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March 08, 2007

Comprehensive, Affordable Health Coverage for All Children

The value of having a progressive Democratic governor and a Democratic legislator with enough of a majority to flex its muscles will be clearer and clearer as this session moves into its final weeks. 

We already have an early win with the passage of SB 5093, the Children's Health Bill, in both Houses.  There was bi-partisan support (Senate 38-9, House 68-28) for this innovative bill but the leadership came from Governor Gregoire, the Democratic leadership and progressive organizations.  Washington State now leads the nation in providing comprehensive, affordable children's health coverage for all children.  This bill, which the governor will sign on Tuesday, offers affordable health coverage options to all children, including immigrant children.  Children in families above 200% of the federal poverty level ($40,000 for a family of four) will share the cost with sliding scale premiums.
That means that approximately 38,000 children, who are currently not able to obtain basic health care, will be able to do so immediately.  And there will be outreach to other eligible families to let them know they can enroll their children. 

Then, the bill gets really comprehensive.  The bill seeks to ensure that children will be able to see a doctor without a long delay; provides for what they call a "medical home", a clinic that supervises the child's overall health, and provides goals for nutrition and exercise in schools.  The bill also provides for coverage for all children of whatever income through a non-subsidized system for families of middle or higher incomes to obtain healthcare at more affordable rates.  That last part is one of most innovative parts of the bill and kicks in January of 2009. 

I thought I'd try to lay out the organizations and people who worked hard to get such a wonderful bill all the way through the process. 


According to Jon Gould, Deputy Director of the Children's Alliance, a major long-time backer of this bill, Frank Chopp walked into a lobby day gathering four years ago and asked the children's healthcare backers in the room what should be the name of a program that would give all children in the state health coverage. 

Then we get to the two steps backward part.  The legislature sent a bill to then Governor Locke, championed by Senate Budget Committee Chair Dino Rossi, that cut children as many as 40,000 children off the healthcare rolls and put administrative hurdles in place that made it difficult for families to enroll.  Governor Locke signed it. 

Gregoire ran on this issue in 2004, charging correctly that Rossi was instrumental in preventing low income Washington children from obtaining healthcare.  (She didn't talk much about Locke's part in the two-steps-back bill.)  Then one week after taking office, she implemented an Executive Order that undid a cumbersome and punishing income verification process, provided for continuous eligibility for children whose parents incomes fluctuated somewhat and eliminated premiums for low income families.   Caseloads stabilized and the number of children covered began to go up.  Passage of a bill that year declared that Washington would have the goal of health coverage for all Washington children by 2010.

A strong coalition of children's organization and health care providers supported by a wide range of religious organizations and medical organizations began working with legislators.  That coalition has been unified on exactly what the policy should be and who should be covered.  In addition to a unified message, the group had a great lobbying team and a good grass-roots campaign.  The coalition included Group Health, The Washington State Hospital Association, the Community Health Network of Washington, the American Academy of Pediatrics and Group Health.  (Tell them thank you next time you're in!)

SB 5093 was an executive request bill.  It came from the governor.  Unlike most bills, it got better as it went through the legislature.  About three weeks ago, the Speaker, the Majority Leader and the Governor met and came out with a deal.  This bill was an example of the good relationships between the three Democratic leaders. 

Go with me over the fold for a few words from Senator Chris Marr, chief sponsor, and more on the details of the bill.  The PI has an editorial up this morning praising it as well.

New Senator Chris Marr Sponsors the Bill

Lisa Brown asked newly elected Spokane Senator Chris Marr to lead the charge in the Senate and it was ultimately his bill, SB 5093, that made it through. 

I talked with Senator Marr for a few minutes today about why this was important to him. He said that he has been intrigued by people saying that we need to be better consumers of healthcare.  Marr is past owner of a group of Honda dealerships in the Spokane area.  Prior to running for the State Senate from the 6th LD, I saw Marr speak forcefully two years ago for the Clean Car Bill in the legislature and effectively undercut the opposition by the national car dealers association.  I was personally thrilled that he ran and won (and that was even before I found out he was a Buddhist). 

Marr talks about his background running a business with 150 employees and serving as Chair of a Hospital Board.  He said that the working poor has had huge difficulties paying for healthcare and the result is higher health care costs for all of us.  Hospitals are required by federal law to provide care in the emergency room.  As a result the emergency room is the only health care that many low income people can get.  The idea that it is how they do health care becomes a family tradition and shunts all-important preventative healthcare to the side.   

The cost of this terribly inefficient healthcare is borne by all of us who pay health insurance.  Marr says that 27% of our premiums support the hospital emergency room care - care that should be addressed elsewhere for the benefit of all of us. 

