This editorial will appear in tomorrow’s print edition.
It helps to have friends in high places.
When President Obama signed the new health care reform package March 23, he was also – thanks to U.S. Sen. Maria Cantwell – throwing a lifeline to Washington’s 23-year-old effort to give medical insurance to the working poor.
That brave and pioneering effort is known as the Basic Health Plan. Originally conceived by U.S. Rep. Jim McDermott when he was a member of the state Senate, it ultimately attracted broad Republican support. When the Legislature transformed it from a pilot project to a permanent program in 1993, the vote was unanimous in both House and Senate.
Considering that the BHP was a pricey social welfare program that captured no matching federal dollars, that unanimity was as close to a miracle as you find in state politics.
The reason for the bipartisan support is worth revisiting in the bitter national argument over the new federal law. GOP lawmakers originally bought into the Basic Health Plan because it reflected fundamental, traditional principles of personal responsibility.
The program’s low, subsidized premiums were designed for Washingtonians who held down jobs but didn’t make enough money to buy health policies at market rates. The working poor, in other words – people whose wages left them ineligible to qualify for the Medicaid coupons that came with welfare.
Part of the idea was to help the poor stay afloat while working. Welfare-dependent families could go to the doctor; why not families who were trying hard to stay off welfare?
That’s also part of the logic behind the national expansion of health coverage under federal health reform. Roughly three-quarters of uninsured Americans could be defined as working poor, earning up to 200 percent of the federal poverty level – for example, into a family of fourgetting by on $44,112 a year or less.
On such incomes parents must choose between paying the rent and buying groceries or paying health premiums. Insurance nearly always takes a back seat to shelter and food.
America provides coverage for the non-working poor, and even the most conservative Republicans seem OK with that. The argument for offering affordable insurance to those who work seems at least as strong.
Washington’s Basic Health Plan eventually fell on hard times because its costs rose faster than expected and the Legislature found it increasingly hard to cover those costs. Last year, amid a brutal fiscal crisis, lawmakers took a meat ax to the program, cutting it by 40 percent and forcing tens of thousands off its rolls.
A provision Cantwell shoehorned into the congressional legislation will allow Washington to secure federal money to keep the BHP going until the reforms take effect in 2014.
On a more cautionary note, the history of the Basic Health Plan also shows what can go wrong with publicly subsidized insurance. Over the years, its administrators got sloppy and overly generous – not rigorously checking whether enrollees met the income guidelines, for example.
A lax attitude toward costs helped pull the BHP into fiscal and political crisis. Precisely the same has been happening to Medicare. The federal expansion of health insurance will meet the same fate if no one is minding the bottom line.