FINAL BILL REPORT

SHB 99

                                  C 431 L 87

BYHouse Committee on Health Care (originally sponsored by Representatives Niemi, Cantwell, Vekich, Braddock, Fisch and Brekke)

Creating the Washington state health insurance pool.

House Committe on Health Care

Senate Committee on Financial Institutions

SYNOPSIS AS ENACTED

BACKGROUND:

In the state of Washington, approximately 720,000 persons under the age of 65 do not have health insurance.  Three hundred and ten thousand of that number have income in excess of 200 percent of the federal poverty level.  Of these, as many as 30,000 people do not have coverage because of denial for poor health or because available coverage is very expensive with restrictive exclusions for existing conditions.

The Washington Health Care Project Commission, in its report outlining recommendations for a basic health plan, recognized the need for "the creation of an insurance pool for the medically uninsurable with incomes over 200 percent of the poverty level."

SUMMARY:

A non-profit comprehensive health insurance pool is created that includes all health insurers, health care service contractors, and health maintenance organizations that do business in the state.  Provisions are made to include self-funded programs in the pool, if permitted by federal law.

A board is created to develop a high risk insurance plan and submit it to the insurance commissioner for review and approval.  The board will select a plan administrator through a competitive bid process.

Persons eligible for coverage under the high risk insurance plan include state residents who have been rejected for coverage or who have had related problems obtaining coverage within a six-month period prior to application.

The package of benefits must be comprehensive, including in-patient and out-patient care, drugs, nursing home care and other services.

The plan must have:  (1) two deductible options of $500 and $1,000 with related caps on out-of-pocket expenses; (2) coinsurance of 20 percent of benefits provided; (3) maximum coverage of $500,000; and (4) premiums set at 150 percent of the standard group rate set for groups up to 10 persons.

Limitations, exceptions and reductions are permitted, but only if they are similar to general health insurance coverage, do not exclude specific diseases, and are approved by the insurance commissioner.

The cost of providing care beyond premiums, deductibles, and co-payments collected will be assessed among pool members on a per capita basis.

Premiums of the pool are exempt from premium taxes.  Certain deductions of assessment from business and occupation taxes are allowed.

VOTES ON FINAL PASSAGE:

      House 96   0

      Senate    45     4 (Senate amended)

      House 97   0 (House concurred)

EFFECTIVE:May 18, 1987