With the election of Donald Trump and retention of a Republican Congress, “Obamacare” dies. But “repeal and replace” simply means that Congress will repeal and Washington State will replace. Sure the money will be gone; but, the rules won’t change. Instead, we face the tedious, expensive, and confusing process of revising insurance forms and processes to do the same thing without Obamacare.
Washington the state will still travel the same road in the same direction. Why? Because Washington State laws remain largely intact. The longstanding state rules varied little from the federal reforms. With repeal of Obamacare, you get the state version minus the money and the individual and employer mandates.
Federal health care reform modestly changed Washington’s laws. These Washington laws remain on the books and include all of the following:
- Guaranteed issue and renewal of health plans with exceptions for very sick people purchasing individual plans. (RCW 48.43.035, 48.43.018, and 48.43.038)
- Guaranteed, subsidized health plan coverage for people who need ongoing, costly care who are not eligible for public programs [ending as federal reforms phase in over the next few years]. (RCW 48.41.100)
- Limits on exclusions and waiting periods for coverage of known health problems. (RCW 48.43.012 & 48.43.015)
- Minimum benefit standards for individual health plans including maternity and prescription drug benefits. (RCW 48.43.041)
- Dozens of required plan benefits ranging from access to particular types of health care practitioners to coverage of particular types of care.
- Prohibition on discrimination against practitioners by type of license [chiropractors have additional protections]. (RCW 48.43.045 & 48.44.310)
- Mandatory health care practitioner dispute resolution process. (RCW 48.43.055)
- Mandatory consumer dispute resolution process including independent outside review of insurer coverage denials. (RCW 48.43.530 & 48.43.535)
- Right of individuals, plans, and health care providers to object to services that violate religious beliefs. (adopted in 1995 – RCW 48.43.065)
- Regulation of health care networks and freedom of individuals to obtain the care of their choosing. (RCW 48.43.085, .087, and .515)
- Women’s right to access the care need from the type of practitioner they choose. (WAC 284-170-360)
- Coverage of dependent children until age 26. (federal reform added a year – RCW 48.43.215)
- Community rating for individual and small group plans except for associations. (adopted in 1995 – RCW 48.43.022)
- Minimum loss ratios (plans have to return a minimum amount of benefits for the price of coverage) (RCW 48.44.017 & WAC 284-60-060)
Washingtonians have deep experience with health care reform dating back to its own reform experiments in the early 1990s. Twenty years of rolling the health care reform rock up the hill should have taught that:
Complex reform leads to complex deformation;
Big bites lead to choking;
Community rating creates surly neighbors; and
Health care costs money but runs out.
Let’s be clear that criticism of federal reform or any reform doesn’t mean that reform isn’t needed. Federal regulators ignored the history and experience of the state experience with health care reform. But no one is happy with the cost, complexity, and confusion of a system of health care that depends upon a committee of strangers to decide whether people get care.
Families and businesses tired of the constant tinkering with health care and health insurance roll in the turbulent waters and fall overboard. They drown in red tape created by insurers and by government. The rescue protocol is to enact a new law.
Just because you can enact a law, it doesn’t mean people will get saved. And yet again, we’ve discovered that people lose patience when promises fail to match reality.