How Inslee plans to pay for and operate Cascade Care

Governor Jay Inslee announced this week that he and other officials will be pushing for a new public option in Washington state. They call it Cascade Care, and it attempts to fight back against attacks on the Affordable Care Act occurring at a national level.

“This is building off the Affordable Care Act, and improving the situation that Congress and the president have put at risk for many Washingtonians,” said Jason McGill, Governor Inslee’s senior policy advisor for health care.

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There is only one option for health care in some parts of the state, which has made it difficult for many to obtain coverage.

“Two problems here particularly, one is affordability and one is stability on the individual market here in Washington,” McGill said. “We have 14 counties that have only one plan offered today. And so they are at risk of offering potentially no plan.

“And affordability,” he said. “The individual market is inherently risky. In addition to that, the federal changes starting back with President Trump’s decision to eliminate the (cost subsidies) on the exchange have really increased the price. And of course, the individual mandate (being removed) and numerous other policy changes that have not helped the situation.”

How will they pay for Cascade Care?

McGill said that, currently, officials are not asking for any further subsidies from the state Legislature to pay for Cascade Care, but they are looking into it.

“A few other states have done that, and that has helped in terms of insuring more people,” McGill said.

He added that they are studying options for more subsidies from the Legislature, especially as it relates to low-income and working families.

“That may be necessary to really get universal health care in the state,” McGill said.

To get Cascade Care up and running – not to subsidize any plans – it will cost $500,000. That will cover set up, design, and contracting.

People would still pay their premium — which officials hope will be lower — and get a tax credit subsidy through the Affordable Care Act. McGill notes that, by law, no more than 10 percent of what a person earns can be spent on health care – they want to “improve on that.” State officials plan to use the health care products the state currently has, with a few policy changes to keep costs down.

Policy changes

McGill says the governor’s office thinks it can accomplish the aims of Cascade Care by doing three targeted policy changes:

• State backing: Leveraging the state’s purchasing power. The state already insures people through its public employee program – that work can be leveraged to help Cascade Care.
• Standardizing the plans so it’s easier for consumers to use them, which will lower out of pocket costs. For example, the bronze, silver, and gold plans under Obamacare will remain in effect and will be come standardized.
• Capping rates: Having an upper limit to keep rates and costs down. The governor’s office is proposing Medicare rates for this.

McGill says that third policy – capping rates – is the most significant part of the public option. That would make Cascade Care pretty close to “Medicare for all” proposals that have been called for nationally, but at a state level.

McGill said that people who would most likely take advantage of the state’s public option live in rural counties where options are already limited.

“They would see this as perhaps more affordable, they would hopefully see the rates lower, they might like the standardized plan which is clear… and it gives them an additional choice,” he said.

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