Issue Position: Health Care

Issue Position

As a member of the Senate Committee on Finance, Maria has worked to ensure that Washingtonians have access to low-cost, high-quality health care. Maria has fought to strengthen health care for all by focusing on rewarding providers for quality outcomes, rather than the quantity of services delivered. This focus helps to encourage efficient, coordinated, patient-driven health care. Maria has also worked to increase access to care for rural and underserved areas in Washington, as well as improve access to care for Medicare enrollees. Maria's efforts are helping to provide better care at a lower cost for all.

IMPROVING QUALITY OF CARE

For too long the Medicare system rewarded doctors for ordering redundant, unnecessary tests that drive up health care costs for all. This system of over-using services leaves Medicare enrollees to foot costly bills. Maria has worked to reverse the backwards payment system and encourage patient-focused care that drives down consumer costs.

Washington state has been a leader in providing efficient, high-quality care; yet for years Washington's Medicare providers were not rewarded for those practices because the previous system valued quantity over quality and penalized Washington's efficient care model. Maria's 2010 provision reverses this flawed formula, by incentivizing, rather than discouraging excellent, patient-focused care in Washington state and nationwide. Maria's efforts will help fix Washington's low Medicare reimbursement rates, making it easier for seniors to find new Medicare providers, while also helping to encourage better health care practices nationwide.

"The focus of cutting costs in Medicare is particularly critical to the eventual success of any health care reform. Washington Sen. Maria Cantwell has been among those in the forefront of these efforts." -- Yakima Herald Republic Editorial, 12/29/09

PRIMARY CARE JOBS

Maria has supported Senate efforts to break barriers to graduate medical education, enabling more students to access the training they need to join the Washington healthcare workforce. As a member of the Senate Committee on Finance, Maria championed a provision, which passed as part of the Affordable Care Act in 2010, that provides scholarship incentives and repayment options to encourage more medical students to work as primary care doctors in Washington state, especially in rural and underserved areas. Maria's efforts helped to expand a program originally championed by the late-Senators Scoop Jackson (D-WA) and Warren Magnuson (D-WA) for the National Health Service Corps, which connects primary doctors to rural and underserved areas.

By 2020 the state of Washington will need 40 percent more practicing primary care physicians to meet patient demand, according to a study conducted by the National Association of Community Health Centers. Critical shortage areas exist throughout the state, especially in rural portions of the state including Franklin, Yakima, and Walla Walla counties. Primary care shortages often force residents to turn to expensive specialists or emergency room care for basic health care. Primary care provisions in the Affordable Care Act, which passed with Maria's support, work to reverse this trend and accelerate primary care job growth to meet Washington state's growing patient demand.

Without these provisions to help keep these medical graduates as primary care doctors in the state, eastern Washington could face a shortage of nearly 640 doctors by 2025. Maria's efforts will help to ease primary care shortages by expanding medical education in Spokane. She supports efforts to expand a four-year medical program in Spokane, which could bring as many as 600 medical students to the region, and allow them to remain in the area to practice. To meet growing patient demand, Spokane needs to add 20 primary care doctors per year for the next decade.

USING WASHINGTON'S BASIC HEALTH PLAN AS A MODEL FOR NATIONWIDE COST-SAVINGS

Maria has led efforts to preserve Washington's Basic Health Plan and bring the state's cost-cutting health care model to the national level. When state budget shortfalls threatened to cut Washington's Basic Health Plan (BHP), Maria successfully fought to pass a provision in the Affordable Care Act to keep Basic Health running.

Washington's Basic Health Plan covers tens of thousands of the working poor in Washington state. The Basic Health Program moves to a patient-centered system that encourages better care results and expands access to preventative care services, which drives down costs and improves care for all. Washington's model will help states expand coverage to an underserved population group while driving down costs and still improving quality of care.

Maria's 2010 provision preserved and ultimately expanded Basic Health for Washington, freeing up millions of dollars in the state's budget to maintain other crucial programs and services. States that adopt Washington's Basic Health model will be able to cut costs and significantly increase access to care.

As The Seattle Times noted in an October 2009 editorial, Maria's provision "…fills a vacuum left by Medicaid, which covers individuals with very low incomes. About 75 percent of the uninsured, however, fall in the working-poor range." -- Seattle Times Editorial

Maria has long advocated for more competition among healthcare providers to cut costs for consumers. In 2009 she urged Congress to adopt the model of Washington state's Basic Health Plan. Under this model, individuals purchase their health insurance as a group and the state is able to negotiate directly with insurance companies to ensure the best price for each individual. Maria's Basic Health provision will be 95 percent federally-funded in 2014, and will allow states to implement Washington's successful model--which means more choices, better care, and lower costs.

"That's what the American people want. They want us to stand on their side, drive down the price by buying in bulk and compete with this unrelenting increase in rates that they have seen…" -- Senator Maria Cantwell, 9/9/2009

FIGHTING FOR CHILDREN'S HEALTH CARE

For years Maria fought to fix a funding flaw that, since 1997, penalized Washington for being one of the first states to provide health insurance to children in low-income families.

In 2002 Maria introduced a bill to fix the flaw and expand health care coverage under the Children's Health Insurance Program. She continued to champion year-after-year fixes and introduced legislation in 2006 to help Washington state use even more of its allotment of federal support. At a field hearing in August 2006 with now-Chairman of the Senate Finance Committee Max Baucus (D-MT) to learn about the devastating effect this flaw had for Washington's children, Maria reiterated her support for fixing the problem. Following Maria's lead, both the Senate and the House passed companion legislation that would have expanded the program to cover up to 10 million children nationwide. But President Bush vetoed the bill multiple times.

Two years later, Maria led the Senate to pass her bill, fixing the funding flaw and providing Washington with its fair share of support for children's health care. President Obama, who also understood the importance of the program to children's health, signed the reauthorization in to law in 2009. Maria's "fair share fix" allows Washington to cover 6,000 more children.

The Spokesman Review hailed Maria's bill as "a tremendous gain" and "a long overdue sweetener for Washington state." -- Spokesman Review Editorial, 2/1/09

Maria's SCHIP legislation significantly increased federal commitments to health care coverage for low-income children. Nationwide, Maria's efforts have preserved coverage for as many as 6.7 million children enrolled in CHIP and enabled state programs to expand to cover nearly 4 million additional uninsured children.

"... Last year, out of $79 million in federal funds for children's health care, Washington state was restricted to using only half. Credit Sen. Maria Cantwell for dogged advocacy over the past six years. Cantwell returned congressional session after session to demand SCHIP rules that treated Washington state fairly." -- Seattle Times Editorial, 2/1/09

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