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Health Care Policy
Monday, April 20, 2009
There Will be A Tax Package on the Ballot ... Or Maybe Not
Posted by Richard S. Davis on 4/20/2009 3:58:00 PM
Lots of stories over the weekend on the prospects of lawmakers sending a tax package to the voters. This close to the scheduled April 26 adjournment, tax and spending issues dominate. And there's a great deal of uncertainty.
I'm told the reason the tax referendum was revived from near-certain death over the weekend was that House Speaker Frank Chopp
has some members of his Democratic caucus who absolutely refuse to vote
for a budget with $4 billion in spending cuts -- unless there is a tax
proposition on the ballot, too.
We'll find out more tomorrow. That when the tax vote coalition
members say whether they are in or out. The campaign really needs two
components: It's gotta have the Service Employees International Union,
which represents homecare workers and nurses, to provide the foot
soldiers for doorbelling. And it needs the hospitals and nursing homes
to pony up the money.
The Everett Herald takes an unusually sharp tone in its Sunday editorial warning lawmakers: " Don't blackmail the voters." They take Rep. Eric Pettigrew to task for saying "people will die" if voters don't approve new taxes.
Yes, the recession has hit the state budget
hard. But before asking taxpayers for more, lawmakers need to do a
better job prioritizing existing dollars. Why not, for example, ask
state employees to share a greater portion of their health-benefit
costs? They're getting a significantly better deal than most
private-sector workers -- the very people who would be asked to pay
more in sales taxes.
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Monday, March 02, 2009
A Constitutional Right to Health Care?
Posted by Richard Davis on 3/2/2009 3:19:00 PM
Adam Wilson reports in the Olympian that House Speaker Frank Chopp is backing a constitutional amendment making health care for children a constitutional right. Speaker of the House Frank Chopp said Friday that he wants coverage for children to become part of the state's fundamental obligation to children, like basic education. "Sometimes it will look like we're pitting education for our kids versus health care for our kids. We have a historic opportunity to mingle those together, to move both groups forward," Chopp told a crowd of 150 during a children's services rally Friday at the Capitol. It's true, health care and education are the two largest shares of state spending. In recent years, as this WashACE brief points out, Health-related expenditures accounted for more than one-third of state general spending in the 2005?07 biennium, an increase of nearly 8 percentage points from their share of spending in 1997?99. Over the period, the growth in healthcare costs squeezed other spending priorities. Looking to the future, as health-related expenditures represent an ever-increasing share of overall spending, the squeeze their growth places on other priorities will become more severe
I've not seen any detail on the plan Wilson reports, but we know that the constitutional requirement making basic education the paramount duty of the state has spurred lots of costly litigation.
Think it'd be any different with health care? This TNT editorial on national health care reform points out the problem: Universal access to quality care cannot happen if costs aren?t controlled. Cost and access are the same problem. And costs are least likely to be controlled when a generous Congress pretends to offer patients something for nothing.
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Thursday, December 18, 2008
Early Reactions to Governor's Budget
Posted by Richard Davis on 12/18/2008 2:09:00 PM
As she predicted, reactions to the governor's budget have been swift. While the scramble to understand the details will take us all a while, the broad brush strokes are enough to frame the likely debate. As we posted earlier today, Sen. Joe Zarelli likes the approach Gregoire has taken, saying it puts the process on the proper course. Zarelli is ranking Republican on the Senate Ways and Means Committee. His counterpart in the House, Rep. Gary Alexander, also likes the direction. I commend the governor for putting forth a balanced budget that does not raise taxes or fees. House Republicans have long believed that increasing taxes or fees is not the right approach while families are struggling with everyday expenses and workers are losing jobs. While there are certainly some details of her plan that we might do differently, the governor has offered a good first step in correcting the past four years of overspending.
Alexander and Zarelli both emphasize the importance of building early savings into the 2009 supplemental budget.
AWB president Don Brunell issued a brief statement.Noting that AWB continues to review the budget proposal, Brunell emphasizes the groups support for her decision not to raise taxes on families and employers. He adds: It is critical that Washington state look beyond the current budget woes and prepare for what happens after we emerge from this recession. Part of that discussion must include creating the conditions for a healthy business environment so that when we do emerge from the recession, Washington is positioned as a good place to create those jobs. As devastating as the economic conditions may be, the recession is an opportunity to reshape the way government operates and position our state to attract and retain businesses.
The largest union representing state workers call Gregoire's plan dead on arrival. They say that approvingly, looking for legislative support for tax hikes.
?Our biggest concern is that everything should be on the table and that includes tax loopholes and revenue enhancements, Federation Executive Director Greg Devereux said. ?If the economic parts of our negotiated contracts that were ratified two months ago can be suspended, why can?t a campaign pledge on no revenue increases be retracted?
Senate Majority Leader Lisa Brown has reservations as well. She calls reliance on $1 billion in federal assistance a "glaring flaw" and, pointedly, does not pledge to resist tax hikes. Brad Shannon notes her concern in his Olympian story, which includes Alexander's assessment that the estimated federal money is a "reasonable assumption." Today's Wall Street Journal story on the Obama stimulus plan adds weight to the Gregoire/Alexander position.
