Washington's new health insurance rules don't add up to access (guest column)

Dyman Associates Insurance Group of Companies:


Scott Bond and Dale Reisner, Washington State Hospital Association and Washington State Medical Association

More than half a million people have newly enrolled in health insurance in our state. This is cause for celebration. People now have the security of knowing that if they get sick or injured they will not be devastated financially.

But insurance and access to health care are two different things. Will insurance companies contract with enough hospitals and physicians to serve all of these people — to provide the in-network care that people rightly expect?

Our state’s insurance commissioner, Mike Kreidler, is grappling with this question right now. Kreidler’s job is to ensure that health insurance is meaningful for consumers, so they can find a doctor and get the care they need. If you get sick, you need care, preferably at your physician’s office or local hospital. If you have to travel long distances to get this care, will you feel you are truly covered? If you cannot get to the right specialists for a potentially life-threatening condition, will you be satisfied with your coverage?

Kreidler is finalizing regulations defining minimal standards for access to care. But these proposed regulations fail to guarantee access to care; in fact, they may be a license to reduce access. Although these 27 pages of regulations set out specific requirements for access to in-network providers, they also contain huge loopholes. These loopholes allow insurance companies to be exempt from the new requirements without providing meaningful proof that they tried to bring facilities and providers into their network.

We know the system needs to innovate. Washington state’s hospitals, medical groups, clinics and individual physicians are using new ways to reduce costs. But we also need minimal standards to protect the consumer.

All Washington residents should have insurance plans that meet minimal standards for access to care. Obviously, there will be times when exceptions are needed. But shouldn’t we hope that rural residents can access care locally, or that people can get to the right specialists when someone is seriously ill?

The insurance companies are not happy with these regulations, either. The fact that both sides dislike these rules suggests they do not represent a reasonable compromise. The commissioner’s office has rushed these rules through so they will apply in 2015. This is unfortunate, because we need to get this right. The insurance commissioner should take more time to work on these rules to ensure that everyone who now has health coverage can get the care they need and expect.

Hospitals and physicians in our state have waited a long time for health care reform. We are delighted this day has come. But we want everyone who now has insurance to get the care they need so they can truly be on a path to a healthy life.

Scott Bond is president and CEO of the Washington State Hospital Association. Dr. Dale Reisner is president of the Washington State Medical Association, which represents physicians.