WASHINGTON - Local health care providers and community health centers will be watching the Legislature carefully this year on the one program they say is critical to meeting the demand for health care: the expansion of Medicaid under federal health care reform.
Washington was one of the first states to commit to Medicaid expansion effective in 2014 under the Affordable Care Act. Former Gov. Chris Gregoire and newly elected Gov. Jay Inslee have endorsed it. The expansion would allow coverage under the state-federal health care Medicaid program for at least 300,000 previously uncovered adults statewide and up to 30,000 in Yakima County.
But with a new Republican-driven coalition in the state Senate and a complicated health reform implementation process, providers are worried the rollout might not be a slam dunk.
"While a case for expanded Medicaid is strong, and it's in the budgets that outgoing Gov. Gregoire presented, we don't consider it to be a given or a done deal," said Dr. Mike Maples, CEO of Community Health of Central Washington. "But we do consider it, for health centers and the patients we serve, to be the No. 1 issue for the Legislature."
In the state Senate, a political shake-up just before the 2013 session has put Republicans, with help from two conservative Democrats, in the majority and replaced committee chairs with Republican senators. Sen. Randi Becker, R-Eatonville, is the new head of the Senate Health and Long-Term Care Committee, replacing Sen. Karen Keiser, D-Kent, who had chaired the committee for seven years and has been a strong supporter of expanding health care coverage.
Becker said in a telephone interview Wednesday that the Senate majority caucus has not taken a position yet on Medicaid expansion. If the state does accept federal Medicaid money, she said Republicans want "flexibility" in the rules in the event the federal government cuts back on its share of funding. For example, she said the state would want to be able to move people into private health insurance plans offered in a new health care exchange, also part of the Affordable Care Act.
"We don't want to be giving people something and then taking it away," Becker said. "We're trying to make sure we've looked at all the details so we don't set people up for false promises."
Becker noted that the federal government just recently published proposed rules that will apply under expanded Medicaid and said state officials need time to review the fine print and make comments.
Maples remains wary.
"I think that there is broad bipartisan support for Medicaid expansion at this time," he said. "But we've all seen minorities impact measures that appear to have broad support."
Most providers, however cautious, believe that the expansion will go forward, calling it a cost-saving measure that will reduce "cost shifting," the practice of placing the cost covering the uninsured on the insured.
The expansion would give Medicaid coverage to childless adults ages 19 to 65 at or below 138 percent of the federal poverty level, or about $15,000 in yearly income for an individual. The federal government will pay for 100 percent of the expansion for the first several years; in 2020, the states will start picking up 10 percent of the cost.
In Yakima County, with the highest rate of uninsured in the state, an estimated 23,000 to 30,000 people would be newly eligible for the program beginning Jan. 1, 2014. That's 40 to 50 percent of all the people currently uninsured in the county, providers estimate.
Rhonda Hauff, chief operating officer for Yakima Neighborhood Health Services, said the expansion would not only improve access to low-income populations, but would also bring millions of federal dollars into the state and county.
"It's going to impact our economy and create jobs," Hauff said.
The ramifications of leaving people without health care are obvious, providers say. The uninsured often delay health care. When they need it, they often resort to the emergency room or community health centers. If they can't pay for their care, the cost is absorbed as charity care, shifted to insured patients or written off as bad debt.
So far, Yakima Valley legislators have been noncommittal about Medicaid expansion. Hauff said she has spoken with legislators from the 14th District, who have not indicated to her what they would support or oppose.
"They haven't stated their positions in our conversations with them, but they certainly appreciate the issues," Hauff said. "We'll certainly be talking to them more."
Gail Weaver, Yakima Valley Memorial Hospital's legislative liaison, said the hospital is also concerned about the Medicaid expansion because of its status as a "disproportionate-share provider," which means it serves a lot of Medicaid patients in the obstetrics unit.
Regardless of what individual states do with the expansion, Weaver said, the federal government will start to decrease its disproportionate-share funding in 2014 on the assumption that more people will be covered by Medicaid and the hospital will thus be less burdened by the cost of uninsured patients.
For Memorial, those funds amount to $8 million a year. Weaver doesn't know how much or how quickly the federal government will start cutting back. Toppenish Community Hospital also receives a certain amount of disproportionate-share money. Toppenish, like Yakima Regional Medical and Cardiac Center, is privately owned by Health Management Associates of Naples, Fla.
Regional CEO Rich Robinson said the loss of disproportionate-share money at Toppenish would not be enough to severely affect the hospital.
But he said the complexity of the expansion -- in particular implementation of the health care exchange -- where the uninsured will shop for coverage -- worries him.
"Our concern is ... how confusing the system might ultimately be simply because of the uncertainty at the legislative level on how to implement it," he said. "I think we're facing probably a three-year time frame of a very confusing time."
It's set to be a scary transition, he said.
"What makes it really fearful is while we're expected to change, we're still expected to provide what we currently provide at a high level of quality."
But, he added, "health care providers are not losing sight of the fact that it's all about health care; it's all about the patient."
--Reporter Mike Faulk contributed to this report.
--Molly Rosbach can be reached at 509-577-7728 or [email protected] ___