With lives in the balance, voters should decide the fate of the Basic Health Plan

TWENTY years ago, Washington created the Basic Health Plan (BHP) to provide reasonable health care for people who work for employers that do not offer them insurance and do not pay enough for them to afford to buy individual coverage on the market. The BHP is partly financed by income-adjusted premiums paid by participants, and since 2002, partly by a voter-approved tax on cigarettes.

Today, facing a massive revenue shortfall thanks to the recession, lawmakers are weighing whether to shut down the BHP entirely. The consequences of doing so were vividly described by Times reporter Carol Ostrom's story ["Amid budget crisis, hard health-care decisions: Where to cut?" Jan 13]. The loss would not only threaten people's health, but their very lives. And it would eliminate a program that will be fundamental for the state's participation in national health-care reform in 2014.

The irony is that the BHP, while financed by direct-user payments and a voter-approved tax, faces closure. Meanwhile, our state is forgoing billions in tax revenue through hundreds of corporate tax loopholes and exemptions that voters never approved in the first place, and that haven't been seriously re-examined since.

Is every tax break bad policy? Not necessarily. But each one reduces vital tax receipts, so at the very least they should be examined very closely — and very often — to answer the question: "Is this special treatment more important to the common interest than the pain of a steep budget cut?"

Of course, every tax break has its defenders. That's why, between political inertia and strong lobbying efforts, it's unlikely we'll see legislative action to take them off the books. But there is an alternative to status quo gridlock: Put the choice to a vote of the people via referendum, starting with funding for the Basic Health Plan.

Here's why — and how — it could work. First, a referendum requires only a simple legislative majority to be put on the ballot. Second, the BHP is currently funded until this May; an April vote would be both feasible and timely. Third, it gives citizens a clear choice about public priorities: spend money on tax breaks, or to ensure our lowest-paid people can live healthy and productive lives?

Two examples: Washington currently offers a business-and-occupations (B&O) tax deduction by nonfinancial firms for interest, dividends and capital-gains income unrelated to their business — it costs taxpayers $442 million in lost revenue. There's also a sales-tax deduction on the books for items used in interstate commerce, such as fuel (taxed in many states) worth $609 million.

Eliminating the first would fully fund the BHP; eliminating the second would also take many of the more than 100,000 people eligible for the BHP off the program's waitlist.

Most nations in the industrialized world — and a good number of developing countries — have found a way to ensure all citizens have access to basic and preventive health care. Each country has its own system — ranging from highly regulated and tightly controlled private insurance systems to single-payer public systems. But in every case, those systems are based on the notion that ensuring everyone has affordable health care is not just economically rational, but also a morally responsible act.

That's why, with the health and well-being of thousands of our neighbors hanging in the balance, Washington voters should be the ones to decide the fate of the BHP.