The broad parameters of the package are known already. It will include a tax cut designed to pump $50 billion to $100 billion into the economy almost immediately; about $100 billion in aid to state governments, primarily to temporarily assume more of the cost of Medicaid, in hopes of staving off benefit cuts or tax increases; and funding in five main areas: traditional infrastructure, school construction, energy efficiency, broadband access and health-information technology.
Finally, both the Evergreen Freedom Foundation and the Washington Policy Center have posted first impression comments on the new budget.
Update University of Washington president Mark Emmert says the proposed budget would "seriously harm" the UW.
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Monday, October 20, 2008
Hawaii Abandons Experiment with Universal Health Care for Children
Posted by Richard Davis on 10/20/2008 7:35:00 AM
The State Policy Blog reports briefly on Hawaii's decision to end its effort to provide universal health care for children in the state. It cost too much and led people to leave private carriers and take the public subsidy. As state budgets get pinched by declining revenue growth, look for more states to dig into the understated costs of unsustainable promises. Also on State Policy, John R. Graham provides some context for understanding Hawaii's health care experiments.
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Wednesday, September 03, 2008
Massachusetts Math: Paying Too Much for Health Care Plan
Posted by Richard Davis on 9/3/2008 4:58:00 PM
The blown cost estimates for the still-struggling Massachusetts health care reform are common knowledge. But last week the New York Times ran an editorial touting the plan's success in reducing the number of uninsured in the state. The State Policy Blog takes a look behind the numbers, though, and finds the touted success comes with a hefty price tag. ... even the figures reported in the editorial lead to the conclusion that this is a massively expensive experiment with miniscule results. The editorial reports that hospitals' uncompensated care dropped from $166 million in the first quarter of 2007 down to $98 million in the first quarter of 2008. That's $68 million, or $272 million a year. The state budget for the program is going to be $869 million this fiscal year. $272 million in savings for $869 million of costs: that's $3.19 of taxpayers' dollars spent for every dollar of uncompensated care avoided.
Just one of the reasons Massachusetts is among the states facing large budget deficits this year. And if a proposed income tax repeal is approved by the voters in November, Bay State politics could get exciting quickly. In 2002, a similar measure garnered 45 percent of the vote. Astonishing. Add Maryland and Illinois to the roll call of states in dire fiscal straits. We're not far behind, with a $2.7 billion shortfall projected last June. With a new revenue forecast due in a few weeks and revenue collections running below projections, the state deficit seems poised to deepen. And while the Seattle Times reports that economists say a Boeing strike would have "minimal impact" on the economy, I'm sure no one wants to put the premise to a test. Ask your candidates how they're going to address the shortfall without adding to business costs, taking money from consumers' pockets, and further dampening economic growth.
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Tuesday, August 26, 2008
Second Thoughts in NY (family leave) and Wisconsin (health care)
Posted by Richard Davis on 8/26/2008 5:07:00 PM
At Olympia Business Watch Don Brunell takes note of the New York legislature's adjournment without passing paid family leave. It was a matter of dollars and sense. There were many versions of the paid leave circulating around Albany. They were all very costly. Here is a sample of the proposals: - One would impose 12 weeks of disability insurance benefits for family leave on ALL businesses for employees of newborns, families adopting children and caregivers of sick parents, spouses and children.
- Another would provide 13 weeks of leave and would have increased the maximum disability benefit from $170 to $550 per week by 2010 and would have permanently indexed the benefit to one-half of the state's average monthly wage.
As for the proposal to pay for it. Workers would have to pay a mandatory 45 cents per week payroll tax...
In Wisconsin, support for the so-called "Healthy Wisconsin" program proposed last legislative session also seems to be waning. The State Policy Blog reports candidates are in "full retreat" on the pricey "universal health care" plan. Dollars and sense again. The blog links to this story in the Wisconsin State Journal. "The issue is money and right now, not many legislative candidates are talking about big, broad programs simply because we all understand that practically speaking, there's no money," said Jim Holperin, a new Democratic Senate candidate who praised the Healthy Wisconsin plan but said his focus was on reviving the economy.
Few would deny the importance of improving health care access and affordability, or for helping employees work through difficult times, but the lessons being learned in Wisconsin and New York (they're not the only places) should be heeded here.
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Wednesday, August 20, 2008
Canadian Physician Pans Canadian Health Care System
Posted by Richard Davis on 8/20/2008 3:56:00 PM
The incoming head of the Canadian Medical Association, no less, has some pretty harsh words to describe the Canadian health care system. (h/t State Policy Blog) The Canadian Press reports on his inaugural address to the association. He says a private system can help where the public system is "overburdened." He cited a host of statistics to back his case: Canadian health-care costs have quadrupled in the last 20 years; the country's doctor-to-patient ratio has plummeted; by 2011, the number of Canadians over 80 will have jumped by 43 per cent. Ouellet called the overall state of Canadian health care "alarming." "We have one of the most costly and least efficient health systems of any industrialized country," he said.
