6333-S.E AMH HCW H5812.1

     By Committee on Health Care & Wellness


     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. The work group shall engage Washingtonians in a public process on improving access to quality, affordable health care, and review and develop recommendations to the governor and the legislature related to the health care reform proposals in section 3 of this act.
     (1) 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) Consistent with funds appropriated specifically for this purpose, the work group may employ up to two full-time staff to enable the work group to complete its responsibilities in a timely and effective manner.
     (3) 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 shall begin when the work group receives the results of the evaluation of health care proposals under section 3 of this act. The 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.
     (4) 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 proposal or proposals.
     (5) In reviewing the proposals, the work group shall evaluate the extent to which each proposal:
     (a) Provides a medical home for every family;
     (b) Provides health care that Washington families can afford;
     (c) Promotes improved health outcomes, in part through a more efficient delivery system;
     (d) Requires that individuals, employers, and government share in financing the proposal; and
     (e) Enables Washington families to choose their provider and health network, and have the option of retaining their current provider.
     (6) The work group may seek other funds including private contributions and in-kind donations for activities described under subsection (3) of 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, similar to Proposed Second Substitute Senate Bill No. 5789 (2008), proposing modifications to insurance regulations to address specific groups that have lower rates of coverage, such as small employers and young adults;
     (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";
     (c) A proposal, as described in Senate Bill No. 6221 (2008), to cover all Washingtonians with a comprehensive, standardized benefit package purchased through a competitive procurement process or a fee-for-service option, funded through a payroll assessment applied to employers and employees; and
     (d) A proposal to establish a single payer health care system, similar to an approach described in Senate Bill No. 5756 (2007) and to the health care system in Canada.
     (2) In addition to the evaluation of the three proposals described in subsection (1) of this section, the consultant shall conduct a review to validate the actuarial analysis of the insurance commissioner's guaranteed benefit plan, as described in Senate Bill No. 6603 (2008). The consultant group may seek additional information from sponsors of the proposals described in this section.
     (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 impact on employment;
     (f) The impact on consumer choice;
     (g) Administrative efficiencies and resulting savings;
     (h) The impact on hospital charity care;
     (i) 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 networks, and by the state; 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.

EFFECT:  The Governor will appoint a 13-member citizens' work group on health care reform, including 9 citizens and 4 legislators. The work group may hire up to two staff. The work group will engage in a public engagement process when the work group receives the results of the evaluation of health care proposals by December 15, 2008. The work group will submit a final report by November 2009. The Legislature will contract for an evaluation of three health care reform proposals. The evaluation of the health care reform proposals will be submitted to the governor, legislature, and work group by December 15, 2008.

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