Is it time for the government to assume responsibility for providing health care coverage in our state? Are costs so out of control and the private market so badly broken that the only solution is to allow the state to identify a set of predetermined benefits and levy new taxes to pay for those benefits? If we move in this direction, can we avoid the pitfalls of Massachusetts, where their new system, after its second year of operation, is running at an $860 million deficit, for which an increase in employer taxes is expected to cover the overrun?
This underfunding is in addition to the absence of adequate numbers of primary care physicians necessary to meet the increased patient demand that is driving month-long waiting periods for routine appointments. And what about demand for other types of services? Will a government-run system be able to ensure timely access to the services residents need and want, or will it need to develop a Canadian-style model of rationing to balance demand with cost?
The issue of health care reform and curbing the ever-increasing cost of health care services is being debated nationwide. Questions abound as to whether our current system of employer-based coverage can be sustained, or whether it is irreparably broken. Prevailing discussions lean toward vastly different financing mechanisms to address the needs of the uninsured and restore affordability of services for those who are already insured, but find that the cost of care is still prohibitive for the services they either need or desire.
During the 2008 legislative session, five distinct ideas regarding reform were introduced and discussed by legislators. The plight of small and struggling businesses’ efforts to provide and sustain coverage for their employees was center stage, and each proposal claimed to address that specific need. Unfortunately, the majority of these proposals created new and significant employer taxes to support a new state system designed to address universal coverage. Rather than make a decision this year, the Legislature chose to study those proposals over the year and make a recommendation as to which might be the best option for Washington.
Given this focused review by the Legislature, AWB sent a short survey to members in May to identify whether members supported the main themes within the identified proposals. The survey included a variety of questions that incorporated the primary components of the proposals as well as asked very basic questions regarding employer perceptions of available health care coverage and the rising costs of coverage.
More than 500 AWB members responded to the survey; 69 percent of those responding were small employers with fewer than 50 employees. Overwhelmingly, respondents do not favor a government-run system (88 percent oppose, 12 percent support), and of the small employers responding, 90 percent oppose a government-run system. There was significantly broad agreement that the system has problems, but confidence that the system can be retooled to address the affordability and access issues
Recent news headlines point to outside survey responses that would seem to contradict these findings. However, if one drills down to the specific questions being asked in those surveys, it is true that employers are highly concerned about the rising cost of premiums, it is also true that soon premiums will be so high that employers will have to make a decision about whether they can afford to keep coverage, and it is further true that employers believe they have no bargaining power with insurers because there are so few insurers offering coverage in the state. While these are indeed consistent expressions of employer frustrations, they do not intuitively lead or point to widespread support for a government-run system.
When asked what role the government should play in health care reform, more than 63 percent of respondents to AWB’s survey indicated that the proper role for the government in this area is to create incentives that would entice additional insurers into the state to provide the competition necessary to control premium costs.
Also of interest in the AWB survey: Of the 12 percent of respondents who favored a state-run system, the majority of those respondents — 41 percent — prefer the Canadian-style health care system over both the Massachusetts-style connector program (introduced in both the House and Senate last year) and the Wisconsin model of predetermined benefits purchased through local purchasing cooperatives (also introduced this year). All three of these models are to be further studied by the legislature this interim.
Finally, survey responses also indicate that the majority of respondents are happy with the coverage they currently receive but are very concerned that it will soon be unaffordable. The overall message from the survey points to significant support for the maintenance of the private market coverage system that is serving the majority of individuals throughout both this state and country. However, the results also point to a system near the brink of collapse if we cannot address affordability. AWB will be working with our members to develop real solutions to addressing these issues in order to restore affordability and reduce the number of uninsured citizens throughout our state.
