Health care changes are starting to take shape in Washington's capital with almost one-third of the legislative session left to run.
The state House has approved one major bill that could lead to a public-private "partnership" or insurance exchange that lets small businesses, workers and the state pool resources on insurance plans in 2009.
The Senate had also approved a major overhaul measure that would address 16
different recommendations from last year's Blue Ribbon Task Force on Health Care Access and Costs.
The Senate also approved a flat-fee plan letting individuals pay doctors for limited coverage that is outside the insurance arena.
Together, the measures are raising hopes across both sides of the Democratic-Republican divide that some kind of real reform is in reach.
"The pieces are jelling. I've never seen this kind of willingness - the 'let's just try,' " Sen. Karen Keiser, D-Kent, said Saturday of the new attitude that has risen up this year.
"There's a lot of energy on this."
"We're a long way from the end, but the fact we got a bill as significant as (SB) 5930 out of the Senate this early in the session is very significant," said Republican Sen. Linda Evans Parlette of Wenatchee.
Parlette has other ideas in the mix that have not gone anywhere, but she's still trying, and considers the session far from over. One would offer insurers more options for coverage plans that target young adults in the 19-34 age group, because that age band represents just more than half of the state's 593,000 uninsured, Parlette said.
In the House
The same kind of optimism can be heard in the House, where House Bill 1569 won approval on a 53-44 vote on Saturday afternoon. Republican Rep. Bill Hinkle of Cle Elum had worked across the aisle with Democratic Rep. Eileen Cody of West Seattle on the connector or insurance exchange concept - and both sides altered their stances during more than a month of negotiations.
"It is bold," Cody said of the joint proposal. "It is a compromise."
Hinkle said the concept is to let any insurer sell a small-group plan through the "partnership" but only four plans could win favored designations allowing a state subsidy for the workers. More Republicans would have voted for it, Hinkle said, if the Democrats had accepted amendments to allow even more of a free-market approach than HB 1569 now embodies.
Cody said some of the Republicans' ideas would have weakened the connector, shifting the sickest patients into the new partnership - thus driving up costs in the new program.
But at the same time, her concept is running into resistance with members of her own caucus. Eleven Democrats voted against the connector or exchange, while two Republicans crossed over in support.
Cody said she was not surprised by the defections, and she expects lawmakers to now take the next major step of comparing the two Senate and House reform concepts. The ideas could eventually land in one bill, she said.
"What it's going to look like, I don't know. But yes, all of these elements will be in there," she predicted.
Some Democrats like Majority Leader Lynn Kessler of Hoquiam are worried by the so-called connector or partnership, which mirrors an unproven effort in Massachusetts. Kessler said she is afraid it could drive up costs for employers like her husband's law firm, which pays 100 percent of its employees' health, dental and vision insurance premiums.
Even with those disagreements, change is in the air on health care. And unlike past years when the legislature locked into ideological positions, lawmakers are still talking.
"This is less of an ideological debate than it's been since I got here," Hinkle said, expressing hope that some kind of significant legislation will pass this year.
In what might be the most telling sign that things are changing, the National Federation of Independent Business is expressing optimism that lawmakers will pass a law that makes the state's health-insurance situation better.
Carolyn Logue, director of NFIB's Washington chapter, said the governor's bill, which Keiser sponsored, is the reason for optimism, especially now that Republican amendments were added to allow flexibility for small-group insurers.
"It's the best health-care reform business has seen in probably 20 years," Logue said. "I'd be surprised if the House kills it. We've known for some time that people want to do a mix of things."
By contrast, Logue said the "partnership" or "connector" bill from Cody and Hinkle is the wrong approach. She said she favors the governor's approach in the Senate bill, because it calls for a study of the connector concept before the state moves down that road.
In the end, Gov. Gregoire wields considerable clout over the end product. But she has not weighed in on some of the changes made to her omnibus bill. One, for instance, lets insurance companies offer a small-group plan to consumers that is not bound by the state's list of almost 50 mandates - everything from maternity care to chiropractor care and acupuncture.
Jonathan Seib, health care policy adviser to Gregoire, said the governor welcomes the movement of legislation by each chamber and plans to take a closer look at the ideas the two houses have put on the table. House Bill 1569 passed the House on a 53-44 vote Saturday. Eleven Democrats crossed over to join Republicans in opposition, while two Republicans joined the majority Democrats in favor.
* South Sound lawmakers voting for the measure included Democratic Reps. Sam Hunt, Olympia, Brendan Williams, Olympia, and Kathy Haigh, Shelton, and Republican Tom Campbell, Roy. Those against included Democratic Rep. William Eickmeyer, Belfair, and Republican Reps. Gary Alexander, Thurston County, Richard DeBolt, Chehalis, and Jim McCune, Graham.
* HB 1569 creates a "partnership" agency in the private sector that would serve as the "connector" between small-business employees and insurers starting in 2009. Employers would contribute a portion of insurance costs to the intermediary, and the state could contribute a subsidy to help low-income employees. The state-run Basic Health Plan and state workers ultimately would be moved into the partnership program.
Senate Bill 5930 passed the Senate on a 48-0 vote Friday. Sen. Jerome Delvin, R-Richland, was excused. The measure is a compendium of several bills including Gov. Chris Gregoire's sweeping Blue Ribbon Commission reform package. It includes several pieces to:
* Create a reinsurance program to backstop insurers.
* Reward health care treatments that get results.
* Put a focus on patients with chronic problems.
* Create a consumer-centric medical records pilot program.
* Reduce unnecessary emergency room usage.
* Reduce health care administrative costs.
* Require insurers to extend coverage to unmarried dependents up to age 25.
* Sets up a board to study an insurance connector.
* Lets insurance carriers in the small-group arena offer a product free of coverage mandates.
Also passing was a measure, SB 5958, that lets individuals hire doctors on a flat-fee basis, outside of insurance policies, for limited care options.