Only 56% of low-income kids get enough well-child visits

According to the Kaiser Family Foundation in Washington almost all (95%) of children have medical insurance. ALL low-income (below 300% of the federal poverty level) children have access as part of Apple Health for Kids.

This chart shows the performance of all the Apple Health plans at actually getting low-income kids to visit the doctor on the recommended schedule. 56% of infants received the typical schedule of well-child visits. As you can see we are both significantly below the national average (61.55%,) and more importantly totally pathetic in an absolute sense. You can read the full report here.

Why is the early learning guy writing about this you ask? Well… if our goal is to have all kids being ready for kindergarten by age five, then the earlier we can provide appropriate care for a child who’s experiencing a developmental delay the more likely we are to be able to have the best possible outcome. The pediatrician is the person most likely to discover a concern and provide the family with free options, but this won’t work if the kid doesn’t appear in the office.

As part of our Essentials for Childhood effort to coordinate the activities of the Department of Health and the Department of Early Learning we’re looking into problems like this and finding ways to work together to coordinate services for children in Washington.

I’m particularly frustrated by this one because we pay the managed care organizations to coordinate this care. My personal thought is that we don’t pay the plans at all if they don’t get the kids to show up, but there is probably a more nuanced approach to solving the problem that will work better. We’re working on this.

Post-Session Notes, Operating Budget Comments

Thank  you again for letting me represent you in Olympia. It’s an honor and a privilege, though I feel much less privileged when the session runs into July. We finished our work Friday morning June 10th, passing a transportation spending bill and bills that allow the state to take out bonds based on the revenue. We also passed a small bill changing high school graduation requirements, the centerpiece of a disagreement in the Senate over initiative 1351 (class size reduction.) The graduation bill delays the imposition of the science standards for two years, allowing 2000 kids who met all the graduation requirements other than passing the biology end of course exam to graduate. It does NOT make a number of other changes I took issue with when they came up earlier in session.

In the last week of June we passed the 2015-17 operating budget, my particular responsibility in the Legislature. It’s reasonably straightforward and didn’t need to take us until the end of June to resolve, but the Republican Senate was unwilling to compromise on their all-gimmicks, no revenue strategy until the very end. In the last few days we came to an agreement that is a true compromise – the House conceded to the use of more financial shortcuts than we would have preferred and the Republican Senate agreed to close $350 million of tax loopholes. I didn’t get everything I wanted, and there are some elements of the deal that are distasteful. I think the same is true for the Senate Republicans. Had we gone past June 30th the state would have gone into a partial shutdown, including laying off doctors and nurses, shutting childcare facilities for 50,000 kids (which would cause 30,000 low-income single moms to lose their jobs or depend on sketchy care), and other bad things.

I’m glad to live and work in “this” Washington, a place where we can discuss issues rationally and come to compromises, unlike the “other” Washington where they seem to have great difficulty in doing so. I do wish it took less time. Continue reading “Post-Session Notes, Operating Budget Comments”

Compelling Speech from New Rep. Tom Dent (R-13) on Mental Health

We passed our first two bills today. It’s always fun on the first day – lots of people feel moved to speak and there’s always been some minor change to the voting software that is weird to figure out. The first bill typically tries to make a statement about priorities, but is usually pretty simple because complicated bills take longer.

Joel’s Law was first passed last year by the house, but not taken up by the Senate. I wrote about it last week. It passed the House unanimously, with compelling speeches, particularly the one from Freshman Rep. Tom Dent (R-13). He spoke compellingly about his struggles with his son’s mental illness. I don’t usually pay much attention to the (lack of) eloquence on the floor, but Rep. Dent’s comments were spellbinding. It’s less than 5 minutes and well worth watching – click the clip below.

I was also super-pleased that our initial supplemental budget passed 83-15, with strong bipartisan support. Rep. Chandler and I worked closely together to get the bill done in a way that would work for both of our caucuses. The comment I made below is in addition to the press release I put out earlier this week when we introduced the proposed amendment to the bill together.

Ross sig small

Legislative News: Washington House Democrats – Olympia, Washington

Statement from Rep. Ross Hunter on supplemental budget passage

Statement from Rep. Ross Hunter (D-Medina) on the passage of HB 1105 – Making 2015 supplemental operating appropriations.

