6333-S.E AMH APP H5946.1

     By Committee on Appropriations


     Strike everything after the enacting clause and insert the following:

"NEW SECTION.  Sec. 1   The legislature finds that:
     (1) In the past two decades, Washington state has implemented legislative initiatives to improve access to quality, affordable health care in the state. These initiatives, which placed Washington in the forefront of states addressing their residents' health care needs, include:
     (a) The basic health plan providing affordable coverage to over one hundred thousand individuals and families below two hundred percent of the federal poverty level;
     (b) The "cover all children" initiative, expanding publicly funded coverage to children in families under three hundred percent of the federal poverty level and promising to cover all children by 2010;
     (c) The blue ribbon commission on health care costs and access resulting in the passage of Engrossed Second Substitute Senate Bill No. 5930, that, among other actions, directed state agencies to integrate prevention, chronic care management, and the medical home concept into state purchased health care programs;
     (d) The movement toward evidence-based health care purchasing for state health care programs, including the prescription drug program and its preferred drug list, the health technology assessment program, the use of medical evidence to evaluate medical necessity under state medical assistance programs and the direction provided in Engrossed Second Substitute Senate Bill No. 5930 relating to aligning payment with evidence-based care; and
     (e) The development of patient safety initiatives, including health care facility reporting of adverse medical events and hospital-acquired infection reporting.
     (2) Despite these initiatives, the cost of health care has continued to increase at a disproportionately high rate.
     (3) Affordability is key to accessing health care, as evidenced by the fact that more than half of the uninsured people in Washington state are in low-income families, and low-wage workers are far more likely to be uninsured than those with higher incomes. These increasing costs are placing quality care beyond the reach of a growing number of Washington citizens and contributing to health care expenditures that strain the resources of individuals, businesses, and public programs.
     (4) Efforts by public and private purchasers to control expenditures, and the stress these efforts place on the stability of the health care workforce and viability of health care facilities, threaten to reduce access to quality care for all residents of the state.
     (5) Prompt action is crucial to prevent further deterioration of the health and well-being of Washingtonians.
     (6) Addressing an issue of this importance and magnitude demands the full engagement of concerned Washingtonians in a reasoned examination of options to improve access to quality, affordable health care.

NEW SECTION.  Sec. 2   The Washington citizens' work group on health care reform is established.
     (1) On or before January 30, 2009, the governor shall appoint nine citizen members, who may include, but are not limited to, representatives from business, labor, health care providers and consumer groups, and persons with expertise in health care financing. The citizen members shall be selected from individuals recognized for their independent judgment. In addition, the majority and minority caucus in the house of representatives and the majority and minority caucus in the senate shall submit the names of two members of their caucus to the governor, who shall select one member from each caucus to participate in the work group.
     (2) Staff support for the work group shall be provided by the office of financial management. Consistent with funds appropriated specifically for this purpose, two full-time staff shall be hired to enable the work group to complete its responsibilities in a timely and effective manner.
     (3) The work group shall:
     (a) Begin its deliberations by reviewing in detail the findings and recommendations of the 2006 blue ribbon commission on health care costs and access. The work group shall review all prior relevant studies related to health care reform efforts in Washington state and consider the recent health care reform experience of other states such as Massachusetts, Wisconsin, and California;
     (b) Engage Washingtonians in a public process on improving access to quality, affordable health care, as described in subsection (4) of this section;
     (c) Review and develop recommendations to the governor and the legislature related to the health care reform proposals in section 3 of this act. In reviewing the proposals, the work group shall evaluate the extent to which each proposal:
     (i) Provides a medical home for every family;
     (ii) Provides health care that Washington families can afford;
     (iii) Promotes improved health outcomes, in part through a more efficient delivery system;
     (iv) Requires that individuals, employers, and government share in financing the proposal; and
     (v) Enables Washington families to choose their provider and health network, and have the option of retaining their current provider.
     (d) Through the activities outlined in this act, develop a careful understanding of the essential requirements for health care reform as seen by the many different primary stakeholders in Washington state.
     (4) The work group shall design the public engagement process with a goal of having structured, in-depth discussions related to:
     (a) Trends or issues that affect affordability, access, quality, and efficiency in our health care system; and
     (b) The health care proposals described in section 3 of this act, the principles guiding evaluation of the proposals, and the economic analysis of the proposals.
     The public engagement process may include, but is not limited to, public forums, invitational meetings with community leaders or other interested individuals and organizations, and web-based communication.
     (5) By November 1, 2009, the work group shall submit a final report to the public, the governor, and the legislature that includes a summary of the information received during the public engagement process, and a summary of the work group's conclusions, and recommendations related to its review of the proposals, including suggestions for the adoption of any health care proposal by the legislature. The work group may develop its own recommended proposal or proposals.
     (6) The work group may seek other funds including private contributions and in-kind donations for activities described under this section.
     This section expires December 31, 2009.

