ESHB 2252



BYHouse Committee on Health Care (originally sponsored by Representatives Braddock, Prentice, Sayan, Vekich, Brekke, Wineberry, Todd, Nelson, H. Sommers, Cole, Spanel and Scott)



Establishing the Washington universal health access and containment commission.



House Committe on Health Care



Rereferred House Committee on Appropriations



Senate Committee on Health & Long-Term Care


      Senate Hearing Date(s):February 28, 1990


Majority Report:  Do pass as amended and be referred to Committee on Ways & Means.

      Signed by Senators West, Chairman; Smith, Vice Chairman; Amondson, Johnson.


      Senate Staff:Don Sloma (786-7414)

                  March 1, 1990



Senate Committee on Ways & Means


      Senate Hearing Date(s):March 2, 1990


      Senate Staff:Randy Hodgins (786-7715)

                  March 2, 1990







Health care services in Washington, as in the rest of the United States, are largely delivered by private physicians, hospitals, clinics and allied health care providers.  Services are financed through private insurance, and a variety of state and federal programs.  In general, government programs provide financing for poor and disabled populations while private insurance arrangements provide financing for those who are employed or who have the means to pay directly for health care.


State and national studies indicate that access to health care services is not universal in Washington or within the United States.  A number of explanations have been advanced for this including the cost of care, reductions in the provision of health care insurance by employers, controlled growth of federal health care spending, the geographic distribution of health care providers, a lack of health care insurance for the unemployed or underemployed, the effect of provider fear of professional liability exposure, cultural differences, and a lack of consumer willingness to seek needed care.


State and federal proposals abound to address the access problem.  The Washington Legislature has enacted several programs in recent years to address the issue including the Basic Health Plan, various expansions of the Medicaid program, and the High Risk Insurance Pool. 


However, some reports indicate that access to health care is decreasing in Washington, that costs continue to escalate well in excess of the Consumer Price Index, and that the health of infants, children, the poor, the elderly and the disabled are threatened.




This act addresses the problems of health access, quality of care, and rising costs by establishing a set of policy principles and by creating a commission to develop a universal health plan based on these principles:


Citizens have the prime responsibility for their health status and, accordingly,  should play a key role in the development of their health service system.


Appropriate health services should be available to all Washington state residents regardless of age, sex, race, employment, health status, economic status, or place of residence.


A state health services budget, established in a public manner, is necessary to control costs.


The burden for financing the health service system should be equitably shared by government, employers, and citizens.


Freedom of choice is important from both the perspective of the patient choosing a provider and the provider choosing a practice setting.


Health service providers should receive fair compensation for their services in a timely and uncomplicated manner.


Illness and injury prevention and health promotion should be a major part of the health service system.


Quality of care should be promoted through the establishment of effective health services and by the assurance of acceptable standards for health professionals and facilities.


To put these principles into state policy, the Washington Universal Health Access and Cost Control Commission is created, and composed of 17 members as follows: two House members, one from each political caucus, appointed by the speaker; two senators, one from each political caucus, appointed by the president of the Senate; the chair of the Health Care Access and Cost Control Council. The Governor shall appoint the following members: three members representing employers, at least one representing employers of small business; three members representing employee organizations; three members representing health service providers; three members representing citizens; one shall be over 65 years of age and one shall be a current or recent recipient of medical assistance.


The commission's chair shall be designated by the Governor from among the members.


The commission shall be appointed by June 1, 1990, and hold its first meeting no later than June 15.


The commission shall have the usual powers to hire staff, contract for services, and create technical advisory committees.


The commission shall conduct a study of the problems relating to health access, cost and quality and make recommendations for the development of a Washington universal health access plan.  In its deliberations, the commission shall analyze the advantages and disadvantages of including in the plan the elements put forth in the bill.  The commission shall also study other approaches identified that address the problems including various private and public health service financing systems and a variety of mechanisms used by other states and countries relating to the reimbursement of hospitals, and other health providers delivering inpatient and outpatient health services.


