Thursday Q&A: Sens. Karen Keiser and Linda Evans Parlette on health care reform

For today’s Q&A, I spoke with Sen. Karen Keiser, a Democrat who has worked in healthcare, and Sen. Linda Evans Parlette, a Republican and pharmacist. I asked both of them about efforts at the state and federal level to reform healthcare — and what else they’re working on. Read the entire interviews below — as usual, posted in the order in which they were conducted.

Sen. Karen Keiser:
Q: Health care reform at the federal level is moving fast. Can you give your perspective on what’s going on?
Keiser: Well it’s the legislative sausage-making season in Congress on healthcare reform. It’s always harder at the moment before breakthrough and I think that’s where we’re at. So I’ve been back to D.C. several times this year. I’m hoping this week’s trip was my last because I really need to turn attention to the Legislative session now. It’s a roller coaster. One day things seem to be coming together and the next they fall apart. I’m hopeful that they will get to yes by the end of the year.
I can’t tell you exactly what’s in and what’s out. I will say this: This is a very big piece of legislation not just in pages but in breadth of topics and it goes from accountable care organizations, which is a new way of providing for payment reform, to workforce training. From A to W, though I can’t find a Z. It’ s a very broad breadth. At least 85 percent of the bill is agreed to, so a lot has been agreed to, a lot would be a tremendous improvement in what we’re doing now. But there are some tough issues and the tough issues could derail or even wreck the whole deal. I’m hoping the tough issues get resolved.

Q: What have you worked on at the national or state level to cut healthcare costs or increase access?
Keiser: In the last session of the state Legislature, we had a disastrous budget. We had to make tremendous cuts in many important he care programs, including Basic Health and other key programs. I could see that the budget wasn’t going to be any better in 2010, because we were making such deep cuts there would be more damage done in 2010 unless we had a change in the system of healthcare. So I decided at the end of the session that the only hope we had as a state for our people, their healthcare and the state’s budget was to do what I could to make healthcare reform a reality.
I started on my own reaching out to our state’s Congressional delegation. I made a few connections and started working with the White House through their Intergovernmental Affairs Department. It’s much more active and open than in previous administrations. They’re really interested in working with the states as partners. We were able I think to establish some good communications back in May.
Then I’ve been back to D.C. six times in the last few months. We do weekly conference calls as well. I think I was one of the first to get started but what we did was organize — we tend to do that — a group of state legislators. We’re called the White House workgroup and there are about 35 of us. We’ve been making our treks to our various delegations’ offices as well as to leadership. We’ve met with Nancy Pelosi’s office, Harry Reid’s office, the White House.
One thing we do is to tell and encourage our Congressional representatives to do no harm to the states, especially those that have already done pretty well in terms of healthcare programs. Sometimes there’s a kind of one-size-fits all approach that would cause our programs to go backwards. We don’t want to go there.
So that was one of the key messages. The other key message is to make sure that the states who are facing budget crises – all 48 states — have a bridge to the future. If most of this healthcare reform doesn’t implement until 2013, we have a few years of interim where we need a bridge to get there, rather than dismantling the Basic Health plan, then rebuilding t in 2013, we should figure out a way to maintain it.
That’s a second very key message is how to figure out a way to maintain state healthcare.
Third is how to make this new approach more affordable. What kind of changes can the states offer, and can we work with the federal government on, to make this work. I shared many of the Washington state initiatives which have been real ground breakers.
Last year, we passed an administration simplification bill, which is a wonky effort but an important one to reduce costs. Currently 30 to 40 cents of every dollar in small group and individual health insurance is wasted on bureaucracy and paperwork. And we need to capture at least half of that back instead of more duplication of forms and credentialing and pre-authorization and other bureaucratic processes. We’ve shared our success for that. We shared that with our Congressional representatives and both Sen. Maria Cantwell and Congressman Jay Inslee have adopted a lot of the language.
It’s a roller coaster.

Q: What do you consider crucial elements of healthcare reform?
Keiser: Where we really have to get to agreement is if we’re going to have an individual mandate, which is pretty much the quid-pro-quo for eliminating the pre-exisitng condition – then how can we create a system of insurance that doesn’t create captive customers for out-of-control private insurance plans? There’s a couple of ways of doing it. One way would be a real public option, but that seems to be off the table. Another is to give people the option to buy into Medicare. Again, that appears to be off the table.
One other way would be to look at the system in a country I’m familiar with: Germany. They have a mostly private insurance but it treats the insurance kind of like a utility – it’s highly regulated with a lot of oversight. If we’re going to give captive customers to insurance companies, then those companies should be treated like a utility. We really have, with the requirement of the individual mandate. And we haven’t got any ability to affect the marketplace with competition. We’re delivering it, and most states have one or many two big providers of insurance. So it’s really important, it’s actually incumbent that we have more accountability, more oversight more transparency.

Q: What else are you working on?
Keiser: I’m pretty much obsessed with healthcare. We’re also trying to find other ways for federal funding, beyond health reform legislation, to help our state through the recession. So we’re looking for additional federal funds for children’s healthcare, for Basic Health plan and so forth. So that health reform isn’t the only thing I’m obsessed with, I’m also obsessed with finding some ways to support our existing plans.

