Excerpts from Pam MacEwan’s testimony to Congress

On June 12, Pam MacEwan, Chief Executive Officer of the Washington Health Benefit Exchange, testified before the US House Ways and Means Committee regarding the Affordable Care Act (ACA) and Washington State’s progress in the health care arena.


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MacEwan began her testimony by describing how Washington has expanded coverage under the Affordable Care Act, resulting in 800,000 new people covered through Medicaid and commercial plans. She also told the committee how Washington is on its way to having the nation’s first state-based public option.

“I hope Congress can look to Washington state as an example of how progress can be made when lawmakers, advocates, carriers and delivery system partners work together on data-driven, actionable solutions.”

MacEwan explained that after the ACA was passed, Washington created a state exchange and expanded Medicaid, which resulted in a 60% decrease in Washington’s uninsured rate. Now, only 5.5% of people in Washington state are without health insurance.   

“The ACA is not perfect, but it has had a major positive impact on our state, providing life-saving benefits and financial security to hundreds of thousands who do not have the option of employer-sponsored coverage.”

The impacts are more covered lives and covered veterans, less delays in accessing necessary care because of cost, treatment for people struggling with opioid and substance use, treatment for people with cancer, and benefits to hospitals and Washington’s economy.

“Today, our marketplace is much stronger than before implementation of the ACA. Both the number of participating insurers and the number of available plans have increased. Average premium increases were markedly lower after ACA implementation — 6.7 percent between 2015-2017, compared to 18.5 percent between 2008-2010. Overall, in 2018, Washington’s average premiums were 15 percent lower than the national average.”

MacEwan believes there is more work to be done across the health care spectrum, both in Washington and throughout the nation, related to minimizing costs and reaching universal coverage.

“These challenges have been exacerbated by recent federal policy actions — including the federal elimination of payments for cost sharing reductions and the penalty for the individual mandate with no effective substitute, the promotion of short-term limited duration insurance plans, termination of federal reinsurance, the reduction in marketing and outreach at the federal level, and the renewed threat of ACA repeal — which have all undermined the health and stability of our market.”

In Washington state, about 250,000, or about 4%, of people buy their own health insurance because many work for people who do not offer health insurance, or are self-employed or retired. Often times, people who purchase individual insurance have no other coverage options, so Washington state has made efforts to preserve the strides that have been made in the state in the midst of market instability. These efforts include extending the open enrollment period, securing state funding for outreach, requiring insurance carriers change their silver plan premiums, defending people from short-term limited duration insurance plans, organizing consumer protections in state law, terminating surprise medical billing, and making large efforts to respond to complaints from consumers.

“This year’s insurance carrier filings in Washington are further evidence that our full adoption of the law and the steps we have taken are critical to reducing costs and expanding coverage. For 2020, thirteen health insurers filed a record-low average proposed rate increase of less than 1 percent for the individual health insurance market.”

In regards to the first public option in the nation, “Cascade Care” legislation was signed into law by Governor Jay Inslee this year to refine the affordability and quality of options in the individual market. This legislation produces plan options for consumers, produces the nation’s first public option for consumers, and produces an implementation plan for a state premium subsidy program.  

“Once fully implemented, it will help ensure Washingtonians have affordable insurance options, while strengthening and improving our existing market. We hope it can serve as an example to other states looking to improve their health care systems.”

To end her testimony, MacEwan expressed that each American deserves quality and affordable health care, and Washington state is prepared to provide long-term solutions to the problem the nation is facing. These solutions include increasing the number of states that have state-based exchanges, providing education to consumers on a plan that best fits them, and addressing prescription costs.

“Although our states’ markets, stakeholders, political environments, and sizes may vary, we share a common commitment to being there for the residents of our states who need high-quality coverage.”

This article was cross-posted on our sister site, Washington State Wire