Marr says there is not a lot of debate about the importance of this Children's Health Care bill.  The preliminary steps that have already been carried out by the state have proven quite effective in providing healthcare for children in low income families and in bringing down costs. 

For Marr, coming from the Spokane region, where 22% of the jobs are based on health care (vs. 11% in Puget Sound), the benefits to his constituents were also key.  He wants to change the world around health care and sees this bill as a good beginning.

Jon Gould says that Marr could not have been a better champion of this bill.  There were a number of Republican amendments that would have weakened the bill and Marr had a quick, cogent response to every one of them.  Gould said that for a freshman Senator, he's been as effective as anyone who's been in the legislature for a long time.

Marr wrote an op-ed in the Spokesman Review a month ago laying out his support of SB 5093.

The Bill

I'll let the Children's Alliance provide the details of the bill:

Senate Bill 5093 will provide affordable, comprehensive health coverage options to all children in Washington State. Beyond coverage, this bill seeks to ensure that children will be able to see a doctor, encourages high quality care through a medical home, invests in outreach to find and enroll eligible families and declares goals for nutrition and exercise in schools. All components are critical to improving the health and wellbeing of Washington children.

Key features of the children’s health legislation:

One unified program – Several health coverage programs will be consolidated into a single unified coverage program for children. All children receive equal treatment, regardless of citizenship status. Benefits are comprehensive: medical, dental, vision, and mental health. Consolidation of programs will streamline the process of determining eligibility and enrolling children for both families and the state.

No more waiting lists – The state budget will accommodate all children in families up to 250% of the Federal Poverty Level who enroll in public health insurance programs. These children will not have to be placed on waiting lists for coverage while the state budget is debated every year.

Sliding-scale coverage – This legislation opens up public insurance to families making up to 300% of the federal poverty level (FPL) in January 2009, with sliding scale monthly premium contributions from families above 200% of FPL. (200% FPL for a family of three is $34,340 and for a family of four is $41,300.) At a small cost to the state, families that currently lack affordable coverage options will now have a reasonable means of obtaining comprehensive health coverage for their children. Beginning in January, 2009, middle-class families (those above 300% FPL) will be able to obtain comprehensive coverage through the state at full cost.

Outreach to eligible families – About 70% of the children who lack coverage were eligible for public insurance even before this bill was passed. The legislation invests in comprehensive outreach to ensure that responsible parents have access to accurate information about available children’s health coverage options and the enrollment process.

Cutting the red tape – The bill directs DSHS to simplify the application and renewal process through mechanisms such as online applications to reduce the number of children who “churn” on and off public-supported health coverage programs.

Better care through “medical homes” – Quality improvement measures and targeted provider rate increases aim to provide coordinated regular care for children through “medical homes.” Children with “medical homes” have improved health outcomes.

Healthy schools – Healthy schools promote healthy lifestyles that result in healthier children. This bill declares goals for nutrition and physical activity standards in K-12 public schools and creates a legislative school health task force to ensure that Washington’s schools are healthy environments for the health and development of children.

The full bill is here.  The Children's Alliance's detailed summary is here.

Posted by Lynn Allen on March 8, 2007 at 01:04 PM in Inside Baseball, Policy | Permalink


A friend who read this post asked me how many children don't have health coverage today. The answer: 73,000.

When this law is fully implemented, the answer should be zero.

Also, the federal government still has a huge role to play. Federal dollars about half of the cost of covering children in low income families. Bush wants to cut those funds (S-CHIP). We need to urge Congress to expand SCHIP funding by $60 billion when it is reauthorized this year.

Posted by: Jon Gould | Mar 8, 2007 8:30:39 PM

Wow, thanks so much for this comprehensive piece.

I understand many things now that I'd wondered about. This is really helpful.

And what an interesting story about Chris Marr....

Posted by: Noemie Maxwell | Mar 13, 2007 10:54:49 AM

I'm still wondering about what this is going to mean. I currently get employer-provided health coverage for my family--at a cost to me of $260 per month, plus ample copays, deductibles and so forth.

Bad as that sounds, I know that my employer's share of the premium is probably close to twice what I pay.

Why would my employer want to keep offering family coverage to me, when I can get it at taxpayer expense elsewhere?

I'm below the 200 percent level, so I could probably come out ahead by transferring to state insurance for my kids. My employer would also come out ahead.

All that is fine for me and the boss. But have state budget planners factored in the kind of shift that may occur? How many other people are in my position?

Posted by: John Stark | Apr 28, 2007 10:11:57 AM

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