A quick read of the 2022 legislative study will illustrate how implausible this is. (Link on the OPS website)
It assumes many waivers, consents and adjustments from Medicare, medicaid, aca etc to keep federal funds flowing at the same rates for current enrollees, and additional funding for newly covered folks.
It assumes essentially all practicioners will accept a single payment schedule and billing criteria set by the state. While aggregate compensation is nearly the same, individual practices will be higher and lower. I'm sure the losers will be fine transferring some of their current income to others.
It assumes that eliminating co pays and deductibles only increases usage by 2%.
Proposed funding is a 7.5 to 10.25% payroll tax and an 8.2% income tax. Boom times for McMansion builders in Clark County. These are high enough rates, when added to the current 9.9% rate to get a significant number of high income folks to start working remotely in WA and NV.
The state has to balance its budget every year. How does it adjust for a recession, and a drop in income and payroll taxes, or a bad flu year, and higher spending.?
The total spend in 2026 was forecast at $55billion. Millions of individual payments to providers. How on earth would it scale that kind of system? Anyone try and get unemployment straightened out during the pandemic?
Finally every dollar of that 55 billion currently goes to somebody. They will each figure out if they are better, or worse off under the proposal. Those who expect make less will descend on Salem with pitchforks and cash. The polite lobbyist version of "Plata o plomo"
It's an interesting thought experiment, but color me skeptical. (Not a fan of the current system. Unfortunately, reforms can't start from scratch, they have to start from here.)
Not exactly. More like you are rearranging the flow of $55 billion annually. While total is similar to what we are spending now, there will winners and losers, and you should expect the losers to fight hard. If you don't have a politics plan for how you overcome those objections, I don't see how it happens.
Separately, I'm skeptical of the state's capacity to administer a program of this size effectively. The annual general fund budget is $16B. This is 3 times as large. With that much money flowing, they will need good fraud and abuse control, and resist special pleading from worthy causes that just want a little piece of $55B.
I'd point to homelessness and addiction as areas that we all agree are important and urgent, and where it's tough to find much evidence of an effective response.
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u/505ismagic 3d ago
A quick read of the 2022 legislative study will illustrate how implausible this is. (Link on the OPS website)
It assumes many waivers, consents and adjustments from Medicare, medicaid, aca etc to keep federal funds flowing at the same rates for current enrollees, and additional funding for newly covered folks.
It assumes essentially all practicioners will accept a single payment schedule and billing criteria set by the state. While aggregate compensation is nearly the same, individual practices will be higher and lower. I'm sure the losers will be fine transferring some of their current income to others.
It assumes that eliminating co pays and deductibles only increases usage by 2%.
Proposed funding is a 7.5 to 10.25% payroll tax and an 8.2% income tax. Boom times for McMansion builders in Clark County. These are high enough rates, when added to the current 9.9% rate to get a significant number of high income folks to start working remotely in WA and NV.
The state has to balance its budget every year. How does it adjust for a recession, and a drop in income and payroll taxes, or a bad flu year, and higher spending.?
The total spend in 2026 was forecast at $55billion. Millions of individual payments to providers. How on earth would it scale that kind of system? Anyone try and get unemployment straightened out during the pandemic?
Finally every dollar of that 55 billion currently goes to somebody. They will each figure out if they are better, or worse off under the proposal. Those who expect make less will descend on Salem with pitchforks and cash. The polite lobbyist version of "Plata o plomo"
It's an interesting thought experiment, but color me skeptical. (Not a fan of the current system. Unfortunately, reforms can't start from scratch, they have to start from here.)