This editorial was published by the News Tribune of Tacoma.


Movers and shakers of American health care are watching Washington, the first state to enter the individual insurance market with a public option to compete against the private marketplace. Or at least a quasi-public option.

Democratic presidential candidates Bernie Sanders and Elizabeth Warren might want to press the pause button on their quest to turn U.S. health care upside down with a $20.5 trillion, government-run Medicare for all scheme.

Washington’s hybrid model, dubbed Cascade Care, was signed into law by Gov. Jay Inslee in May, just in time to claim national bragging rights. “I’m the only candidate who has passed a public option,” Inslee declared on a presidential debate stage with nine other Democrats in June, two months before he withdrew from the race.

Actually, the Legislature passed it. But we take his point and recognize the significance.

If it works, it might lay to rest the idea that a single-payer health care system is the only progressive solution in a nation where more than 27 million people go without medical insurance.

If it fails, far-left politicians may seize on it as evidence that market-based approaches don’t work.

Here’s hoping Washington can prove the single-payer hardliners wrong. We’ve been to the state’s Department of Motor Vehicles, and no one wants that bureaucratic, take-a-number model for medical clinics or hospitals.

Under Cascade Care, the state will dictate the terms of plans on the Health Benefit Exchange but contract with private insurers to administer those plans. It’s more like a state-sponsored system than what purists would call a true public option.

In other words, the revolution will have to wait.

So will health care consumers. They can’t sign up until the open enrollment period a year from now.

By 2021, the exchange will offer a standardized set of tiered plans, providing predictability to consumers who now ride a roller coaster of out-of-pocket medical bills.

The goal is for participants to spend no more than 10 percent of their take-home income on health premiums. Some Washingtonians now pay 30 percent or more of what they earn on premiums and deductibles, a mortgage-sized burden that can crush household budgets.

If all goes according to plan, working-class and middle-income Washingtonians will be less likely to put their health at risk. There will be less self-rationing of doctors’ visits and prescription drugs, fewer enrollees dropping coverage entirely and more uninsured people signing up. And everyone lives happily ever after, right?

Ah, but there’s a catch. The linchpin of Cascade Care is that provider reimbursements are capped at 160 percent of Medicare. That means doctors and hospitals take a hit — although a less painful one than under the original proposal, which sought to limit reimbursements to the flat Medicare rate.

Health care professionals rely on bigger payments from private insurers to offset the cost of accepting Medicaid patients. Take those payments away, and the math that sustains our system doesn’t pencil out.

And since network participation is voluntary, some clinics and hospital systems could close their doors to public-option patients, as Kaiser currently does with the state’s lowest-tiered plan on the state exchange.

Cascade Care also doesn’t solve the lack of statewide coverage; some of Washington’s rural counties don’t have a health insurer.

The success of the Health Benefit Exchange should inspire some confidence this experiment could work. The state this year offered about 248,000 Washingtonians a chance to buy affordable insurance on the individual market. And for 2020, state Insurance Commissioner Mike Kreidler has approved an average rate decrease of 3.25 percent.

Seven percent of adults in Washington don’t have health insurance. Compare that to Texas’ 20 percent, and we look good. Could we do better? You bet.

How this new public option will change the health care landscape remains to be seen — the state estimates premium prices will decrease a modest 5 to 10 percent — but at least our state is working with an existing system, not scrapping it wholesale.

“Washington state is leading the nation in a brighter way to provide for the health and security of our families,” Inslee said at a bill-signing ceremony in Olympia last spring.

Cross your fingers that he’s right.

If America’s final destination is a health care system with lower costs and broader access, this watered-down version of a public option may help us get there. But we’d best buckle up. It could be a bumpy ride.

Recommended for you