Sen. Andy Hill and I made a commitment to Governor Inslee last summer that we would take swift action to address problems in the mental health system. Adopting this budget will settle the state’s legal obligation in the single bed certification lawsuit. The House made good on that commitment in a strong, bipartisan fashion today. It is my hope that the Senate sends this bill to the Governor soon so that we can address immediate and urgent problems within the state’s mental health structure.


For interviews or more information: Rep. Ross Hunter, 360-786-7936 or Staff: Andy McVicar, 360-786-7215 or

For broadcast-quality audio or TV/radio interviews: Contact Broadcast Coordinator Dan Frizzell at or (360) 786-7208.

Joel’s Law and dealing with lawsuits, disasters, and an increase in child abuse reports

The House Appropriations committee is planning to hear two bills Today, (Jan. 26, 2015):

HB 1258 – Concerning court review of detention decisions under the involuntary treatment act. This is “Joel’s Law,” a bill creating the ability for parents and other family members to provide information to the court in involuntary treatment act cases. The House passed this bill 97-1 last year and it was blocked in the Senate.

The law is named after Joel Reuter, a bright, beloved software programmer who lived on Capitol Hill. When he spun into a severe manic episode of bipolar disorder in 2013, Washington’s fractured mental-health system offered no cushion, despite pleadings from his parents and friends to have him involuntarily hospitalized.

Instead, Joel, believing he was fighting zombies, was killed by Seattle police. He was 28.
Seattle Times Editorial | January 22, 2015

Joel’s Law is a targeted intervention in the mental health system. It will allow parents and family members to provide input to a judge making the final decision to commit someone involuntarily. Parents often have the most information about the situation, enabling the judge to make a more informed decision. It’s heartbreaking to hear the stories of parents who watch children drift in an out of severe mental illness, getting worse at every turn. We’re better than this, or at least we should be.

HB 1105 – Making 2015 supplemental operating appropriations. This is a super-early, super-small supplemental budget responding to lawsuits, child abuse caseload increases, and natural disasters (Oso and the big fire season.) Rep. Bruce Chandler (R-Granger) and I are jointly introducing the proposed bill, and I expect it to get significant bipartisan support.

The state lost a lawsuit ten years ago on how the homecare system for low-income seniors and the disabled is paid for. It finally made its way through the Supreme Court and the state lost. We’re paying tens of thousands a day in interest on the judgment and I’d like to get it paid off.

Last summer the state Supreme Court said that we can no longer keep patients waiting in emergency rooms because we don’t have capacity in our mental health system to evaluate and treat them. In many cases these folks are shackled to gurneys in hallways. Even in more humane cases they’re not getting the treatment they need and often get significantly worse waiting for a space.

We expect to lose a third case when a federal district court judge makes a decision in March and we are therefore taking corrective action now. This is similar to the emergency room case above, but occurs when local police arrest someone and ask for a mental health evaluation to see if the person is competent to stand trial. The law says we can’t keep them for more than 7 days in jail without an evaluation and a room at the state mental hospital. In many cases we’re keeping them in solitary confinement in county and city jails for months. People without mental issues are badly affected by solitary confinement, and for the mentally ill it’s torture and they just get worse.

Again, the Seattle Times (or at least editorial writer Jonathan Martin) is unsparing in their disdain here:

The $90 million cut from the state’s mental health system from 2009 to 2013 directly led to a state Supreme Court’s ruling in August banning very sick patients from being warehoused in hospitals, and probably will lead to a similar ruling next year regarding a lack of treatment in jails. A wavering financial commitment to court-ordered foster care reforms in the same era resulted in an extension of court oversight.
Seattle Times | November 14, 2014

With this supplemental budget we create more space at the mental hospitals, more treatment slots outside the hospitals, raise compensation for psychiatrists so we can actually hire some, and a bunch of other items that fix problems with the system. It’s not everything we need to do to have the system be functional, but it’s a step towards repairing the damage we did during the recession.

I expect the bills to both pass out of committee on Wednesday relatively unchanged and to pass out of the House either Thursday or Monday. I hope the Senate will give both serious consideration.

