Gov. Jay Inslee signed into law the nation’s first public option. | M. Scott Mahaskey/POLITICO 2020 elections The 2020 Dem who may actually know how to fix health care

Jay Inslee is running for president as the climate change candidate.

But the two-term Washington governor can credibly claim to have accomplished more than most of his peers on health care, a key issue in the 2020 campaign.


He created both the nation’s first public option and universal long-term care benefit — albeit a limited one — has run a successful Obamacare market, and expanded reproductive rights. His administration has also pushed forward a new plan for controlling drug costs, expanded Medicaid coverage to transgender patients and added programs for school children aimed at preventing chronic diseases later in life.

In another time, Inslee would be running on his health care record, his campaign said. But not now. Inslee, who is among the many Democratic presidential candidates in the crowded field struggling to crack 1 percent in the polls, said he doesn’t have any second thoughts about staking his long-shot bid on tackling climate change, even if that overshadows his health policy accomplishments.

"Those things … become relatively moot if the entire ecosystem collapses on which human life depends,” Inslee told POLITICO earlier this month. “This is a unique issue. It is unique because our survival literally depends upon it.”

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But by declaring himself the climate change candidate, Inslee may be missing a chance to define himself on health care, an issue that’s divided the Democratic field. The front-runner, former Vice President Joe Biden, has promoted a government-run public option that would preserve the private insurance system, while Sen. Bernie Sanders’ “Medicare for All” plan that would virtually abolish private insurance has animated progressives.

While the debate for now is about what could be done, Inslee can boast he actually got something done.

“I respect everybody’s goals and plans here, but we do have one candidate that’s actually advanced the ball,” Inslee said during the first 2020 primary debate last month.

In May, Inslee signed into law the nation’s first public option, set to go live next fall. Under the plan, the Inslee administration will contract with a private insurer to sell coverage on the state’s Affordable Care Act exchange. The state projects that premiums in the public plan will be 5 to 10 percent cheaper that alternatives because of capped payments to doctors and hospitals. That might not translate into a major enrollment boost, and it remains to be seen whether enough providers will participate in the plan.

Inslee also signed legislation making Washington the first state to add a guaranteed long-term care benefit, addressing a growing challenge for an aging population. The law, which in concept is similar to Social Security, creates a payroll tax to offer a $100-per-day allowance for nursing home care, in-home assistance or another community-based option. It’s not enough to fully fund nursing home care, which can top $100,000 per year, but it may ease some financial pressure on families.

“These two bills are models for the rest of the nation to consider,” Inslee said after signing the legislation.

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Still, Inslee believes his focus on climate change will attract voters to his campaign, even though time is running out to break into the upper tier of candidates. It's unclear, though, how much his run has shaped the primary debate about climate change. Polls show it was already among Democratic voters' top priorities, and the candidates all agree with the scientific consensus that climate change is a man-made crisis demanding urgency.

What the governor does deserve credit for, environmental advocates said, is raising the bar for what constitutes an acceptable response to climate change. Inslee has proposed a comprehensive plan that is more detailed than the "Green New Deal," the aggressive climate change-fighting blueprint from progressives that's been vilified by Republicans. Inslee would move the United States to 100 percent clean energy by 2030, backed by a $3 trillion federal investment that would create millions of jobs.

“He gets credit for raising the level of policy ambition,” said John Noel, senior climate campaigner for Greenpeace. “If you look at the platforms of the other candidates running, the baseline for climate policy is much higher.”

Inslee’s campaign knows his health care record isn’t getting much attention, but it said that’s by design to highlight the urgency needed to address climate change. Inslee said he learned the importance of setting presidential priorities while serving in the House during President Barack Obama’s first term. He said there was little chance for climate change legislation to pass during Obama’s first term — the House had approved legislation capping greenhouse gas emissions in 2009, but it died in the Senate — because the ACA, which became law in March 2010, sucked up all the oxygen in Washington.

“In any normal year, at any normal time, he would have run on the major progressive achievements he has achieved in Washington state,” said Jamal Raad, Inslee’s communications director. “But we are at a tipping point. The leadership of the next president matters in terms of the climate crisis.”

Should Inslee break through in the polls, though, his health care record could get a closer look. Inslee in the past few months has taken measures to address top concerns among voters, including high drug prices and health care costs.

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In February, Washington became the second state to propose a new payment system to vastly expand access to pricey hepatitis C medications. Under the system, which proponents have likened to the Netflix subscription model, Washington state will pay drugmakers a lump sum for an unlimited supply of the treatment for patients covered by state health care programs. There are roughly 30,000 people living with hepatitis C who are covered by the state, according to the state Health Department.

Inslee signed legislation in May meant to protect patients from “surprise” medical bills, a bipartisan issue that other states have tried to address in recent years. It's also one of the most pressing health care items on Congress' agenda this year.

“There’s not a single thing Democrats are talking about nationally that we haven’t done in some form in Washington state,” said Democratic state Sen. David Frockt, who sponsored the public option bill.

Washington state Rep. Joe Schmick, the top Republican on the state House Health Care Committee, noted there’s been areas of bipartisan cooperation on health care, including on surprise bills and mental health. But he remains concerned that the public option — an idea opposed by the GOP — will push out competition from private insurers. He's also worried that the state hasn’t done enough to increase access to doctors in rural areas, where health care costs are typically higher.

“Just because you have insurance doesn’t mean you are going to see providers,” he said.

As the Trump administration has sought to curtail access to abortion, Inslee in March signed legislation making Washington state one of the few to require insurers to cover abortion alongside maternity care.

Bob Crittenden, who was a senior health policy adviser to Inslee, said Inslee has the credentials to tout his health care accomplishments as models for the nation.

“If I were running his communications, I would have done it differently,” Crittenden said.



CORRECTION: An earlier version of this article featured a photo of the wrong Democratic presidential candidate, John Hickenlooper.