State Workers

Painful choices for state

The state, faced with the daunting prospect of taking away health insurance from 40,000 people at a time when demand is soaring, asked health care advocates for advice Wednesday.

“We don’t want to give ideas to hurt people,” said Jesus Bervis of Neighborcare Health in Seattle. “What we are doing here is trying to find a solution for an immediate problem we face.”

Bervis was at a meeting in Olympia called by the state Health Care Authority to gather comments and advice from people who work with Basic Health Plan members.

The state budget directs the Health Care Authority to trim $255 million from the taxpayer-subsidized Basic Health Plan. To do that, the agency must trim the number of people on the plan from 102,000 to about 64,000 by Jan. 1.

Rising demand makes the task even more difficult. The authority has a list of 25,000 people asking to get on the plan, up from 18,000 less than a month ago.

“The waiting list itself doesn’t make sense,” Bervis said.

“We can’t give these people any help, probably for years. Why don’t we eliminate the waiting list?”

The reason is that the Basic Health Plan is expected to remain stable at 64,000 members through 2011, said Preston Cody, assistant administrator of the plan.

That means new members can be added when current enrollees begin to drop off the plan after Jan. 1.

Shrinking a health insurance plan quickly is risky.

No one wants to cut a cancer patient off chemotherapy or tell a person who needs dialysis that he or she is losing coverage, advocates said Wednesday.

But healthier people stabilize the plan by paying in money and not ringing up much in medical expenses. If only those who really need health care are allowed to stay, costs likely will soar and even more people might be cut off the rolls.

“You get sick people, not healthy people. … It can torpedo a health plan,” said Rep. John Driscoll, D-Spokane, the executive director of Project Access, a health care advocacy group..

Concerns about being humane might need to take a back seat to cold, hard math when it comes to preserving the Basic Health Plan, he said.

“It’s a numbers game,” Driscoll said. “You have to think about a lot of technical factors where you balance each one out.”

The criteria being discussed include:

 • Implementing a lottery system in which people would be randomly selected to be removed from the plan.

 • Basing membership on when people got coverage, either eliminating the people who have been on the plan the longest or the most recent arrivals.

 • Making it more difficult to qualify. The most a person can earn and still be on the plan now is twice the federal poverty level, or about $22,000 a year for a single person. That limit could be lowered.

 • Dropping people for missing a monthly payment.

 • Reviewing people’s finances more often or more vigorously to be sure they qualify.

The Health Care Authority plans to decide on criteria for disenrolling people by June 20. The longer the state takes in reducing the rolls, the deeper they will have to be cut to save the same amount of money, officials said.

Janet Varon of Northwest Health Law Advocates asked the state to slow down.

“The staging of this set of decisions is really, really important. … Disenrollment is never going to be equitable,” she said.

Adam Wilson covers state workers and politics for The Olympian. He can be reached at 360-753-1688 or