Mental Health, Child Abuse, Disasters, Lawsuits…

OLYMPIA – The House Appropriations committee will have a public hearing on Monday, January 26 to discuss an early action supplemental operating budget proposal. The bill deals with a small handful of items that need immediate attention. The committee expects to adopt a more typical supplemental budget later in the session.
Issues addressed in the bill are limited to the following:

  • Mental health: More mental health treatment capacity is created to resolve the emergency room boarding lawsuit and an expected court order requiring more evaluation and treatment capacity to take pressure off local jails.
  • Natural disasters: Eastern Washington wildfires, the Oso landslide, and other natural disasters had a larger impact on the state budget than what was originally allocated.
  • Homecare shared living lawsuit: The state lost a lawsuit with in-home care workers in the spring of last year. Interest on the judgment is accruing at $20,000 a day. This bill appropriates the money to pay the debt.
  • Children services: Child abuse caseloads have been significantly larger than expected and funds are allocated to help resolve cases as quickly as possible.

Statement from Rep. Ross Hunter (D-Medina):

“It’s a little unusual to do a supplemental budget this early in a legislative session, but last year was an unusual year. The wildfires and Oso landslide took a large toll on our budget. We also need to pay our legal bills and to address critical funding shortages in mental health and foster care services. I’m pleased that we have come to agreement on these issues this early in session.”

Statement from Rep. Bruce Chandler (R-Granger):

“Addressing these costs early on in the session will save the taxpayers money and will get relief to the people who have been harmed by the Oso landslide and the wildfires. This is a constructive beginning as we work towards the creation and implementation of the next two-year operating budget in a timely manner. I’m optimistic that this budget will receive thoughtful consideration from the Senate.”


For interviews or more information:
Rep. Ross Hunter, 360-786-7936 or
Rep. Bruce Chandler, 360-786-7960 or

Staff (Hunter): Andy McVicar, 360-786-7215 or
Staff (Chandler): Brendon Wold, 360-786-7698 or
Print-quality photos:
Credit: Washington State LSS

Lawmakers seek community input on state budget

Posted on January 5, 2015
Rep. Ross Hunter

How would you solve Washington state’s $4.4 billion budget problem?

That’s the central question Senator-elect Cyrus Habib (D-Kirkland) and Representative Ross Hunter (D-Medina) will be asking their constituents at a town hall meeting this Saturday, 10 a.m. at Redmond City Hall. Representative-elect Joan McBride (D-Kirkland) will also be participating in the discussion.

The eastside lawmakers want to hear from 48th district residents on what issues are important to them. They will provide a brief overview of the challenges and opportunities facing the state in the upcoming legislative session at the town hall.

“As I move from the State House of Representatives to the State Senate, I am keenly aware of the challenges before the Legislature: the need to address income inequality, the opportunity gap in education, and climate change,” said Habib who was recently selected to join Leadership of the Senate Democrats. “I look forward to discussing these and other issues with my Eastside constituents on Saturday.”

“We’re facing a large budget problem this session,” said Hunter, the chair of the committee responsible for writing the state budget in the House. “In addition to the constitutional education funding problem pointed out in the McCleary decision, the voters approved an expensive initiative lowering class sizes. Representative-elect McBride, Senator Habib and I are looking for feedback from constituents on the right mix of new revenue and program reductions in other areas necessary to fund these obligations.”

The 105-day legislative session convenes on January 12.

48th Legislative District Town Hall
Redmond City Hall
15670 NE 85th St.
10 a.m. – noon
Saturday, January 10, 2015

Dire Future for State Budgets?

Graph showing state and local health care costs vs. payroll costs over timeThe Washington Post has an article today (or some recent day – I only read online) about the long-term pressures faced by state and local governments.  The article compares growth in key revenue sources with growth in costs and projects a dire future. The title is “GAO: Without draconian cuts, states face decades-long fiscal crisis“.

