It seems apocryphal, but, after the 1932 election, Franklin Delano Roosevelt is supposed to have told his more activist supporters that change had to come from them: “I agree with you, I want to do it, now make me do it.”
This morning, U.S. Senator Maria Cantwell (D-WA) arrived at Seattle’s Country Doctor clinic on Capitol Hill to announce that she’d arm-twisted the Obama administration into launching the Federal Basic Health Plan Option (FBHPO) in 2015. In 1987, the late Governor Booth Gardner signed Washington State’s Basic Health Plan into law at the same Country Doctor clinic — it’s now become the basis for the federal plan, thanks in part to Senator Cantwell’s writing it into 2010’s Affordable Care Act.
The federal plan would allow states to negotiate payment structures with health insurers directly, and cover people ineligible for Medicaid (earning 138-to-200-percent of the federal poverty level) at a lower cost. Cantwell quoted a 2011 projection by the Urban Institute that Washington State could save up to $173 million annually. Nationally, savings could exceed one billion dollars (compared to providing care to the uninsured).
“What is so successful about [the plan],” Cantwell said, “is that it pairs private-sector innovation with public-sector purchasing power, so that states can bundle and direct federal dollars toward a managed care system that’s very creative, very flexible, cuts waste and spending, realigning incentives toward better care.”
More than 75,000 Washington residents could be covered by the plan, with perhaps 15,000 uninsured able to afford the new, lower premiums. Lance Hunsinger, CEO of Community Health Plan of Washington, said someone making $17,000 per year would pay almost $1,200 per year less with FBHPO coverage than through the ACA-created insurance exchange. Kristi Brown Wokoma, a Country Doctor Community Clinic patient and proprietor of That Brown Girl Cooks, admitted that as a small business owner, she went without health insurance. But “$70 per month, I can do,” she said.
Cantwell returned to the Country Doctor victorious over the Obama administration’s unwillingness to provide the guidance necessary for states to put it into action, thanking U.S. Representative Jim McDermott for joining her in the fight. (It had been meant to launch next year, in 2014, but HHS let that date slip.) She had a letter in hand from Kathleen Sebelius, the Secretary of Health and Human Services, promising to “provide more clarity … on implementing the plan in 2015.” Sebelius’s letter states: “The Centers for Medicare & Medicaid Services (CMS) will issue proposed rules … for public comment in 2013, and will issue final rules in 2014.” The federal basic health plan will be “fully operational” in 2015.
Sebelius’s letter arrived after Cantwell mentioned in February she may not support President Obama’s nominee for administrator of the Centers for Medicare and Medicaid Services.
Cantwell was introduced by Linda McVeigh, executive director of Country Doctor Community Health Centers, and Dr. Rich Kovar. The centers had more than 68,000 visits in 2011, despite the fact that enrollment in Washington’s the Basic Health Plan has been dropping (“from 400 in January 2011 to 296 in January 2012, a 26% loss”) due to a freeze on new patients joining the state plan, and its funding cuts. “More than half of the patients we serve at our non-profit clinics are uninsured,” said McVeigh. “This increasingly includes the middle class who have lost their insurance and simply cannot afford to pay for individual plans.”
