When it comes to our health-care system, we ask legislators to consider how each move weighs on other parts of the budget, write guest columnists

Share story

IF we could write a Hippocratic oath for state lawmakers, it might start with the Latin phrase primum non nocere, meaning “first, do no harm.”

As leaders of Washington-based health-care organizations, we recognize the challenge legislators face reaching consensus on a new state budget. The state Supreme Court ordered increased school spending in its McCleary decision — as much as $2 billion in 2015-17. And voters upped the ante in November with Initiative 1351, calling for the hiring of thousands of new educators. The estimated cost: $1 billion per year.

Unlike education, programs where the state and health-care community are partners are unprotected by our state’s constitution. Finding the right balance between mandatory spending on education and discretionary spending on health care will be a hallmark of the 2015 Legislature.

Regardless of your views on the state budget, we want to share some observations that put tough budget choices in context.

Under construction:

• The cranes dotting the Seattle skyline are an apt metaphor for the dramatic redevelopment Washington’s health-care system is experiencing — and the state is a critical part of the development team.

New structures and systems are being deployed throughout Washington’s health-care community and initial results are promising: The care patients receive is better and safer, cost trends are down and access has increased. This innovation is being driven by market forces and state and federal legislation. The state participates in reforms as a purchaser, regulator, educator and a leader.

The timing is right for the health industry to improve its efficiency as the patient population it serves is growing. Medicaid covers 1.6 million people, including 550,000 new enrollees. As the Washington Health Benefit Exchange and Medicaid expand to enroll more residents (nearly 700,000 are newly covered), our health-care system must do more. During this tumultuous period, the need for stable state funding is greater than ever.

Important programs like Medicaid are funded both by state appropriated funds and by federal matching dollars. When state dollars are eliminated, the loss of federal matching dollars significantly magnifies the negative impact.

Getting it right:

• Reform initiatives vary, but the general theme in today’s health-care environment is to make sure all people get the right care in the right place at the right time. State funding reductions can make this much harder to achieve. Short-term cuts lead to productivity loss and increased system costs: People may delay seeing doctors, skip preventive care, and end up in emergency rooms for conditions that could have been caught earlier and handled less expensively. And it almost certainly leads to diminished health for our state’s most vulnerable residents who cannot access needed services.

It’s one system:

• Some see state health care as a two-tier system and believe state funding only impacts underserved residents and “safety-net” providers. In truth, we are one system serving all residents. Health care comes with high fixed costs due to its complex and sophisticated institutions, its workforce training and education, and its rigorous processes that aim to ensure ongoing quality. This makes it very difficult to scale up and down with budget gyrations.

A key area where state investments impact our citizens is the healthcare workforce. Not only is our state growing — it’s growing older. Baby Boom doctors and nurses are retiring, and right now there are not enough resident training positions in our state to meet the demand for care. We need to train more physicians to increase access to care. Reductions in state programs that pay for workforce training can lead to shortages of physicians and nurses. In fact, it is estimated there will be a shortage of nearly 1,700 primary care physicians in Washington by 2030, hitting underserved rural communities the most.

When it comes to our health-care system, we ask legislators to consider how each move weighs on other parts of the budget. The Washington state health-care community stands ready to work with lawmakers to help craft an acceptable plan that sustains and accelerates the innovation and improvement that is under way.