Looks like that's one model we needn't emulate.
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Thursday, August 14, 2008
Massachusetts' Health Care "Reform" Hammers Business
Posted by Richard Davis on 8/14/2008 10:00:00 AM
Over at Olympia Business Watch, Don Brunell reports businesses in Massachusetts are joining a national effort to combat rising health care costs. For more on how Bay State employers are responding - and lessons for other states considering similar health care reform - check out this short National Center for Policy Analysis digest. And the State Policy Blog has a good assessment of how, under the current law, Massachusetts businesses just can't win.
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Tuesday, July 29, 2008
The Healthcare Spending Squeeze
Posted by Richard Davis on 7/29/2008 6:22:00 PM
In a new WashACE Competitiveness Brief, we take an in-depth look at health care spending in the state budget. The Healthcare Spending Squeeze , prepared by the Washington Research Council, examines the effect of rapid growth in health care spending on the state budget, noting that from 1997-99 through 2005-2007, health-related spending grew by 85.5 percent, compared with a 30.1 percent growth in non-health-related spending. Health care spending in the 2005-07 biennium amounted to one-third of all Near General Fund Spending, up 7.6 percentage points over the 1997-99 biennium. Rising health care costs squeeze virtually all other state priorities and drive up the operating cost of state government. The brief also looks at the costs of state employee health care benefits, a growing share of compensation and extraordinarily generous when compared with the private sector. Controlling health-related spending will play a critical role in overall budget discipline, with clear and direct implications for our state's economic competitiveness. A second brief to be released in December will examine various health care "reform" proposals to be considered by lawmakers next year.
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Wednesday, July 23, 2008
Olympian on Kreidler's Full Coverage Health Plan
Posted by Kris Tefft on 7/23/2008 6:01:00 PM
"Commissioner's catastrophic insurance proposal merits debate" You'll have to read the editorial to discover what the Olympian thinks is the catastrophe -- the insurance, or the proposal.
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Friday, July 18, 2008
Health Care Disconnects
Posted by Richard Davis on 7/18/2008 3:49:00 PM
An interesting post by Gracie-Marie Turner on the State Policy Network blog. She links to this review of polling data by Karlyn Bowman. Here's a bit of Turner's thumbnail summary: 77% of Americans are satisfied with the quality of their own healthcare, but only 38% say they are satisfied with the country's healthcare. 48% would prefer to maintain the current system based mostly on private health insurance while 41% would replace the current system with a new government-run healthcare system.
It reminded me of these results from a survey Bob Moore and Tim Hibbitts did for AWB in March, 2007. ... 94 percent of voters are covered by health insurance and most of them (87 percent) are satisfied with their coverage. A lot of people in the state get good coverage through plans offered by associations and other member-governed groups. Yet, many voters (70 percent) do not believe that most people in the state have adequate health insurance coverage.
There are legitimate reasons to be concerned about America's health care system. And we all know them. But it's important to remember that for most of us, most of the time, the system works remarkably well. If nothing else, that should alert would-be reformers to be both humble and cautious. There's a great deal at risk. MORE Pat Muir writes in the Yakima Herald-Republic of another of the "Healthy Washington" forums. Again, People's highest health care priority is making sure everyone is covered.
How to get there? Well, that's for later.
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Thursday, July 17, 2008
Health Care Updates
Posted by Richard Davis on 7/17/2008 3:24:00 PM
The requirement that all residents of Massachusetts have health insurance has run into problems. A lot of people choose not to buy the policies, possibly because they cannot afford them. The Boston Globe reports that the agency overseeing the "Connector" regulating the state's vaunted health care reform will be setting aside a chunk of money for appeals. (h/t State Policy Network) The Commonwealth Health Insurance Connector Authority set aside $3.3 million - nearly 10 percent of its $39 million fiscal 2009 budget, which it finalized yesterday - for the 8,000 appeals the board expects to process. In the year that ended June 30, there were an estimated 2,000 to 2,500 appeals, the board said.
One reason for the increase in appeals: The penalty for not having coverage has bumped from $219 to $912. Oh, and this will make it better. Also, the board is considering regulations that would set a minimum standard for what kind of coverage individuals must buy, and members said that probably would also raise the price of coverage.
No wonder Grace-Marie Turner writes that "states should exercise caution before following Massachusetts." Read AWB president Don Brunell's thoughts on Maine's health care fiasco here.
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Wednesday, July 09, 2008
More on the Cigarette Tax, Health Care, and ...
Posted by Richard Davis on 7/9/2008 5:39:00 PM
Earlier today we noted Massachusetts's desperate resort to cigarette taxes to help pay for their budget-busting health care reform. One problem they face might be the high cost of state health care mandates. We've commented on these costs before, as in this competitiveness brief. We have another recent example in our state. The Health Services Account, which funds the Basic Health Plan here, is projected to be short by about $434 million at the end of the 2009-2011 biennium. What's it mean when it's short? That's money that's likely to be backfilled from the general fund, a common pattern in recent years. So much for the cigarette tax paying for health care.
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