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Q&A: Senator Karen Keiser on health policy in 2021

Senator Karen Keiser represents Washington’s 33rd Legislative District, which contains cities south of Seattle, including Des Moines, Seatac, Kent, and Burien. She presides over the Senate as President Pro Tempore and is chair of the Senate Labor and Commerce Committee.

She is also a longtime member and former chair of the Senate Health and Long-term Care Committee. In this Q&A, she talks about the 2021 session and upcoming health policy in Washington.

Sydney Kurle: What are your plans and goals for health care policy in the 2021 legislative session?

Sen. Karen Keiser: The 2021 session is going to be tough because it’s a virtual session, and we’ve never had that situation before. I have two bills that will be oriented towards the health care committee, and I have one that’s in [the] labor [committee]. These are my top goals for the 2021 session, and I’ll tell you what they are:

One is called health equity zones [SB 5052]. It’s patterned on a program in Rhode Island that’s very successful. It is to address the issue that we keep hearing over and over and over again about how communities of color have all these health disparities. Whether it’s COVID, whether it’s diabetes, whether it’s high blood pressure, over and over. But the next step never seems to be taken, so health equity zones has the state department of health establish a statewide program, starting with some pilot programs, that will identify geographically contiguous areas that are identified by data as having under-performing health outcomes for preterm birth, maternal complications, chronic health conditions, and COVID. It’s going to jump out at you because there are all kinds of communities of color, and it just so happens that my district, the 33rd district, has a lot of those communities that are suffering those maladies. So the idea is that we would have a focus on the communities and build community capacity and build trust, community communication, outreach with community leaders. People who are on the grassroots level in these communities who we can work with to get the information out about health care needs, health care access and health care treatments. We just have to get underway with a program, a more active activist approach, and this is my attempt. So I’m hoping that we get this established in the upcoming session, and I’m certainly not inflexible about it. I’m certainly willing to negotiate on it. 

My second bill has to do with prescription drugs [SB 5020]. This week my bill for insulin cost copay limits went into effect, and as of January 1 no patient who has diabetes will have to pay more than $100 out-of-pocket for their insulin. Whether they need one vial of insulin a month or four, it’s $100 maximum. That is sort of the poster child for some of the issues we have with prescription drug prices. I have another bill going forward this session on prescription drug prices that looks at unsupported price increases. Price increases of a drug that’s been in the market for some time, that are not supported by new research, by new clinical trials, by new formulations, that is the same drug as it was two years ago, but somehow it is twice as expensive. And there are many of those. What [this bill] does is it imposes a tax on the excessive cost increase, of the increase of the cost over the price of the drug and it could produce some significant revenue, because the price increases are so big.

SK: And the third bill?

KK: My third piece is the one that’s going to my Labor and Commerce Committee. I call that one my HELSA bill, and that’s the Health Emergency Labor Standards Act, and it has to do with essential workers. Especially the low wage workers, who are in this health emergency of COVID and really have so little protections. They have no legal right to demand Personal Protective Equipment. They have no real defense against retaliation if they talk about workplace health standards that are not up to par or if they put a complaint out on Facebook.They could be fired over it, and it’s happened. It also requires employers to provide childcare leave for workers when there is no school and no childcare available. It allows for expanded sick leave for essential workers who are exposed. For example, EMT’s are exposed repeatedly to COVID cases, each time you’re exposed you have to quarantine. Your sick leave is eaten up after your first or second exposure, and I know people who have had five exposures! So what are they supposed to live on, because they don’t get a [sick] wage?… And then it also provides presumptive workers compensation coverage for essential workers who get sick, what that means is they don’t have to worry about their medical coverage if they didn’t have health care, and they don’t have to worry about their income because they have time lost payments from workers compensation. So that takes away a lot of anxiety, for all the tens of thousands of people who are getting up and going to work everyday and facing the public. They really have a high level of anxiety that needs to be addressed. 

A secondary priority of mine is the public health system because in our state we have four different public health districts without any leadership. They’ve either been fired or resigned and there’s a lot of political pressure on our public health leadership under this COVID controversy. Especially when politicians, like in Pierce County recently, try to take over the public health district. 

These are all pieces of the puzzle. Then we have this overarching crisis which is we have a half million people out of work. Most people get their health care insurance from their jobs, so most of those people have to go on the exchange or on Medicaid. We’re keeping an eye on the numbers but a lot of people are going on the exchange and they apply and they look at the cost and they don’t follow through and buy the insurance. So they’re going without care, without coverage, which is a very dangerous position to be in when you’re not working and there is COVID all over the place. So is there enough to worry about? Oh yeah!”

SK: For people that are buying on the health exchange, is there talk of creating a true public option in Washington, especially when so many people cannot afford care?

KK: I know that Cascade Care is functioning, and that’s better than nothing, having a standardized plan. But I still think that our current exchange is way too complex and confusing. It needs to be simplified and a public option could offer some simplification I think for people to default to that if they can’t make up their minds and end up in the public option program. Which I think would make a whole lot of sense personally. But we will see if that actually gets to fruition, but maybe under this new Biden administration we will have more of a green light approach to things like that. I hope so.”

SK: You are sponsoring SJR 8200 which deals with the Long Term Care Trust. This got rejected this last year by voters. What, in your opinion, has changed, and why would voters be more willing to pass it this year?

KK: I think we could put more attention on the issue in 2021. I think it got lost in all the weeds of all the political controversies in 2020. And of course COVID, making everybody anxious about anything. But if we don’t pass this, if we don’t invest the trust funds in what is the same program that our pension program is invested in, we will have to put that money into very low interest treasury bonds. And it won’t provide the income we need to pay the benefits, and there is only one way out of that: increase the premium on working people. I’m not willing to go there and that would take a statutory change anyway because the premium level is based in statute. It isn’t just a fluctuating thing. So I don’t think we could pass an increase in the premium, it would kill the whole program. This is really essential in order for the Long Term Care Trust to actually be implemented and survive.”

SK: Partisanship is increasing all over the nation. What do you think is the likelihood of passing bipartisan legislation in the 2021 session?

KK: Our state legislatures are not Congress, thank god! Because Congress is totally dysfunctional and that’s what happens when you get to be totally partisan. I work across the aisle all the time… we have to work across the aisle. We cannot just do slam dunks and have our will because we have a slim majority. It doesn’t create long term stability and if you want to make long term change you have to have long term stability. So bipartisanship is a goal. It isn’t an absolute, but it is always a goal. And I think that in Washington state we have a pretty good record of bipartisanship, and I’m going to continue it. I run the Labor and Commerce Committee and you can’t find a more partisan committee.”

SK: With Biden’s recent election, what are your hopes for that administration on COVID-19 and health care as a whole?

KK: Competence! Surely we need a government that functions and is able to do what it sets out to do, and the hollowing out of our institutions has created a nightmare. And the pandemic is absolutely a case and point. We are in a world of hurt, with tens of thousands of people dying who didn’t need to die. It is an outrage that we’re here, and it’s because we’ve had an incompetent federal government. So if the Biden administration can do anything to restore competence across the board in all the agencies — from the state department to HHS to the defense department –we will be so much better off. Having competence and the ability to have reliable information and stable policies, we will be able to move forward at the state level with all of that. And I’m encouraged immensely by that.”

This conversation has been edited for clarity and length.

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