Tracking the implications of federal health-care reform for Washington

Seven days after President Obama's impassioned speech for health-care reform, the Senate Finance Committee produced a controversial bill for review. America is ready and eager for details.

The legislation unveiled Wednesday mandates Americans carry health insurance, creates exchanges for small groups and individuals to buy policies, and would outlaw odious practices insurers use to deny coverage.

Chief among those poring over the arcana of health-insurance language are state lawmakers anxious to avoid losing ground as the country moves ahead.

Much of the heavy lifting to ensure Americans eventually receive comprehensive health-insurance coverage will happen in state capitols.

Remember the bedlam at Rep. Rick Larsen's health-care rally early last month in Everett? Thousands turned out to Memorial Stadium to wave signs, exchange insults and try to influence a congressman with a vote on federal legislation.

Great political theater, but the human quotient of the debate was more clearly revealed in a series of quieter town-hall sessions hosted around Washington by two state legislators. Twelve days after Larsen's policy mosh pit, state Sen. Karen Keiser and state Rep. Eileen Cody met with five dozen people in the Snohomish County administration building a mile away.

Keiser and Cody each chair key health policy committees in Olympia, and they are political pros. With one subtle change, they calmed the tempo and temperature of the public forum: Questions had to be in writing. So much for grandstanding.

Two emotions were apparent that evening. People were confused and frightened. Confused by dueling media sound bites, and just plain fearful of losing coverage and the financial devastation of becoming ill without it.

Keiser's work on health care has taken her to Capitol Hill and both lawmakers are wired into White House organizing efforts to explain the proposed changes to ordinary people beyond the Beltway.

In later conversations, Keiser, a Democrat from Kent, makes it plain she does not want gains made by Washington state eroded by so-called reforms in the other Washington. She wants to maintain flexibility and local prerogatives — a uniform floor across the states, not a ceiling in any new federal regulations. Premiums are directly affected by insurance standards.

Progressive Washington already forbids gender discrimination in rates and coverage, and extends coverage for children through age 26. The Senate bill seeks to catch up.

Keiser said mandated insurance coverage is part of doing away with pre-existing conditions, caps on coverage and recisions — predatory record screenings to annul coverage. Risk has to be spread across the population to get insurance company support. In Washington, think 856,000 new customers.

Keiser looks to health-care-reform legislation to refigure Medicaid and Medicare reimbursement rates. This state's efforts to keep costs down and quality high came at a price. Currently, Medicare rewards high-costs states such as Texas and Florida.

Washington has an assessment program to compare new and existing health technology. An attempt to tamp down the "Gee whiz" effect, and measure results and dollars-and-cents value.

Keiser sees a serious problem ahead with the availability of primary-care providers. Debt-ridden new doctors are not drawn to family practice because it does not pay as well as health-care specialties. The problem speaks volumes about the current system of keeping Americans healthy.

For now, all the action is in D.C., but Keiser, Cody and others are parsing the reforms to see how they will actually work close to home.

Lance Dickie's column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com