2021 Federal Public Policy Agenda
The Washington State Hospital Association’s federal public policy agenda guides the association’s congressional and regulatory advocacy activities. This agenda identifies public policies that enable hospitals and health systems to meet the challenges they face in serving the health needs of their communities.
WSHA’s public policy advocacy is focused on the following areas:
- Providing adequate resources for hospital and public health response to public health emergencies such as COVID-19;
- Increasing the number of Washington residents with health coverage;
- Ensuring access to high-quality services in all areas of the state;
- Transforming the delivery system to reward quality and greater value for dollars spent on care;
- Educating and training an adequate supply of health care professionals;
- Enhancing equitable care; and
- Taking steps toward a commonsense approach to health care regulation that ensures accountability while allowing for flexibility to support a transforming health care system.
Increase health care coverage
WSHA is committed to the goal of affordable, comprehensive health insurance for every resident of our state.
Washington state has made significant gains toward achieving this goal through Medicaid expansion, its health insurance exchange and other policies enacted in the Affordable Care Act (ACA). As a result, our state’s uninsured rate has declined significantly. We support the provisions of The American Rescue Plan Act that expands the opportunities for coverage through the ACA health insurance exchanges.
More can and must be done for patients. WSHA supports building on the foundation created by the ACA as we seek to further decrease the uninsured rate. Specifically, Congress and the Department of Health and Human Services should:
- Build on the coverage expansion in the American Rescue Plan Act and take steps to continue to expand subsidies to ensure affordability in health insurance marketplace plans;
- Rescind or withdraw policies that could limit coverage to BIPOC and historically targeted communities such as the Public Charge Rule;
- Increase access and funding for behavioral health services;
- Preserve and strengthen the Medicaid program; and
- Repeal the June 2020 final rule that narrowed non-discrimination protections under Section 1557 of the Affordable Care Act.
Advance access to high-quality services
WSHA is committed to preserving access to high-quality health care services in communities – from the largest to the smallest – across our state. The first step toward achieving this goal is to protect vital federal programs that provide coverage to Washington state residents, including Medicare, Medicaid, the Children’s Health Insurance Program, the Veterans Administration and the Indian Health Service.
A second and equally important step is to ensure payments for services are adequate. WSHA supports:
- Ensuring fair and adequate reimbursement;
- Preserving the 340B program and slowing the growth of the cost of prescription drugs;
- Encouraging and supporting efforts to increase the behavioral health work force;
- Expanding broadband coverage and telehealth services and supporting health information technology; and
- Reinstating the inpatient-only list from Medicare.
Specifically, WSHA opposes:
- Enacting site neutral payment policies, which ignore the reality that hospital-based outpatient departments and clinics comply with far more extensive – and costly – regulatory requirements than physician offices or ambulatory surgery centers. Hospital departments and clinics also serve sicker, older and more low-income patients. In many communities, these departments and clinics are the only source of care for Medicare and Medicaid patients.
- Making other cuts in the Medicare program, such as reductions in Medicare bad debt payments and in graduate medical education.
- Enacting Medicaid payment policies aimed at reducing funding to providers, such as adopting block-grants and restricting the use of provider assessments.
Principles governing efforts to ensure access in rural areas include:
- Promoting new models for the delivery of care to sustain access to vital services and address the social determinants of health;
- Restoring adequate payment rates to provider based Rural Health Clinics;
- Designing a delivery system that fits the circumstances of unique communities, including alternative payment models for rural communities; and
- Removing regulatory burdens, such as the 96-hour length-of-stay rule.
Transform the delivery system
WSHA is committed to delivery system reforms that reward quality and greater value for the dollars spent on care. We stand for providing care in an equitable, coordinated manner; we stand for focusing on prevention and wellness; and we stand for putting our patients and their families at the center of care. This includes support for proposals specifically aimed at addressing structural inequity in the health system.
For this effort to continue, existing barriers must also be addressed. Specific actions we support include:
- Enacting provisions included in the Momnibus Act of 2021;
- Enhancing the coordination of care by reforming 42 CFR Part 2 regulations with HIPAA to allow the responsible sharing of substance use disorder treatment records;
- Developing new alternative payment models;
- Removing barriers to integration (such as modernizing the Stark Law); and
- Making investments in the health care infrastructure.
Grow the work force
WSHA is committed to ensuring an adequate supply of health care professionals and other staff. A major investment in training new physicians, nurses and other health care professionals is critical. Investment in the behavioral health work force is also crucial.
In the long-term, this means growing the number of primary care residency training programs, support for efforts to increase diversity in the workforce, expanding nurse training opportunities and investing in training programs for other key health care workers.
In the short-term, this means strengthening the National Health Service Corps, the Teaching Health Centers program, nurse work force development programs, and the Conrad State 30 J-1 Visa Program. It also means expanding licensing reciprocity through proposals such as the TREAT Act.
Enhance equitable care
WSHA is committed to supporting the delivery of equitable health care services via policy and funding initiatives aimed at addressing structural inequities in our health care system and society. A number of areas for action mentioned previously in this document impact the equity of care including:
- Expanded access and insurance coverage;
- Support for rural health care;
- Elimination of regulations that deter patients from seeking care such as the public charge rule;
- Momnibus Act of 2021; and
- Increased diversity in the health work force
Ensure commonsense regulations
WSHA is committed to working toward commonsense regulations that protect patient safety and enhance quality while not overburdening providers. Regulatory compliance is a growing cost in hospitals, forcing hospitals to hire additional staff that often do not add value to patient care. The COVID-19 Public Health Emergency has provided an opportunity to reevaluate the utility of many regulations that do not support access to patient centered care. Hospitals and the health systems provided high-quality services under extreme stress with a significantly slimmed-down regulatory structure.
However, more can be done. In this regard, WSHA endorses efforts by the American Hospital Association to identify specific regulatory barriers that should be eliminated.