The proposal would create a state insurance option that would be offered at a discounted rate to some. It would also require officials to plan expanded state subsidies for private insurance, including for part of the middle class.

Share story

OLYMPIA — Gov. Jay Inslee’s proposal for a limited public health care option cleared the state House of Representatives on Friday, advancing what he has called the most practical option for expanding health coverage — and bringing to Washington state a national debate over what universal health care means.

The proposal would create a state insurance option that would be offered at a discounted rate to some. It would also require officials to plan expanded state subsidies for private insurance, including for part of the state’s middle class.

The bill calls for state plans by 2021, but rather than providing them directly to consumers, the state would contract with one or more private companies to offer the plans. The state would determine the outlines of the plan, while the company would handle the work of enrolling customers and paying out claims.

That plunges the state into a national debate over the future of health care, and especially the meaning of universal health care, a phrase used by most of the Democratic hopefuls in the 2020 presidential election. Inslee declared his candidacy in that race March 1.

Broadly, conservatives have resisted calls to involve state or federal governments in providing health care, while moderates have called for making private health care more affordable. Some further to the left have advocated removing private insurers from the equation entirely.

“The left thinks it doesn’t go far enough, but the right thinks it’s socialized medicine,” said Rep. Eileen Cody, the Seattle Democrat who sponsored the House version of the bill at Inslee’s request.

Speaking at a news conference the day before the vote, Inslee called the bill an achievable goal, but he did not elaborate on the role of private insurers or the government.

Although available to all residents, the cost of the public option — dubbed Cascade Care — would be based on sliding subsidies, meaning that for some it would be cheaper than private insurance but for others it might offer no cost savings.

Residents would buy Cascade Care on the state’s health plan website, just like any other plan.

The expanded subsidies would be similarly tied to an income threshold — 500 percent of the federal poverty line, or about $62,000. Around two-thirds of Washington residents make that much or less, including some in the state’s middle class. But the subsidy would only be available to those with no other source of coverage.

In the state Capitol, the bill has provoked argument that mirrors the national debate.

On the House floor Friday, Republican lawmakers warned that government intervention would destabilize the state’s health care market, and especially that the payment rates proposed for doctors treating Cascade Care patients were too low.

“This is an illusion of care,” said Rep. Joe Schmick, a Colfax Republican and the ranking member of the House Health Care and Wellness committee.

As it stands, he said, providers often take a mix of Medicaid or Medicare patients and patients with private insurance, with the higher-paying private plans balancing out the lower-paying public ones. Letting more people shift to lower-paying public plans would throw off that balance, and the lower rates could ultimately lead to fewer available doctors, he said.

Meanwhile, a Democratic lawmaker had introduced an alternative plan on the other end of the spectrum: Single-payer health care, run by the state, an idea Cody and others have noted has some backers.

After Friday’s vote, however, Cody resisted both arguments.

Unbalancing the market shouldn’t be a problem, she said, because Cascade Care targets only people not already covered by employers’ plans or low-income subsidies, who instead buy individual insurance themselves, directly from insurers. Cody put that group at about 4 percent of the state.

At the same time, Cody also said she also saw good reason not to shoot for a completely government-run plan right away.

While plans run by private insurers — including a state-contracted plan — qualify for federal subsidies, a plan run by the state would not, which would mean the state would have to pay a much larger share of the costs.

“It’s too much money,” Cody said.