Key concerns they have include

  • The sales tax continues to decline as a fraction of GDP. This means that over time people buy less stuff (as a percentage of their income) that is taxed.
  • Tax revenue in general will not return to pre-recession levels, as a percentage of GDP, until 2058.
  • State and local healthcare costs for employees and retirees, as well as Medicaid costs, will grow from 3.9% of GDP to 7.4% of GDP by 2060.

Continue reading “Dire Future for State Budgets?”

WA Budget 2015-17: High Degree of Difficulty

Recession Job Recovery graphWhen writing about the budget it’s important to share good news as well as bad. First the good: (it’s short) the revenue forecast picked up a little bit. The bad is that we face one of the most difficult budget cycles of my time in the Legislature, and perhaps worse than we’ve seen in many decades.

The budget is showing strains from the slow recovery from the recession, we are seeing a slew of court cases that require us to spend significant amounts of money, and we are going to have to make significant progress in meeting our constitutional responsibility to fund public education.

Continue reading “WA Budget 2015-17: High Degree of Difficulty”

Teen Births Decline!

birth rates by state - 2012I got email from one of our regular contributors yesterday that wanted us to follow Colorado’s example in reducing teenage births in Washington. Since 2008 teenage births (to women age 15-19) have declined almost 40% in Colorado, an amazing statistic. The website this is from ( claims this has saved Colorado $41 million in that time. This is not unreasonable – both states pay hospital costs for births to women below about 250% of the federal poverty level through Medicaid.

Colorado provided IUD and implants to women at no or low cost through 68 family planning clinics. The cost of the birth control is very low per-person (particularly with long-lasting examples like implants and IUDs) compared to the cost of a live birth, let alone one with complications. Colorado nets a pretty significant savings.

I told him I didn’t want to do what Colorado is doing. Why would I do that?

The great story here is that teen birth rates have declined precipitously across the nation. The rate of decline can obscure the relative position of the states. You can see the overall decline in the chart on the right.teen birth rate decline

In the map at the top of the post you can see that the two states are close to the same actual birth rate (the same lavender color). Colorado’s rate of decline was steeper than ours, but they started in a much worse position. Washington  was about 20% lower than Colorado in 2008 and dropped about 30% in the time since. We are still lower than Colorado today.

The teen birth rate (per 1000 women age 15-19) in Washington was 23.9 in 2012. In Colorado it was 25.4. I am not interested in getting to the Colorado level.

The chart with these numbers is available in the most current CDC report on this issue, available at the following link: The comparison data are on page 20.



No More Boarding the Mentally Ill in Emergency Rooms

The WA State Supreme Court released a decision this morning on psychiatric boarding in hospitals that basically prohibits the state from doing this. Judge Gonzales’ summary is quite pithy.

GONZALEZ, I.-Washington State’s involuntary treatment act (ITA), chapter 71.05 RCW, authorizes counties to briefly detain those who, “as the result of a mental disorder,” present an imminent risk of harm to themselves or others, or are gravely disabled. RCW 71.05.153(1), .230. The initial brief detention is for the limited purpose of evaluation, stabilization, and treatment, and once someone is detained under the IT A, he or she is entitled to individualized treatment. RCW 71.05.153, .230, .360(2). Pierce County frequently lacks sufficient space in certified evaluation and treatment facilities for all those it involuntarily detains under the ITA. It regularly resorts to temporarily placing those it involuntarily detains in emergency rooms and acute care centers via “single bed certifications” to avoid overcrowding certified facilities. Such overcrowding-driven detentions are often described as “psychiatric boarding.”  Patients psychiatrically boarded in single bed certifications generally receive only emergent care. After 10 involuntarily detained patients moved to dismiss the county’s ITA petitions, a trial judge found that psychiatric boarding is unlawful. We agree and affirm.  (

There are hundreds of patients in this category statewide and we are going to have to take action to resolve the situation or the courts will release the involuntary commitment petitions on these folks. In general, people in this situation need immediate treatment. Not providing treatment, but keeping them strapped down on gurneys in the hallways of hospitals has always been inhumane, now it is clearly illegal.

During the recession the state budget made significant reductions in mental health spending. We are starting to see the outcomes of this. Yet another category where we most certainly cannot take reductions in order to fund other more visible state services.

Continue reading “No More Boarding the Mentally Ill in Emergency Rooms”