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Originally published December 20, 2012 at 8:02 PM | Page modified December 28, 2012 at 1:50 PM

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Shift in state Senate may affect how Olympia handles health care

Democrats worry that implementation of President Obama's health-care law could get caught in the crossfire of a state Senate leadership coup backed by Republicans.

Seattle Times staff reporters

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While a state Senate leadership coup backed by Republicans would impact budget and education debates, another issue could get caught in the crossfire: how to implement President Obama's health-care law.

Some Democrats are worried that a Republican-controlled Senate health-care committee would seek to stop or limit provisions of the law, including Medicaid expansion and a new state insurance marketplace known as an exchange. Such an effort would likely face opposition from the Democrat-controlled House and Gov.-elect Jay Inslee, a Democrat and champion of the health-care law.

Sen. Randi Becker, the Eatonville Republican whom the new majority coalition has tapped as health-care committee chairwoman, says she supports some parts of the Affordable Care Act and opposes others, but that "the law is the law."

"I really don't expect that we'll have a radically different approach to health-care this year," she said. "I think what is going to happen is we're going to have to work more collaboratively to find bipartisan solutions."

The impact on Obamacare implementation is among the questions lawmakers have been pondering since two Democrats joined with 23 Republicans earlier this month to form a new coalition with just enough votes to control the chamber. Before the move, Democrats held the majority.

Democrats, so far, have rejected the new coalition's proposal, which would divide 12 Senate committees between Republican and Democratic control when the Legislature convenes next month. Three other committees would each be co-chaired by a Republican and a Democrat.

The Senate budget, K-12 education and health-care committees all would be led by Republicans.

Becker would replace Sen. Karen Keiser, D-Kent, who has chaired the Senate Health and Long-Term Care Committee since 2005. Becker, the ranking minority member, has been on the committee since her election to the Senate in 2008.

Sen. Rodney Tom of Medina, one of the two Democrats who helped form the coalition, described Becker as "a very pragmatic person."

"I don't see her being a hard-core partisan who is trying to swim upstream," said Tom, who would be Senate majority leader under the arrangement.

But Sen. David Frockt, D-Seattle, a member of the health-care committee, said Becker "has not shown great enthusiasm for health-care reform" and would be pressured by other Republicans to take a hard-line against Obamacare.

Suellen Harris, chairwoman of the Chelan County Democratic Party, was more blunt.

"I'm stunned," Harris said in an email. She said Keiser and Rep. Eileen Cody, D-West Seattle, chairwoman of the House health-care committee, have laid the groundwork for implementation of Obamacare.

"Replacing Keiser with Republican Randi Becker puts that all at risk," she wrote.

Keiser said she was particularly concerned about the fate of the Reproductive Fairness Act, Medicaid expansion and key elements of the federal health law.

Becker's background

Becker has experience in the medical field. Starting out as a receptionist, she eventually became the administrator of a multimillion-dollar surgical center in Puyallup, helped develop a surgical practice and started several hospital-owned clinics, including an urgent-care center.

In her most recent campaign, she cited health-care costs as a prime concern.

On the health-care committee and on the floor, she voted against some insurance mandates, including one to require coverage of smoking-cessation treatment and another to require policies covering reproductive services to also cover abortions.

However, Becker supported a bill to expand coverage of diagnosis and treatment of autism-spectrum disorders. And she occasionally supported bills sponsored by Keiser and other Democrats, including one to strengthen Medicaid-fraud recovery efforts and one to continue insurance-commissioner review of insurance rates.

She said she is not opposed to Obamacare-style measures, but she is concerned about moving too far too fast.

Tom Curry, CEO and executive director of the Washington State Medical Association, which named Becker its Legislator of the Year in 2011, said Becker understands the impact of legislation on medical practices and patients and would likely focus on creating fertile market conditions.

Patrick Connor, state director for the National Federation of Independent Business, said Becker has been committed to the needs of small businesses, including their struggles to get cost and coverage information when purchasing health insurance.

Rep. Joe Schmick, R-Colfax, the ranking Republican on the House health-care committee, said he expects Becker to take a hard look at cost drivers for health care, including the 45 coverage mandates lawmakers have imposed on health insurance.

Schmick said the state needs to create a more welcoming atmosphere for insurance companies, and he believes Becker agrees.

"We need the competition here, and we don't have it," he said.

Obamacare

Many Republicans think Obamacare would be harmful to competition and would add unsustainable costs to the state budget.

They're particularly concerned about the cost of Medicaid expansion; under that provision, the federal government would initially pay 100 percent of the costs for the newly eligible adults — more than the current 50-50 match. But the federal contribution would slowly shrink after 2016 to 90 percent by 2020, and the state would pay the difference.

Medicaid expansion could add up to 300,000 state residents to the program. Authorization of the additional costs by lawmakers is a requirement, even when the federal government is providing the money.

Becker said potential Medicaid expansion is mainly a budget issue. While she has some concern about future costs, she said, "early indications are that the expansion could be a net savings to the state and I'm going to work under that assumption and that we will be participating."

But Becker signaled a more conservative approach to the other most talked-about Obamacare provision, the state exchange, the public-private insurance marketplace designed to bring together insurance plans for purchase by about 280,000 residents in 2014, many with federal subsidies.

Michael Marchand, the exchange's communication director, said setup and operation of the exchange through 2014 has been funded by federal grants.

Because so many more people will be buying insurance, the state expects the total revenue from an existing tax on premiums to grow by $110 million over four years. But that money goes to the state, and even if lawmakers sent it all back to the exchange, they would have to increase the premium tax or add a service charge to cover the $50 million the exchange is expected to cost in 2015 — the year it must be self-sufficient under federal law.

"This is a new cost to the state," Becker said. "We've not paid for anything like this before, and to have a such a high price tag associated with that immediately is very concerning to me."

For her part, Keiser said she had planned to focus the health-care committee's work on cost containment and transparency, improving incentives for providers to better manage patients with chronic conditions and encouraging evidence-based health-care practices.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com. On Twitter @costrom.

Brian M. Rosenthal: 206-464-3195 or brosenthal@seattletimes.com. On Twitter @brianmrosenthal.

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