By Don C. Brunell, President, Association of Washington Business

One of the major provisions in the federal health reform law calls on states to establish health insurance exchanges by 2014. These exchanges were envisioned as virtual “open air markets,” managed by new state agencies, where consumers could compare insurance offerings and choose the best health coverage at the best price.

Good idea. But early indications are that states are using the exchanges to create their own vision of health-care reform, including everything from cross-state competition to single payer, government-run health care.

Massachusetts created its own insurance exchange of sorts in 2006 when it established the “Connector,” a public authority that acted as an insurance broker to offer private insurance plans to residents. Under the state’s universal coverage law, residents are required to purchase health insurance, and the Connector was set up to help people find the right policy.

But the devil, as they say, is in the details. Private insurers complain that rules and regulations have made it virtually impossible to survive economically in the state. Recently, the Boston Herald reported that a senior state health-care official suggested that Massachusetts might be better off with a state-run single-payer health-care system.

In Vermont, state-run, single-payer health care is also part of the plan as lawmakers set up that state’s insurance exchange. The bill, which would set up a state panel to design a benefits package, is openly acknowledged as the first step in Gov. Peter Shumlin’s plan to establish single-payer health care in Vermont.

In Connecticut, the proposed SustiNet program would create a state-run public option to offer health insurance coverage in direct competition with the private insurers on that state’s insurance exchange.

Ironically, the highly controversial public option that nearly derailed the national health reform law is quietly reappearing in states across the nation as state legislatures design the insurance exchanges required by the federal law.

In the meantime, lawmakers in 13 states have proposed state compacts that would allow residents to shop for health care in other compact states. The option to purchase health care across state lines, which supporters say will increase competition and lower prices, was not included in the federal health reform law.

What’s happening here in Washington state? While the insurance exchanges don’t have to be in place until 2014, state lawmakers passed legislation this session that establishes an exchange in Washington, but without any form, function or financing — all those details would be decided later. That’s problematic, because all the research to date indicates state exchanges — which are in essence new state bureaucracies — will cost taxpayers millions of dollars.

The vote was eerily reminiscent of the rushed federal health-reform vote when then-House Speaker Nancy Pelosi, D-Calif., said, “We have to pass the bill so you can find out what is in it.” Washington state lawmakers quickly passed an empty shell instead of waiting a few months until the analysis of the form, scope and projected cost of our state exchange was released in December. One has to wonder, what’s the hurry?

This situation bears watching. While no one knows for sure what our state exchange will look like or what it will cost, one thing is certain: The decisions made in the Legislature over the next two years will affect the health care of every man, woman and child in Washington state.

About the Author

Don Brunell is the president of the Association of Washington Business. Formed in 1904, the Association of Washington Business is Washington’s oldest and largest statewide business association, and includes more than 7,400 members representing 650,000 employees. AWB serves as both the state’s chamber of commerce and the manufacturing and technology association. While its membership includes major employers like Boeing, Microsoft and Weyerhaeuser, 90 percent of AWB members employ fewer than 100 people. More than half of AWB’s members employ fewer than 10. For more about AWB, visit

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