The Washington State House of Representatives has passed a simple bill, a public option for health insurance that would be available to all Washington Staten residents. The Program is called “Cascade Care.”
“Cascade Care” may be exactly the alternative to the “Medicare for All” options being pushed nationally. Flying the banner of Progressives, Senator Bernie Sanders and Representative Pramila Jayapal want to extend Medicare to cover all Americans just as it now covers those of us over 65. Bernie and Pramila, Senator Sanders from Vermont and Representative Jayapal from Seattle, have offered legislation see Medicare for All as a simple .. fix for America’s health issues.
The idea is simple, however, Medicare for All is based on the claim that Medicare is cheaper than private care. The premise is false because Medicare is heavily subsidized by cost shifting. Under Medicare, health care providers, drug companies, hospitals, and physicians, lose money on Medicare but make it up by higher fees negotiated with private 
insurance plans.
Now the Washington House of Representatives has passed a simple bill, a public option for health insurance. The plan, called Cascade Care, ix patterned after the state employee insurance program called “Uniform.” Uniform saves money because private insurers need to pay private underwriters a fee to ensure that money is available to pay for the patient’s costs. Having the state underwrite insurance saves money. Patterned after the existing Washington State employees’ insurance, Uniform, Cascade Care would contract with one or more private companies to offer the plans. Uniform is currently administered by Regence but is able to cost less because Uniform is underwritten by the State. The state uses Regence because the private firm simply costs less than the state would have to pay if it created its own agency.
Under Cascade Care, citizens of Washington would buy Cascade Care on the state’s health plan website, just like any private plan. However, Cascade would be subsidized for families making less than $62,000 for anyone not having an alternative source of coverage, presumably including employers or Medicaid. Like Uniform, Cascade would be able to negotiate with health care providers …. doctors, hospitals and drug companies.
It is not yet clear whether all providers in Washington would be required to accept the State reimbursements as, I assume would be the case nationally under Medicare for All.
Opponents of Cascade rightfully worry that payment rates proposed by Cascade Care patients could be too low. This is a major concern for Medicare already. Fees offered by the Federal plan for the elderly can be as low as 10 to 20% less than the prevailing fees paid by private insurance. As a result, bankruptcy is a very real issue, especially for rural hospitals. Also, many physicians refuse to accept Medicare. Even though providers can opt out of Medicare, the force of the Federal government and the sheer size of the Medicare population means most hospitals, but not all doctors, accept Medicare and subsidize their losses by increasing charges to private insurance companies.