This white paper was prepared for the Economic Opportunity Institute (EOI) to explore  practical and short-term approaches to expanding health care access in Washington state.  There are a number of serious problems with health insurance which combine to leave an  increasing number of people without coverage for needed health services. EOI convened a  health policy brainstorming session on October 11, 1999 to discuss practical and incremental  approaches to expanding health care access in Washington state in the near future (please see  Appendix C for a list of participants). More than two dozen potential ideas for short-term  improvements were identified and discussed at the meeting, and the ideas have subsequently  been analyzed to form the basis for this paper. The EOI believes that all ideas identified at  the brainstorming session were creative and useful, but given available resources it is  necessary to prioritize those that EOI can pursue at this time. The underlying philosophy of  the paper is that it is preferable to successfully pursue a smaller number of concrete strategies  than to attempt to address an unmanageably large number of policy initiatives.

The purpose of this white paper is to present a description of practical, incremental ideas that  can then lead to public or private actions to expand health care coverage. The paper does not include recommendations for comprehensive, long-range reform of the current health care  system, in Washington or nationally. While many policy experts believe that comprehensive,  fundamental reform is likely to be the only way the related problems of rising costs and  dwindling access to care can be successfully addressed in the long term, EOI (and many  experts) recognize that the timing may not be right to initiate comprehensive reform. Rather,  the goal of this white paper is to identify, and then pursue, a manageable number of shortterm activities that can lead to concrete, if incremental, improvements in health care access.  As a result, this paper focuses on short-term, partial “fixes” to the current crisis that can at  least help more people get access to care in the near future.

This paper is organized into three parts. The first part – the main body of the report –  summarizes six recommended, high priority strategies that health policy experts identified as  having the most potential to lead to improvement in the short-term. The criteria used to  make the selection of these strategies included expanding access to health care services,  being achievable or “winnable” politically, being sustainable over time, and other factors  including being simple to explain, implement, and administer. The final section of the first  part outlines potential mechanisms by which the priority strategies can be implemented.

The second major part of the paper – Appendix A – presents a detailed examination of the six  recommended strategies, including a discussion of the major open issues to be resolved for  each strategy and a listing of the major advantages and challenges for each strategy. The  third major part of the paper – Appendix B – presents a brief synopsis of the other ideas  identified by the brain-storming group as potential approaches to improving access to care.  Even though these other ideas were not selected by the EOI as options to pursue at present,  they do represent a wide array of other strategies that could be adopted to improve access or  help finance health insurance. These ideas are included to encourage other organizations to  consider their viability. Improving access to needed health services is a key policy objective  of EOI, and the following pages outline six high priority strategies for achieving this goal.