Washington State House Reps Sponsor Single Payer Bill

Washington State House Bill 1026

Several House representatives in Washington have sponsored HB 1026 which would establish a single-payer health care system in Washington state using the Affordable Care Act’s State Innovation Waiver 1332. The 1332 waivers first became available to state legislators this year, and these waivers allow states to utilize 95% of the federal funding afforded State residents for Marketplace cost assistance to use for creative alternatives to the Affordable Care Act.

What Does Washington’s HB 1026 Do?

You can read the original bill here or follow this bill progress through the Washington legislature. This bill has only recently been submitted to the committee and will likely see a few changes before it is scheduled for a vote. It charts a course towards a single payer health care model at a state level but leaves many specific decisions to the board and committees it would create.

Here’s a brief rundown of what this particular bill does:

• The bill would create a state institution known as the Washington health security trust and lay out guidelines for establishing a board and advisory committees responsible for managing the budget and ensuring the care of all residents in Washington.
• It would provide guidelines on how the budget should be managed to ensure solvency, efficiency, and transparency. This includes limiting administrative costs to no more than 11% of budget and mandates to ensure it doesn’t run a deficit for more than a year.
• All residents of the state of Washington would be eligible once federal waivers are approved, but non-residents would be eligible for emergency care and transportation only.
• The joint select committee on health care oversight would contract out services. It would find someone to provide an actuarial value of the trust and benefits and to recommend funding resources including health security assessment (aka payroll tax), health security premiums for those earning more than 200% of FPL. It would also provide a list of other potential funding resources.
• The health trust would require a federally approved waiver to replace other federally funded programs like Medicaid, Medicare, and the Affordable Care Act. If the bill passes, the health trust will act as a secondary insurance to any other federal health insurance coverage a resident is eligible for except under three conditions. First, the resident volunteers to participate. Second, their employer paid the Health Security Assessment based on their income. Third, either the resident or their employer paid the premium. This would allow for voluntary participation of workers in the trust almost immediately.
• The trust would provide a comprehensive health benefits package above and beyond minimal essential coverage which would have copays on long-term nursing care for enrollees whose incomes are over 150% FPL.
• The bill would require that pharmaceuticals and durable medical equipment be provided to the trust at the lowest cost available to federal and government agencies.
• The trust’s board would establish a means for providers to collectively bargain budgets, payment schedules, and terms. The board would negotiate reimbursement on a fee-for-service, a case rate (total fee for all services needed for a diagnosis), or capitation (monthly payment to cover all of a patient’s medical needs).
• Providers would be able to receive payments from other sources as well, but if a provider accepted the trust’s payment for a service, the provider must accept that payment as payment in full for that service.
• The bill would also create a waiver to redirect funding from federal programs and well as instructing the governor to negotiate incorporation of a long list of federally funded health insurance programs.

How Would This Bill Work if the ACA were Repealed?

If the ACA is repealed in total, then several taxes employers pay would be repealed as well. Washington’s HB 1026 would fall to the general fund if federal funding were reduced. That means that Washington state legislature could choose to do nothing. Depending on how efficient the program is, however, they would likely seek to make up lost taxes within the state.

However, it is more likely that funding for programs like Medicaid will be block granted to the states. This would make it easier for states to be more creative with funding but might involve an overall reduction of the per capita funding going to states.

It’s also possible that Republicans and Trump will seek to keep the 1115 Waivers for State Innovation to Medicaid and a form of the 1332 Waivers for State Innovation to the Affordable Care Act in a future ACA replacement plan. Considering that many states have already used 1115 waivers to customize the way their Medicaid program functions and what benefits it offers, it would be difficult not to have a way for states to customize programs in the future too. Mike Pence and Seema Verma (Trump’s pick to head CMS) were both actively involved in the expansion of Medicaid in Indiana via the Healthy Indiana Plan 2.0. That state-run program, despite challenging the norms of Medicaid administration, is popular and it depends, at least in part, on the federal Medicaid funding for expanding Medicaid to function. It is my guess that federal funding for many programs will not disappear completely but may be reduced, and there may be fewer federal guidelines for state programs.

Who Sponsored Washington State’s HB 1026?

• LD 23 Sherry Appleton
• LD 24 Steve Tharinger
• LD 38 June Robinson
• LD 1 Derek Stanford
• LD 40 Kristine Lytton
• LD 3 Timm Ormsby
• LD 27 Laurie Jinkins
• LD 49 Sharon Wylie
• LD 45 Roger Goodman
• LD 38 Mike Sells
• LD 46 Jessyn Farrell
• LD 22 Beth Doglio
• LD 3 Marcus Riccelli
• LD 27 Jake Fey
• LD 46 Gerry Pollet
• LD 34 Joe Fitzgibbon
• LD 22 Laurie Dolan
• LD 24 Mike Chapman
• LD 36 Noel Frame