SENATE BILL REPORT

SB 6020

BYSenators Talmadge, Kreidler, Williams, Fleming, Warnke, Moore and Murray

Changing provisions relating to comprehensive health care coverage.

Senate Committee on Health Care & Corrections

Senate Hearing Date(s):July 13, 1989

Senate Staff:Don Sloma (786-7414)

AS OF JULY 11, 1989

BACKGROUND:

There are estimated to be some 700,000 persons in Washington with no health insurance.

None of these are among the 250,000 enrolled in Medicaid, the state and federally funded health care program for low income persons.  The vast majority of Medicaid enrollees may select from a large number of providers, charging widely varying rates, often not systematically integrated into managed health care systems. 

The Washington Basic Health Plan is authorized to offer subsidized health insurance through managed health care systems to up to 25,000 enrollees on a pilot basis. 

Some two-thirds of the uninsured have ties to the work place.  However, their employers are not providing health insurance.  Many believe this group of employed persons with no access to health care is increasing as more and more employers hire part-time persons and do not provide health insurance.  Many believe this restricted access will result in an increase in illness, an increase in preventable diseases, and an increase in work days lost. In addition, some believe that reduced access to health care through private insurance could result in increased publicly funded health care costs in Medicaid or other public programs.

There is a perception by health care providers that Medicaid recipients in need of prenatal care are more likely to bring suit against them for improper care.  This, coupled with low Medicaid reimbursement rates, is thought to be contributing significantly to a growing shortage of physicians willing to provide prenatal care to low income women.

Major increases are projected in the number of elderly persons needing long term care (nursing home and similar in-home care).  At present, no public and only a very few private programs provide long term care insurance for middle income persons.  Health care insurance organizations interested in the area are hampered by a lack of reliable information and experience in providing such insurance.  Because of this, many are unwilling to take the risk of offering such care alone.

SUMMARY:

The Basic Health Plan statute is amended to establish the public goal of enrolling Medicaid recipients into managed health care systems to insure that they receive at least the same quality of care as they currently receive.

Physicians who treat Medicaid recipients in need of emergency obstetrical care are exempt from civil liability so long as they act in good faith and without gross negligence. 

The Department of Social and Health Services must indemnify physicians who provide obstetrical care to Medicaid recipients for negligence claims in excess of $5,000.

In 1990, employers must contribute 2 percent of $18,000 per employee into the Basic Health Plan account.  Thereafter, employers must contribute to the Basic Health Plan account an amount equal to 2 percent of average wages paid to employees in the previous year with certain adjustments.  Employers may deduct amounts expended on health care or health insurance for employees from this amount.

The Insurance Commissioner must recommend a reasonable plan for a joint underwriting authority for long term care insurance by January 1, 1990.

Appropriation:    none

Revenue:    yes

Fiscal Note:      requested