The elements put forth are as follows: 


A universal health plan for residents of Washington State, that shall include a uniform comprehensive set of basic health services that is defined through a public process, based on the best scientific information available, and determined to be effective in the prevention and treatment of illness and injury.


A single public or private administrative organization that shall have complete operational authority over the plan, and include a uniform budgeting, billing, payment, and data system.


A state health services budget that shall set forth a finite amount of funds for the purchase of all health services provided in the plan.


A financing system with funds from government, employers, and residents: government contributions that will include all state and federal sources, e.g., Medicare, Medicaid, public employee benefits, and all others;  employer contributions that are set on a per capita basis, with special consideration for employers with small businesses;  individual premiums that are based on family size, with reduced or no premiums for low-income families.  Employers will be permitted to directly pay employee premiums.  The commission will study the appropriate use of utilization fees and include them in resident participation, if deemed appropriate.


Hospitals will be funded by annual hospital budgets based on historical data and adjusted semiannually.  Health providers will have the options of being reimbursed by way of fee-for-service, capitation, or annual budget; however, there will be incentive to practice in cost effective managed health care settings.  No extra or balance billing will be permitted.


The plan will include portability provisions so residents will be covered when out of state.


Long term care will be fully integrated into the plan, as recommended by the current Long Term Care Study Commission.


The commission shall study the advantages and disadvantages of prohibiting care service contractors, and commercial insurers from independently providing health services included in the plan.  This would not preclude such entities from independently providing services not included in the plan, such as, excess medical coverage or procedures not covered by the plan, nor union negotiating for additional benefits.


The commission shall analyze all state and federal laws that would need to be repealed, amended, or waived in order to implement the Universal Health Plan.


The commission shall study issues relating to medical malpractice liability and recommend any remedial action necessary.  This analysis shall address the desirability and feasibility of creating a publicly funded malpractice insurance program.


In its deliberation, the commission shall provide for public input, and report to the Governor, the state Board of Health, and the Legislature by December 1, 1991.


As an early step in the implementation of this act, the administrator of the Health Care Authority shall develop an implementation plan to place all federal and state funded health services under a single administrative organization by July 1, 1993.


The commission terminates on January 31, 1992.


The commission's report shall be deemed advisory to the Governor and Legislature.  No part of the report shall take effect without full legislative enactment.


Beginning January 1, 1992, all insurers, health care service contractors, and health maintenance organizations are required to submit certain patient-related data to the Health Care Authority.


$200,000 is appropriated to the Office of Financial Management to fund the commission.


Appropriation:    $200,000 to the Office of Financial Management


Fiscal Note:      available


Effective Date:The bill takes effect on June 1, 1990.


Appointments by Legislature Required:     Two House members, one from each political caucus, appointed by the Speaker of the House; two senators, one from each political caucus, appointed by the President of the Senate.





The House bill is stricken and replaced with language to do the following:


The Legislature finds that state, local and private agencies have been established to plan and deliver social and health services to arrest, treat or cure illnesses and injuries, not to prevent them or the conditions under which they are known to spread.  The Legislature further finds that no entity in state or local government is presently charged with the duty to determine the risk factors that cause illness, injury and death, or to take action to reduce these risk factors, prevent illness or promote health.


The Legislature finds these duties to be essential to the protection of public health and that they should be pursued by state and local health departments.


The Legislature finds that access to health care is vitally important to Washington's citizens, but that many may not have access to the care they need.  Several factors may contribute to this problem including the cost of care, the availability of services in remote areas, consumer knowledge or available health care resources and a lack of insurance coverage.  In addition, no clear policy exists defining the basic health care services which should be universally available.


The purposes of the act are to establish health promotion and injury and illness prevention efforts and to create a mechanism for thorough and open consideration of the questions of access, cost and quality of health services.


