HOUSE BILL REPORT

HB 1291

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by House Committee On:

Health Care & Wellness

Title: An act relating to health care for Pacific Islanders residing in Washington under a compact of free association.

Brief Description: Concerning health care for Pacific Islanders residing in Washington under a compact of free association.

Sponsors: Representatives Santos, Jinkins, Fey, Robinson, Fitzgibbon, Stanford, Ormsby and Riccelli.

Brief History:

Committee Activity:

Health Care & Wellness: 1/25/17, 2/8/17 [DP].

Brief Summary of Bill

  • Creates a premium assistance program for Washington residents who are citizens of the Republic of the Marshall Islands, the Federated States of Micronesia, or the Republic of Palau.

HOUSE COMMITTEE ON HEALTH CARE & WELLNESS

Majority Report: Do pass. Signed by 9 members: Representatives Cody, Chair; Macri, Vice Chair; Clibborn, Jinkins, Riccelli, Robinson, Slatter, Stonier and Tharinger.

Minority Report: Do not pass. Signed by 7 members: Representatives Schmick, Ranking Minority Member; Graves, Assistant Ranking Minority Member; Caldier, DeBolt, MacEwen, Maycumber and Rodne.

Minority Report: Without recommendation. Signed by 1 member: Representative Harris.

Staff: Jim Morishima (786-7191).

Background:

The Washington Healthplanfinder.

Under the federal Patient Protection and Affordable Care Act (ACA), each state must establish a health benefit exchange through which consumers may compare and purchase individual and small group coverage, access premium and cost-sharing subsidies, and apply for Medicaid coverage. Premium subsidies are available to individuals between 100 percent and 400 percent of the federal poverty level. Qualified health plans (QHPs) sold in an exchange must meet certain standardized actuarial values: Bronze (60 percent), Silver (70 percent), Gold (80 percent), and Platinum (90 percent).

Washington's health benefit exchange, the Washington Healthplanfinder, is a public-private partnership governed by a board consisting of members with expertise in the health care system and health care coverage.

On January 20, 2017, President Trump signed an executive order directing federal agencies to "minimize unwarranted economic and regulatory burdens of the ACA."

The Compact of Free Association.

Under the Compact of Free Association (COFA), citizens of the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau may live and work in the United States and serve in the United States Military. Citizens of COFA nations are also eligible for premium assistance through the Exchanges established by the ACA. Citizens of COFA nations are, however, ineligible for Medicaid.

Health Impact Review.

The Washington State Board of Health (Board), in collaboration with the Governor's Interagency Council on Health Disparities, may complete health impact reviews on legislative proposals to evaluate the proposals' impact on health and health disparities. In 2016, the Board completed a health impact review of House Bill 2986 (2016), which created a premium assistance program for citizens of COFA nations. The Board determined that the program would improve access and outcomes for COFA citizens and decrease health disparities.

–––––––––––––––––––––––––––––––––

Summary of Bill:

The COFA Premium Assistance Program (Program) is established. Through the Program, the Health Care Authority (HCA) must, within funds appropriated for the specific purpose, pay the premiums and out-of-pocket costs associated with a QHP purchased by an eligible individual. A person is eligible for the Program if he or she:

A person is disqualified for the program if he or she:

The HCA must establish:

The HCA must appoint an advisory committee (Committee) that must include insurers and representatives of communities of citizens of COFA nations. The Committee must advise the HCA in the development, implementation, and operation of the Program.

By December 31, 2018, the HCA must report to the Governor and the Legislature on the implementation of the Program. The report must include:

–––––––––––––––––––––––––––––––––

Appropriation: None.

Fiscal Note: Available.

Effective Date: The bill contains an emergency clause and takes effect immediately.

Staff Summary of Public Testimony:

(In support) Citizens of Compact of Free Association nations find themselves caught between the changing winds of federal and state policy. United States nuclear testing has led to illness related to radiation exposure in COFA nations. The United States has a trusteeship relationship with these nations under which citizens of COFA nations may travel freely and have medical benefits. Access to medical benefits was cut off in the mid-1990s. Citizens of COFA nations living in the United States pay taxes and serve in the military. They are entitled to the same benefits as other citizens. Consistent with Washington's commitment to eliminating health disparities, this bill should be enacted to correct something that should have been done on the national level.

(Opposed) None.

(Other) The Board conducted a health impact review on this proposal. The review found that this bill will lead to increased enrollment in health plans, which will result in better health outcomes and reduced disparities by income and ethnicity.

Persons Testifying: (In support) Representative Santos, prime sponsor; Robin Narruhn, Pacific Island Health Board; and Keju Thompson.

(Other) Alexandra Montano, Washington State Board of Health.

Persons Signed In To Testify But Not Testifying: None.