Category: Health Care

Budget Outline 2013-15

In 2013 the Legislature has three big budget problems to address. It may be that there are other issues for the Legislature (gun safety, mental health, transportation…) but as the budget chair I have an odd focus on what I’m responsible for.

  1. Balance the 2013-15 budget, plus make sure that the 2015-17 budget is structurally sound. We start with a $904 million shortfall and have to address the two issues below, plus comply with the strongest 4-year balanced budget requirement in the nation.
  2. The Supreme Court’s 2012 McCleary decision has major impact on school funding decisions and adds $1.4 billion to the already difficult problem.
  3. The Medicaid expansion called for by the federal Affordable Care Act (ACA) is complex, but provides us with the opportunity to cover hundreds of thousands of Washington citizens and save hundreds of millions. Implementation decisions will be difficult given the campaign rhetoric, but I believe we will get there.

The political situation in the state Senate will make resolution more interesting and create a lot of political theater. I look forward to negotiating a rational solution.

For a printable version of this post click here.

2013 Legislative Agenda

My agenda for 2013 is simple to outline here, but I expect great difficulties in working through it:

  1. Produce a budget that balances for 2013-15 and 2015-17, resolves the  McCleary education funding decision, implements the Medicaid expansion envisioned in the Affordable Care Act (Obamacare), and projects rationally into the future.
  2. Inside the education box make some strategic decisions that enable our K-12 and higher education systems to be more productive, including
    1. More thoughtful allocation of proposed new K-12 spending to fund pre-school for at-risk three and four-year-old children. Most research in the field leads me to believe that this is a more optimum spending plan than what we are currently on a path to do.
    2. Create a strategy for how we fund and manage our higher education system so that a reasonable proportion of Washington students can learn the skills necessary to survive economically in the 21st century. Our current path is unattractive. I am concerned (optimistic?) about a radical dislocation in higher education driven by the Internet and think the state should do some planning.
  3. Take a step forward on transportation infrastructure, including finalizing how we will pay for the remainder of the 520 bridge project. (Tolling I-90 is the current plan, and there are not many alternatives.) There are other transportation projects that need to be considered as part of an overall plan, and the business community is pushing us to consider an increase in the gas tax to fund it.

There are lots of other issues that will come up this year. I do not expect to be the lead on most issues outside the budget, but if there is one that will get some of my attention it is taking a rational step forward on gun safety.  What this will be is unclear at this point.

The politics in the state Senate will be interesting, though I don’t think they change the reality of budget votes in any significant way. The mix of votes in the Senate makes it difficult to pass a budget there with 25 Democratic votes, requiring the same kind of bi-partisan budget vote we’ve negotiated in the past few years.

As usual, I’ll try to write about policy developments on my blog at www.rosshunter.info, and will send out infrequent email updates. If I send them out too frequently you don’t read them, so I try to be careful. Of course when I do this they are tremendously long, but you can’t have everything.

Workers Comp Fraud?

The New York Times ran an article a few weeks ago that a constituent sent me for comment. He wanted to know if the same fraud occurred in Washington.

http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html?smid=pl-share

In some states doctors providing care under workers compensation were running schemes that resulted in their making crazy money selling drugs directly to patients. You can read the article for details, but the question the article begs is “What about Washington?”

I rooted around a bit and found out that we stopped allowing this several years ago based on similar concerns. Running all the prescriptions through a single POS system allows us to track drug use, contraindications for multiple drugs, and to prevent fraud like what’s shown in this article.

I’m sure there are other ways inventive people come up with to scam the various state systems (Medicaid, Workers Comp, etc.), but we ride the data to try to prevent as much of it as we can.

 

Leukemia and Lymphoma Society Fundraising

Bald Headshot of Ross (during chemotherapy)Fortunately you all haven’t seen me looking like this in a long time. in 2005 I was diagnosed with non-hodgkins lymphoma. I went through a fair amount of chemotherapy and then a stem-cell transplant in 2007. It’s been five years and all good so far. Thank you Fred Hutchison Cancer Research Center and everyone else involved in the Seattle Cancer Care Alliance.

I’m doing some fundraising for the Leukemia and Lymphoma Society as payback and I’d love your help. Click here to contribute.

I’m going to ride my bicycle 120 miles, in Las Vegas, in September as part of the LLS’s “Team in Training.” I’m doing a lot of training rides to get in shape so it is not insanely painful, but it’ll still be a serious piece of work.

The LLS raises money for both research and support for families who are going through treatment. I was fortunate enough to live within 10 miles of the epicenter of research on my particular cancer. Many others are not and have to spend 3-4 months, or longer, living away from their family in Seattle to get treatment. As you can imagine, this is hard to manage for many people.

Your contribution will mean a lot. You can click here to go to the online contribution page.