A center for health promotion and disease and injury prevention is established within the Department of Health which must contain those functions the secretary determines are most directly related to the promotion of health and the prevention of injury and disease.  The center, in collaboration with state, local, federal and private groups must use available information to (1) identify the leading causes of illnesses and injury in Washington, (2) isolate the causes and risk factors for these illnesses, (3) identify strategies that have been demonstrated effective in reducing these illnesses, injuries, causes or risk factors, (4) act as a clearinghouse for local health departments or private groups wishing to implement these strategies, (5) assess and report on promising strategies, and (6) receive funds and provide grants to local health departments.  In addition, the center must biennially establish statewide health promotion and disease and injury prevention objectives, after consultation with the state Board of Health.  A minimum list of objectives is stated involving reductions in: smoking among adults and children; breast cancer deaths; cholesterol levels; certain cancer deaths; non-fatal head injuries; drowning deaths; diabetes related hospital admissions; physical abuse of children; alcohol-related motor vehicle deaths; infants born to chemical abusing women; and alcohol and other specified drug use among teenagers.  The center must also evaluate local health jurisdictions' efforts in achieving these objectives biennially.


The department must designate health promotion and disease prevention regions based on the department's organizational principals stated in Chapter 43.70 RCW, and after consultation with local health jurisdictions.  The regions must reflect unique groupings of disease and injury within areas of the state, to the extent possible. 


In addition, the department must establish priority health promotion and disease prevention objectives for local jurisdictions, based on data on illness and injury.


At least three regions encompassing no less than 35 percent of the state population must be established by July 1, 1990.  A metropolitan area, a rural area and at least one area in eastern Washington must be included in these regions.  These regions must begin implementation of strategies to address the objectives of the act by October 1, 1990.


All remaining regions must be designated by May 1, 1991 and must submit health promotion and injury and disease prevention strategies within six months of designation.  The Department of Health must prepare a statement of regions' progress toward meeting the objectives of the act biennially.


Health promotion and disease and injury prevention strategies may include screening, assessments, projects to prevent the use of alcohol and controlled substances during and immediately following pregnancy, and education efforts, but may not include the delivery of primary health or social services.


Local health jurisdictions must administer the regions, and may combine to do so.  Combined jurisdictions may determine by mutual agreement which will assume lead responsibility.  If no such agreement is reached, the department must determine the lead jurisdiction.


Available funding for the regions must be allocated in grants based on priorities established under the act and the relative cost of interventions.


The Washington Health Care Access Task Force is created to be composed of 11 members, appointed by the Governor by June 15, 1990.  Appointments must reflect the broad range of opinions regarding health care access and must represent the various geographic regions of the state.  Collectively appointments must possess the perspectives, knowledge and experience of all aspects associated with the provision of health care or the purchase of health care, including senior citizens and other consumers and ethicists. 


The Governor may appoint four legislators in addition to the original 11, so long as one is selected from each of the two largest political caucuses of the Senate and House of Representatives.


The task force may hire staff, contract for assistance or appoint technical advisory committees and may receive gifts, grants or other payments from public or private resources.


Task force members or advisory committee members may be reimbursed for expenses only.


The task force must collaborate with public and private groups to complete an analysis of 15 specified subjects and recommend a plan to promote health and prevent illness and injury, ensure the availability of basic health care services, develop effective cost controls and maintain the quality of health care.


The task force must make periodic progress reports and submit a final report on June 30, 1992.


The task force must ensure adequate public participation in its deliberations.


The Administrator of the Health Care Authority must develop a plan by July 1, 1992 for a single administrative organization to administer all federal and state funded basic health services beginning on July 1, 1993.


The task force must define basic health services.


The termination of the Basic Health Plan, now set for June 1992, is extended to June 1993.


The Health Care Access and Cost Containment Council is terminated.


The sum of $285,000 is appropriated to the Office of Financial Management for the health care access task force.


The sum of $672,000 is appropriated for health promotion and disease prevention activities specified in the act.


A June 1, 1990 effective date is established.


Senate Committee - Testified: HEALTH & LONG-TERM CARE:  Bud Nicola, Director, Seattle-King County Health Department; Bob Crittendon, Governor's Office