Governor signs entire “Cascade Care 2.0” bill into law

Governor Jay Inslee signed legislation on Monday that aims to increase the affordability of standardized health plans on the individual market. Among several provisions, Senate Bill 5377 establishes a state premium assistance program for certain individuals purchasing health insurance on the state exchange.

The bill also builds on the 2019 legislation that established Washington’s public option program by putting in place public option participation requirements.

Prior to the governor’s signature, the future of the bill in its entirety was uncertain.


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At the end of April, the Washington State Hospital Association (WSHA) called on Inslee to veto Section 5 of the bill, which requires certain hospitals to contract with at least one public option plan in the state.

Section 5 states that if a public option plan is not available in each county during plan year 2022 or later, then hospitals that receive payment from Medicaid or a public/school employee benefits program must contract, if they receive an offer, with at least one public option plan to provide in-network services to enrollees of the plan.

In a letter to the governor, WSHA said there was a discrepancy in the language used in the final bill and the colloquy offered in the Senate on April 19. The association said it was concerned that the colloquy “indicates an intent that contradicts the plain language and meaning of the section.” WSHA told State of Reform:

“Contrary to the plain language and meaning of section 5, the colloquy creates a record of legislative intent that contradicts the legislative language. Legislative intent is important if there was a lawsuit brought on this topic. Frankly, we do not understand why this was raised on the Senate floor and what it aimed to achieve, other than uncertainty.”

Senator David Frockt, who sponsored the bill, said he was “fairly livid” about the partial veto request, particularly after what he described as a “tortuous negotiation” process to get the bill to its final form.

Frockt followed up with a letter on May 6 to the governor’s office, urging him to sign the bill in its entirety. The letter states:

“As you know from your time in Congress, any effort at changing the health care system always brings on vast political opposition and challenges, both ideological and stakeholder driven. Cascade Care has seen similar opposition from the time you first proposed it in 2019 to today. Thus, the stakes for this program are high, not only for the 220,000 people who could benefit in the individual market here in Washington, but also for others around the country because of the spotlight on this policy and the lessons that will be learned…

…Vetoing Section 5 of this bill would remove all the provisions that are vital to the creation of our state-based public option. This is a singular effort. Signing E2SSB 5377 into law not only ensures the advancement of a stronger Cascade Care program but also signals to our colleagues across the country and in DC that a public option is not only possible – it’s the next step.”

On Monday, Inslee signed the entire bill into law.