I represent the Kent Valley, which is inundated with threat from the Green River and the Howard Hanson Dam. One of the sad outcomes of this is that surplus lines of insurance – property and casualty insurance – have pulled out of coverage for most of the big business and manufacturers for the Kent Valley. So they’re sitting there with millions of investments and no way to insure it. The federal government provides minimum insurance of $1 million. But for some companies that’s one machine. So we have got to come up with a way to get protection over the next three or four years as they repair the dam.
I’m working with Rep. Tina Orwall to get a joint underwriting authority through the Office of Insurance Commissioner. That’s a very important piece not only for our district, but for our economy. The Kent Valley is the second largest distribution site and center on the West Coast. It produces billions of dollars of goods. And it cannot be shut down by flooding.

Sen. Linda Evans Parlette:
Q: Health care reform at the federal level is moving fast. Can you give your perspective on what’s going on?
Parlette: Can you explain the current state of federal healthcare reform for people who don’t follow it closely?
Regarding the federal level healthcare debate, there are constant changes — daily. And I believe that’s occurring in order for the Democrats to get the 60 votes that they need for passage off the floor of the Senate whether it’s good policy or not.
And I personally believe it’s beyond the point of being good policy. The initial reason to have this healthcare debate was to figure out a way to increase access and to decrease costs. And although they may increase access, every report you read, including the Congressional Budget Office’s, says that so far what is written on paper will only increase costs and put us further into debt as a nation.
Also, since this is one-fifth or one-sixth of the gross national product, the ultimate goal should be to do no harm. And as a nation, we can’t afford to experiment and get this wrong. And anytime you only have one side of the aisle voting for a major policy decision, something’s wrong with the bill. That’s happened in Washington state before also.
I wish our Congressional delegation would profit from the mistakes that Washington state has already been through.

Q: What have you worked on at the national or state level to cut healthcare costs or increase access?
Parlette: I served four years in the House. My second term in the house, 1999-2000, when we had the 49-49 tie (between Republicans and Democrats), I was the Republican chair of the House Healthcare Committee and served with Rep. Eileen Cody, the Democrat chair. We passed in 2000 two reform bills. One was a patient Bill of Rights and another was a reform of the individual insurance market. Because the reforms that occurred in 1993 and 1995 caused, by the time 1999 came around, the insurance companies to refuse to provide individual health insurance policies. They said they refused to sell them because they were losing so much money because of the components of the bills that passed in 1993 and 1995. So the four healthcare chairs sat down with the three CEOs of the insurance companies in the state, in addition to Gov. Gary Locke. We had about 17 meetings in his office and came out with bills that were passed.
In the Senate, I served on the Blue Ribbon Healthcare Commission and we passed a bill with almost 100 percent total support out of the Senate as a result of that Blue Ribbon Healthcare Commission. But, after the changes made in the House, it turned out to be a partisan bill.
Two specific areas I have worked on are a bill to allow Health Savings Accounts to be allowed for state employees. If you are a state employee, you cannot purchase a Health Savings Account – you can purchase a Flexible Spending Account, which is not portable. (HSAs) are portable and any money you don’t spend, you can take to your next job. That bill passed but has never been implemented.
On the Blue Ribbon Commission, we learned that 51 percent of the uninsured are between 19 and 34. So for three years in a row I have tried to pass legislation that would give those young adults affordable options, similar to what 10 other states have. And the majority party has refused to consider those bills. This year, they refused to have a hearing on it.

Q: Will you introduce that bill for a fourth year?
I’m going to wait and see. It is very frustrating to try to put forth what many consider to be good policy and to be denied the option of having a hearing or allowing the bill to come forward.

Q: What do you consider crucial elements of healthcare reform?
Parlette: Number one, healthcare is not free and I believe in co-insurance rather than copays. So you as an individual have to make a decision when you are purchasing healthcare. In other words, when you only pay a $5 copay or a $10 copay, there’s no incentive to make educated decisions as to when you see a physician or a healthcare provider. But if you have to pay a percentage of the cost, then you automatically know it’s best not to go to an emergency room, which normally is more expensive than going to see a physician.
However, I believe the most important thing is transparency – so that an individual, when they have to go see a physician or nurse practitioner or other provider, knows what the cost of that appointment is going to be up front. Americans are born shoppers and there’s no reason we can’t become educated to become better shoppers when we purchase healthcare.
Also, we need to change the incentives so that providers who provide good service get rewarded in their reimbursements.
As a pharmacist, I see a huge abuse in prescription drugs. You address that in several ways. If they’re on Labor & Industry or Medicaid or a state or federal program, you make sure whatever it is – pain management or whatever – that they are limited to one physician and one pharmacy so the state can pay attention. The reason it can only be one physician is many times, if the individual knows they’ve maxed out the quantity of painkillers from one physician, then they’ll get somebody else to write a prescription and they pay cash so it doesn’t get reported.

Q: What else are you working on?
Parlette: I’m working on property tax issues. That is huge in my district. I represent four counties – it’s the second largest geographic district. Last year, I worked on the intermediate drivers license. That bill needs some more work. I often do a lot of natural resource issues. I’m also on the Ways & Means Committee, so I work on the budget.

Q: Can you tell me how that process is working right now?
So far, I think we’re just going to have to wait until the session starts. As Senate Republicans, we had hoped to make some decisions and get them passed during Assembly Days. The sooner you stop spending, the sooner you stop the extra costs. But the Governor and the majority party chose not to.
Fifty-six percent of the Operating Budget in 2009 is one-time money, so not only is it going to be a difficult session in 2010, it’s going to be just as bad — maybe worse — in 2011 when we do another biennial budget. We really have to start talking about restructuring government and putting out a budget that is truly sustainable.

Tags: healthcare reform, Sen. Evans Parlette, Sen. Keiser