Whole Washington presented a comprehensive plan for developing a state-governed health plan that would cover all residents to the state’s Universal Health Care Commission (UHCC) on Thursday.
Whole Washington is a grassroots organization that advocates for a universal healthcare system in the state. The UHCC was established during the 2021 legislative session, works to prepare the state for the creation of a healthcare system that provides coverage and access for all residents, and provides suggestions to lawmakers. Whole Washington Executive Director Andre Stackhouse and Lead Policy Writer Erin Georgen discussed the organization’s plan for developing the Washington Health Trust (WHT) during the meeting.
The WHT was initially introduced as a public initiative in 2018, and it has been introduced through state legislation several times, with the latest version encapsulated in Senate Bill 5335, which is currently in recess.
“Every year, there’s been significant progress made. A lot of the work that needs to be done to achieve universal healthcare has been happening. We hope this is the beginning of an ongoing relationship with the commission. Ultimately, we want to be co-developers of universal healthcare policy with the commission.”
— Stackhouse
Whole Washington hopes that policy will center on the WHT, which would create public options that any individual or company could enroll in for coverage. It would generate revenue from taxes to pay for healthcare expenses, and give existing entities the authority and responsibilities to transition to and maintain a statewide universal healthcare system.
WHT eligibility would be based on residency, regardless of social determinants of health. All Washington residents would be eligible for coverage. Some nonresidents would be eligible, including students attending college, workers employed in the state, and spouses and dependents of eligible nonresidents.
Employers could voluntarily pay the Employment Security Department to enroll their employees in the WHT. All employees in Washington would be eligible to enroll in it, even if their employer offers different coverage.
The benefits package would include hospital services, ambulatory services, prescription drugs, mental health and substance use disorder treatment services, laboratory services, reproductive and maternity services, pediatric and specialty care services, palliative care, oral health, audiology, vision services, short-term rehabilitative services and devices, and licensed naturopathic, acupuncture, and massage therapies.
“It is a single benefits package for all enrollees,” Stackhouse said. “We’re not going to have a system where some enrollees are paying more for better care. We’re trying to set a standard all state-managed plans can meet.”
All licensed providers would be eligible to receive reimbursement for services from the WHT, but participation would be optional. All providers and health systems giving care to a WHT enrollee could accept fee-for-service rates set by the WHT board—which would work under the Department of Health, manage the WHT, and define a single essential health benefits and coverage package—and would not be denied reimbursement by the WHT for any essential health benefits.
“The idea is that providers really want a voice, especially if there’s going to be a single rate that we pursue. It’s important to identify baseline rates. Providers wouldn’t want to make less than they’re making right now. It (would produce) rates that are higher than Medicare.”
— Georgen
All premiums, copays, deductibles, and out-of-pocket expenses would be eliminated for WHT enrollees. Under the WHT public financing model, there would be an employer tax of 10.5 percent per employee, based on payroll. Employers could pass two percent of that tax on to employees.
“This 10-and-a-half percent will be required whether you’re paying into the health trust or other forms of healthcare for employees,” Stackhouse said. “Compared to what it costs to provide healthcare coverage for a workforce anyway, this is quite competitive. It’s not uncommon for an employer to be paying 12-15 percent for a workforce. And there’s no administrative burden.”
The financing model would also include an eight-and-a-half percent capital gains tax.
“About 90 percent of Washington state makes less than 10 percent in capital gains, and would not be affected by this at all,” Stackhouse said. “This funding structure was designed before the passage of the capital gains tax, and before the recent Supreme Court ruling on it, which in our opinion, changes precedent a little bit.
We’ve always wanted to exempt people who have the most need for care and the least ability to pay for it from as many of these financial contributions as possible. And that’s difficult in our tax code, but we believe that there might be more room for exemption at the bottom than previously thought.”
For an employee making $60,000 a year, the employer contribution would be $425-525 (depending on whether a maximum employee contribution option of $100 a month is implemented) per month.
Rep. Joe Schmick (R-Colfax) asked the presenters how they plan to deal with people who do not trust the government and would be reluctant to have it managing their healthcare, should the WHT be implemented.
“This is a very voluntary model. So if people are hesitant, it might be something they consider over a number of years to see if it’s working. People also don’t have great feelings about their health insurer a lot of the time. They have to pay a lot. They’re shocked, a lot of times, to see that things aren’t covered. We can offer something that provides a better experience.”
— Stackhouse
Georgen said the proposal would take significant time to implement.
“It’s designed to give you time to build that trust,” Georgen said. “That’s how you deal with those issues. You can’t force people. You have to show it to them; they may have friends who are getting the benefit. You have to build something and be reliable.”