Washington's insurance commissioner will push for universal health coverage

Kreidler concedes he doesn't have all the answers and is still generating numbers. And he's politically pragmatic enough to realize his evolving proposal might be too radical to become law this coming legislative session. "I wouldn't hold my breath for it to pass this January, but I think I'll be having a strong proposal with some substantive numbers to back it up," Kreidler said in a recent interview. If the bill doesn't get through in 2008, Kreidler figures it will have a better shot in '09, or "we could see it on the ballot as an initiative," he said.

But as a former congressman, Kreidler said it is up to states to innovate in the area of comprehensive health-care reform, because it is unlikely federal action will happen any time soon. Currently, there are between 600,000 and 700,000 Washington residents without health insurance.

Melissa Hansen, a research analyst with the National Conference of State Legislatures who keeps track of health-care reform legislation, said only three states – Maine, Massachusetts, and Vermont – have enacted laws to ensure that all residents have health insurance. A number of other states, including California, are looking at the concept.

Under Kreidler's proposal, everyone would be guaranteed benefits "up to Medicare eligibility," he said. His office is working with Milliman, a Seattle-based consulting firm, which is identifying costs under a variety of scenarios, according to Tim Barclay, a principal with the firm.

Basically, Kreidler's plan will consist of two parts: catastrophic coverage and every-day medical care coverage that emphasizes preventive care, including an annual checkup, immunizations, and cancer screenings.

All residents would be obliged to participate but would also be free to supplement those "universal benefits" with additional insurance for care falling in between "catastrophic" and "preventive," including things like routine doctor visits or coverage for accidents like a broken arm.

Kreidler does not envision a cap per year on catastrophic coverage, which can kick in when fees hit $5,000 to $100,000.

"We're still exploring the possible financial mechanisms, as well as the possibility of a sliding scale so people could afford the coverage they need," according to Stephanie Marquis, a spokesperson for the Office of the Insurance Commissioner. A significant byproduct of the proposed system, she added, is that the state-run plan should make general health-care rates from private carriers more attractive.

Scott Forslund, communications director for Premera Blue Cross, agreed that as a general rule rates should be cheaper if consumers buy "just a fender instead of the rest of the car."

Kreidler has outlined his ideas in two recent speeches. According to his talking points, he told audiences the plan would provide a big pool of money to spread risk and lower costs; incentives for employers; portability for employees who switch jobs; consumer choice; and a free marketplace for private carriers. He also called on carriers to manage risk rather than avoid it, and on consumers to take personal responsibility for their health.

Carl Olson, chair of the Kitsap County Democratic Central Committee, who heard Kreidler's universal-health-care presentation last month at a legislative district fundraiser, said it was received well and that attendees were happy to hear from someone "with a real strong vision."

Scott Beckwith, branch manager of the Lacey office of Frontier Bank, who earlier this month heard the presentation Kreidler gave to Olympia Rotarians, said "everyone agrees it's a great concept." But he questioned whether Kreidler has all the pieces in place, including what aspects would be voluntary and who'd be footing the bill.

Added Beckwith: "I don't think small business owners are interested in an additional tax."

Marquis said that Kreidler knows that businesses are "already feeling the acute effects of the health care crisis. He believes our plan will go a long way to alleviate the stress they're feeling from current health-care costs because it manages the highest costs better."

• Peter Lewis is a Seattle freelance writer and former Seattle Times reporter. You can reach him in care of editor@crosscut.com.