End of Session Budget Update

Thank you for allowing me to represent you in the Washington State Legislature. It’s an honor and a privilege. This year was pretty “special.” There’s nothing like a little drama to spice up a legislator’s life. This session had it all – defections on budget votes, protesters requiring hearings to be shut down, people being arrested, and a sleep-over to end the session.

This newsletter only addresses operating budget issues. Lots of other interesting things happened or are happening (520 bridge construction, for example) and I will address those in the next document.

The Operating Budget

We left the 2011 regular session with a budget that most neutral observers thought was a pretty reasonable product. It was balanced and had a healthy reserve of over $700 million. The final vote was a bipartisan one, with significant participation from Republican Senate members. Since then we’ve had pretty significant declines in our revenue projections due to the economy and faced about a $2 billion projected shortfall coming in to the December special session.

In that session we solved about $500,000,000 of the problem, leaving about $1.5 billion left to fix in January. We got good news in the forecasts, reducing the problem to about $1 billion, which we addressed in this year’s supplemental budget. Our negotiating process was bi-partisan, as was the final voting pattern.

The budget has no cuts to education. This means early learning, K-12, and higher education were left whole. This is a miracle, and was not accidental. I felt strongly that in light of the Supreme Court decision on school funding we could not in good conscience make reductions here, and as the budget committee chairman my opinion was able to prevail.

Continue reading “End of Session Budget Update”

Post-Special Session Newsletter

Now that the “special” session is over I’ve been motivated to write a newsletter that answers many of the questions I’ve received in email. If you want to print it click here for the PDF version that’s better formatted for your printer (or at least for mine.)

As always, it’s an honor and a privilege to serve you in the Legislature. This will be my tenth year, which I find astounding. I never intended to do this – I thought I’d swoop in and fix school funding, then go back to the private sector. It turns out that some problems are harder to fix than you would think. The “great recession” is also making it a little more difficult…

Gov. Gregoire called the Legislature into special session Nov. 28 to deal with a significant decline in our expected revenue over the remainder of the two-year budget period, which ends June 30, 2013. She released her proposed revised budget Nov. 21.

We finished the special session on December 14th with the passage of a “down payment” bill on the budget, along with a handful of bills that were related to the budget or to creating jobs in Washington. The down payment bill saved a little less than 25% of the overall problem: $480 million. We still have about $1.5 billion to go.

Continue reading “Post-Special Session Newsletter”

Healthcare cost reduction: non-obvious solutions

In Camden, New Jersey, one per cent of patients account for a third of the city’s medical costs. Photograph by Phillip Toledano.

If you’re interested in how to reduce healthcare costs you might want to watch this Frontline video from PBS. http://video.pbs.org/video/2070853636/

It’s about an article Dr. Atul Gowande wrote in the New Yorker in January that is an amazing look into non-obvious cost generation. It’s a long read, and a solution that tries to deal with this view of the problem is hard to implement at scale. Here’s the original New Yorker article: http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande

I don’t write about healthcare all the time, but trying to figure out how to deal with the real world in complex ways is how we’ll have a healthcare system that actually works, and save an amazing amount of money for all of us, as the costs for uninsured patients wind up being paid for by all of us, either through Medicaid or by shifting unpaid costs onto the insurance of private-pay patients.

 

Slowing the Growth of Medicaid

New York state has a process for meeting an attractive goal: slowing the growth of Medicaid spending to the level of medical inflation. The New York Times opined positively on it in March. The article is worth reading and it sounds really great, but you have to understand what it means.

Medicaid cost growth has two components: medical inflation and caseload growth. Medical inflation is growth in the cost of covering a single patient, and caseload growth is the increase in the number of patients. Caseload growth is inversely correlated with the economy. When we’re doing well there are fewer people eligible, and when we have high unemployment more people are eligible. As you might expect, we’re swimming in patients right now.

Continue reading “Slowing the Growth of Medicaid”

House Budget Proposal

Earlier this month I released the House budget proposal for 2011-13. Just before the end of the regular session, the Senate released their proposal. I asked for the job of chairman of the budget committee, but it’s clear my timing with the economy might have been better.

This budget is responsible, thoughtful, and sustainable. I’ve also tried to make it consistent with my values and the reason I ran for this job in the first place. I care about children – their education, their health, and their future – and I’ve tried to protect those as much as possible given the situation.

We were well-received critically:

Editorials | House budget passes key test: It balances | Seattle Times Newspaper

HeraldNet.com – Editorials: Serious response to crisis
Apr 05, 2011 · THE HERALD EVERETT, WASHINGTON … Worries that House Democrats were dragging their feet on a state budget … Generally, the House majority’s plan is serious …
www.heraldnet.com/article/20110405/OPINION01/704059973/-1/OPINION03

Continue reading “House Budget Proposal”