NEW SECTION.  Sec. 3   (1) Consistent with funds appropriated specifically for this purpose, the legislature shall contract with an independent consultant with expertise in health economics and actuarial science to evaluate the following health care reform proposals:
     (a) A proposal that modifies insurance regulations in Washington state to address specific groups that have lower rates of coverage, such as small employers and young adults. The proposal would authorize the offering of health plans that do not include mandated benefits, allow health plan premiums to be adjusted to reflect the health status and experience of the members of the group purchasing coverage, allow carriers to pool the health risk of young adults separately from other enrollees, and promote the use of high deductible health plans with accompanying health savings accounts;
     (b) A proposal that includes the components of health care reform legislation enacted in Massachusetts in 2006 as Chapter 58 of the Acts of 2006 - "An Act Providing Access to Affordable, Quality, Accountable Health Care." The proposal assumes the inclusion of health plan design features that encourage the use of preventive, primary care and evidence-based services;
     (c) A proposal to cover all Washingtonians with a comprehensive, standardized benefit package. An independent entity would be established to define the scope of the standardized benefit package, and to undertake a competitive procurement process to offer the package through private health carriers or health care provider networks, with an additional fee-for-service option. The standardized benefit package would be designed to include features that encourage the use of preventive, primary care and evidence-based health services. Washingtonians would purchase the standardized benefit package through the independent entity by choosing a participating carrier, network, or the fee-for-service option; and
     (d) A proposal to establish a single payer health care system, similar to the health care system in Canada in which a governmental entity contracts with and pays health care providers to deliver a defined package of health services to all Washingtonians.
     (2) In addition to the evaluation of the four proposals described in subsection (1) of this section, the consultant shall conduct a review to validate the actuarial analysis of the insurance commissioner's proposed guaranteed benefit plan prepared in 2008 at the request of the insurance commissioner.
     (3) Each evaluation shall address the impact of implementation of the proposal on:
     (a) The number of Washingtonians covered and number remaining uninsured;
     (b) The scope of coverage available to persons covered under the proposal;
     (c) The impact on affordability of health care to individuals, businesses, and government;
     (d) The redistribution of amounts currently spent by individuals, businesses, and government on health, as well as any savings;
     (e) The cost of health care as experienced throughout the state by individuals and families, employees of small and large businesses, businesses of all sizes, associations, local governments, public health districts, and by the state;
     (f) The impact on employment;
     (g) The impact on consumer choice;
     (h) Administrative efficiencies and resulting savings;
     (i) The impact on hospital charity care; and
     (j) The extent to which each proposal promotes:
     (i) Improved health outcomes;
     (ii) Prevention and early intervention;
     (iii) Chronic care management;
     (iv) Services based on empirical evidence;
     (v) Incentives to use effective and necessary services;
     (vi) Disincentives to discourage use of marginally effective or inappropriate services; and
     (vii) A medical home.
     (4) To the extent that any proposal has recent, detailed analysis available, the consultant shall review and may make use of the available analysis.
     (5) The results of the evaluation under this section shall be submitted to the governor, the health policy committees of the legislature, and the work group on or before December 15, 2008.

NEW SECTION.  Sec. 4   If specific funding for the purposes of this act, referencing this act by bill or chapter number, is not provided by June 30, 2008, in the omnibus appropriations act, this act is null and void."

     Correct the title.

--- END ---