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President's Message
Health Care that Works for Americans
Affordable Care Act: While Marketplace Enrollment Ended, Medicaid Enrollment Continues
Initiative Spotlight: Implementing the Affordable Care Act: Washington’s Approach
Health Care Reform in Washington State
Washington State’s Health Insurance Exchange Progress
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Washington State -- Health Care Reform Resources
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Who is ultimately responsible for the successful implementation of the Affordable Care Act in the State of Washington?
Federal Government
State Government
Local Government
Chapter Officers
Kimbra Wells Metz, MHA, FACHE

Andrea Zavos Turner, MHS, FACHE

Immediate Past President
Mary Ann Keogh Hoss, PhD, FACHE

Barbara Anspach, MSN, RN, FACHE

Jim Cannon, MHA, FACHE

Washington State’s Health Insurance Exchange Progress

The federal Affordable Care Act allows each state to establish a health insurance exchange (exchange) to assist individuals and small businesses with obtaining health insurance. The 2011 Washington State Legislature decided Washington State will operate its own exchange.

Over the next year, the state’s Health Care Authority, the Joint Legislative Select Committee on Health Care Reform, and the state legislature, as well as the newly created exchange governing board will explore, recommend, and make key decisions on how the exchange will operate in Washington State. These decisions will impact hospitals and health systems. Preliminary estimates suggest as many as 400,000 people may obtain their health insurance through Washington’s exchange. This summary provides an update of the current activities and outlines the implementation process.

Background: Enacted in April 2011, Senate Bill 5445 creates a health insurance exchange and an independent governing board to oversee its implementation in Washington State. The governing board begins functioning on March 15, 2012. The state’s Health Care Authority is the agency tasked with leading and staffing (through grant funding) the interim work prior to the exchange board’s implementation.

Many details are still emerging, but according to the legislation, the exchange board’s functions are limited to applying for federal grants, establishing informational technology infrastructure, and creating internal operations of the exchange. Key policy decisions, such as whether to implement the federal Basic Health Option or merge the small and individual commercial insurance markets are outside the scope of the board and remain in the legislature’s jurisdiction. Some legislators are interested in making key decisions for the exchange during the 2012 legislative session.

Since no state or federal funding was provided to set up an exchange, the Washington State Health Care Authority applied and received two federal planning grants. The latest grant provides $22 million to:

  • Develop options and recommendations on policy decisions necessary to implement the exchange;
  • Hold Joint Legislative Select Committee on Health Care Reform Implementation (Joint Select Committee) stakeholder meetings statewide;
  • Build a detailed and comprehensive exchange operations plan; and
  • Develop new and update current information technology systems.

Appointment of the Exchange BoardThe exchange legislation, Senate Bill 5445, directs the Democratic and Republican caucuses of both the Senate and House of Representatives to appoint five nominees to serve on the exchange governing board (a total of 20 nominations). The legislation directs the Governor to appoint eight members (two from each caucus list) to serve on the board, as well as to appoint a nonvoting chair, who may only vote to break a tie. The Office of the Insurance Commissioner and the Health Care Authority also have nonvoting seats on the board.

At least four of the 20 caucus nominees must represent the following:

  • employee benefit specialist;
  • health economist or actuary;
  • health consumer advocate;
  • a representative of small businesses; 

The remaining nominees must demonstrate experience in at least one of the following areas: individual health care coverage, small employer health care coverage, health benefits plan administration, health care finance and economics, actuarial science, or administering a public or private health care delivery system.

Technical Advisory Committee The exchange legislation also creates a Technical Advisory Committee (TAC) to help identify and evaluate policy and operational decisions for the exchange in the time period after the legislation’s enactment, but prior to board’s enactment. The TAC’s creation allows the health care industry and other stakeholders to inform the development process. The TAC will also serve to educate the Joint Select Committee’s work to explore policy decisions needed to be made by the legislature for the exchange.

The Health Care Authority approached the Washington State Hospital Association to appoint a hospital/health system administrator to the TAC. WSHA selected Lisa Brandenburg, MBA, MPH, Senior Vice President and Chief Administrative Officer of Seattle Children’s to represent hospitals and health systems. WSHA will continue to be heavily involved in the work moving forward.

The Washington State Hospitals Association will convene a hospital and health system working group to inform Lisa Brandenburg, our TAC representative, of our positions on key issues moving forward. WSHA will staff this working group and provide its members timely information for discussion and development of a hospital and health system position.

Work Program for the TACOver the next year, the TAC will evaluate and develop options and recommendations on key policy issues, including (timeframes outlined):

  • Federal Basic Health option (June-August 2011);
  • Criteria for qualified health plans (July-September 2011);
  • Preventing adverse selection (July-September 2011);
  • Administrative ease within the exchange (July-November 2011);
  • Integration with Medicaid (July-December 2011);
  • Risk leveling, including future of the Washington State Health Insurance Pool (the high-risk pool for the individual market) (August-November 2011);
  • Federally-defined essential health benefits and relation to state-mandated benefits (August-December 2011);
  • Exchange financing (September-December 2011); and
  • Outreach and education plan (including Navigator function) (September 2011-May
  • 2012). 

Joint Legislative Select Committee on Health Care Reform Implementation

As stated previously, many of the key decisions for the exchange need legislative approval. The exchange legislation directs the Health Care Authority to collaborate with the Joint Select Committee. The Joint Select Committee is comprised of ten legislators (six Democrats and four Republicans) who work to understand and prepare for the changes necessary to implement health care reform in Washington State.

Beginning on July 26, the Joint Select Committee will resume its public meetings until the 2012 legislative session. The Joint Legislative Committee informs stakeholders of what may be on the agenda during the 2012 legislative session for health care reform.

For more information, please contact Chelene Whiteaker, Director, Advocacy and Policy, at chelenew@wsha.org or 206-216-2545.

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Become a Health Care Leader

If you are interested in pursuing a master of health administration or know someone who is, WSHEF and the University of Washington Master of Health Administration program are hosting a presentation and networking event with information about the MHA program and future career options. 

Date:  April 29, 2014

Time:  5:00-7:00 PM

Location:  HUB 145 (UW Seattle Campus)

Please RSVP your attendance by emailing Daniel Montanez (montaned@uw.edu) or Lisa Tat (ltat@uw.edu).  

For more information about the UW MHA program go to http://www.mha.uw.edu