Washington state faces tough decisions on health care funding

Washington state’s health care system is facing dire cuts and is coming under fire from health care providers. State lawmakers are working to close a $1 billion budget shortfall and significant cuts to health services for low-income individuals have been proposed leading to an outcry from providers.

The American College of Emergency Physicians issued a press release this morning saying that proposed cuts to Medicaid in the state will significantly endanger patients in need of emergency care. According to the physicians, more than 18,000 emergency patients sick enough to need hospitalization would have been denied coverage of emergency care had they been Medicaid patients living in Washington State.

The Washington State plan also is in violation of the federal “prudent layperson standard,” because it refuses to pay for diagnoses that it considers non-urgent. The physicians note that the list of non-urgent diagnoses were created without input from doctors.

“Perhaps one of the most concerning things about the plan is that it seeks to control spending — and deal with the lack of available alternative care settings — at the expense of the patient,” said Renee Hsia, MD, MSc, of the University of California (San Francisco), who has conducted numerous studies on evaluating emergency department use in several states and nationwide. “The emergency department is the first resort for patients, and also the last resort. If there are no alternatives for people to get medical care, how can you deny them coverage for a urinary tract infection or for a complication from Alzheimer’s?”

Health care providers are asking state lawmakers to barrow against future tobacco settlement funds to provide the $220 million needed to continue offering some level of service to low-income residents who do not qualify for Medicaid until the state gets help from federal health care reform in 2014. However, Governor Gregoire has indicated that she does not want to see a securitized budget.

Borrowing through this scheme would provide a one-time influx of capital, something the state has done before but this would be the first time that something like this would be done for operational purposes. The state legislature is supposed to break on March 8 and no deal has yet been completed. Lawmakers in both houses and in both parties have indicated there is little support for the borrowing plan.

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