Should the Legislature bring universal health care to Washington?

Feb. 19--OLYMPIA -- Universal health care, three words on the lips of many Democratic voters, has gained some traction among state legislators.

And yet it remains a distant possibility for the state.

After campaigning last year on expanding and improving medical coverage, Democratic state lawmakers are introducing bills to make substantial health-care changes.

But the proposals for universal health care also come as Democratic lawmakers and Gov. Jay Inslee consider more modest and some say practical legislation for a "public option" plan for people who buy insurance on Washington's health-benefit exchange.

The proposals are not necessarily mutually exclusive. But lawmakers have limited time, political capital and money to put toward priorities in this year's regularly scheduled 105-day legislative session.

And the two approaches highlight a debate within the Democratic Party -- one that's playing out around the nation -- on how to reshape the health-care system.

"Do we stand up what's not working in the Affordable Care Act?" said Sen. David Frockt, D-Seattle, adding later: "But at the same time, how do you move into a transformational direction into some kind of universal system?"

He called the question "a complicated issue for Democrats."

On Monday, the Senate Health & Long Term Care Committee gave a public hearing to Senate Bill 5822, sponsored by Sen. Emily Randall, D-Bremerton.

It would form a work group with consumers, health-care providers, insurance companies and others to study how a universal health-care system could be created here.

The work group wouldn't have to report its recommendations until November 2020, after that year's elections. Lawmakers would then have to figure out how to pay for the program, which could be prohibitively expensive.

Randall's bill has 14 Democratic co-sponsors -- meaning more than half of the Senate Democratic caucus has signed onto it.

"I think we heard over and over that people are drowning in our current situation," said Randall after Monday's hearing.

Lawmakers are already scheduled in June to receive the final report of a state study on universal health care. But Randall says the work group in her bill would bring together groups to find agreement on how best to actually implement universal coverage.

Otherwise, "We could have the best policy but not have the political buy-in to pass it," said Randall.

Meanwhile, Senate Bill 5222, a proposal by Democratic state Sen. Bob Hasegawa this year to create a form of universal health coverage, has not yet gotten a legislative hearing.

Inslee, who is considering a run for president, on Monday was cool to the prospect of implementing universal coverage anytime soon. He said lawmakers should concentrate on a public option because, "It's something that's achievable now."

"And I'd like to make progress now," said Inslee in a regularly scheduled news conference. He has previously described his proposal as a "first step" toward universal coverage.

The public-option legislation is intended to stabilize the exchange, which has experienced double-digit premium increases and efforts by congressional Republicans and President Donald Trump to roll back the Affordable Care Act.

Currently, 14 Washington counties have just one insurance option on the exchange. Those are: Asotin, Chelan, Clallam, Douglas, Ferry, Garfield, Grays Harbor, Island, Okanogan, Pacific, Pend Oreille, San Juan, Skagit and Wahkiakum counties.

The Senate version, SB 5526, requires the state to create a standardized insurance plan, and contract with health-care insurance providers to offer those plans. The proposal also requires the state to develop a plan to provide subsidies that would help low-income people afford premiums.

SB 5526 -- which counts Randall as a co-sponsor -- also got a public hearing Monday. Its counterpart in the House, HB 1523, has already cleared a committee vote.

Sen. Steve O'Ban, R-University Place, said he's open to a public-option proposal. But he's worried a public option might hurt other parts of the insurance market, such as private coverage, or people who depend on Medicaid.

"There's no question there's a problem there," said O'Ban, ranking Republican on the Senate Health & Long Term Care Committee, referring to the counties with just one health plan on the exchange.

But the health-care system, "just seems like the proverbial balloon, you push it in one area and it becomes a problem on the other end," he added.

O'Ban said he had "serious reservations" for any universal-care proposal that leads to a single-payer health-care system.

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