic Health Plan and GA-U by expanding Medicaid programs.

"This will allow us to save the insurance safety net which is crucial to hundreds of thousands of Washington citizens. The Basic Health Plan, which currently has 100,000 people waiting to enroll, could be expanded under this federal legislation. And other programs such as Apple Health and GA-U will be helped by the federal legislation."

Washington small businesses

"Small businesses are being crushed by out of control health care costs. This legislation will help stabilize Washington businesses by keeping excessive and unjustified insurance premium increases in check.

"This bill complements efforts we took this session to help expand the small business insurance market to sole-proprietors and the self-employed. Plus, we hope to get more federal funding for our Health Insurance Partnership program for small employers -which is expected to begin in 2011.

"Note: During the 2010 regular session, the Legislature passed SB 6538 to expand the small group insurance market to businesses with up to 50 employees. This will allow sole-proprietors and self-employed individuals to access the market. Washington is also due to receive a five-year, $34.7 million federal grant to allow the Health Care Authority to finally implement the Health Insurance Partnership program for small employers. The program allows small companies to get health insurance cover at a lower employer contribution rate than in the traditional small group market. The HIP also offers a premium subsidy to eligible employees, based on their family income. The HIP is expected to begin accepting applications this September and coverage is scheduled to start January 1, 2011."

Middle class families

"Most middle class families are just one major illness away from economic ruin. This bill makes it illegal for insurance companies to cancel coverage simply because they feel like it or institute arbitrary annual limits. This is monumental. This bill is about protecting hardworking families from losing it all just because they got sick."

Older adults

"We have almost 900,000 Medicare beneficiaries in Washington state, and they deserve the best possible care in the world, but federal Medicare reimbursement rates have shortchanged our seniors because we have a more efficient system than other states. They shouldn’t happen, and this legislation should correct the problem. It promises to raise rates to states, like Washington, that have done a better job containing costs. In addition, the new legislation will, over several years, eliminate the so called Medicare Part D 'donut hole.'"

HR 4872: Health Care Reform Reconciliation Act Summary

High risk pools: State will receive addition funding to cover the expense of state high risk pools, including the Washington State Health Insurance Pool (WSHIP). This is the last option for people with pre-existing conditions in the state.

Early Medicaid Expansion: States will be able to expand their Medicaid programs prior to 2014. This is crucial for Washington to refinance the Basic Health and GA-U programs which are under dire budget constraints.

Basic Health: States will be allowed to establish a basic health plan for people with incomes between 133 percent ─ 200 percent of the federal poverty level ($24,352 to 36,620 for a family of three). Starting 2014, the bill provides states 95 percent of the federal funding that would otherwise be used subsidize premiums and cost-sharing in an insurance exchange.

Apple Health for Kids/Children’s Health Insurance Partnership: Creates a new option for states to provide CHIP coverage to children of certain state employees eligible for health benefits. Background: Apple Health for Kids is free for children in families below 200 percent of the Federal Poverty Level ($36,620 for a family of three). Families above that level may be eligible for the same coverage at low cost: $20 a month per child for families below 250 percent of poverty and $30 a month per child for families below 300 percent of poverty. (The premiums max out at two per family, so no family would pay more than $60 a month in premiums.)

Medicaid: Increases the Federal Medical Assistance Percentage match (FMAP) for Medicaid to all states. States that have not previously covered childless adults ("non-expansion states") will receive 100 percent federal match for people who are newly eligible in 2014. Starting in 2017, the FMAP rate will decline until 2020, when it settles at 90 percent.

Community-health centers: Increases funding for community-health centers by $1 billion in 2011 and increasing to $3.6 billion in 2015.

Insurance Reforms:

Immediately prohibits insurers from denying coverage to children for pre-existing conditions.

* Six months after enactment, the legislation will restrict annual limits, extend the prohibition of lifetime limits, prohibit rescissions, limitations on excessive waiting periods, and requires coverage for non-dependent children up to age 26 without an employer offer of coverage.

* In 2014, for group health plans: Prohibits pre-existing condition exclusions, prohibits annual limits.

* Medical loss ratio must be at least 85 percent. Current ratios are often lower, meaning insurers spend more on administration, profits and marketing, and less on claims.

Individual mandate: Reduces 2014 penalty for not buying health coverage.

Primary Care: Increases primary care rates in the Medicare program and then raises Medicaid primary care rates to 100 percent of Medicare rates in 2013 and 2014. The Federal government will pay 100 percent of the additional cost.

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