In 2019, the Legislature established a universal health care work group.  The work group issued its final report on January 15, 2021.  It defined universal health care to mean that all Washington residents can access essential, effective, appropriate, and affordable health care services when and where they need it, and developed three coverage models.  Models A and B are designed to provide coverage for all state residents, including those currently covered by federal programs, and undocumented immigrants.  The models would provide coverage for essential health benefits and include no cost sharing.  Model A would achieve this through a state-governed and administered program while Model B would be a state-governed, but health plan administered program.  Model C would offer coverage to a segment of Washingtonians—those who do not have access to affordable coverage through a public program, an employer, or in the individual market.  It is primarily designed to increase coverage for uninsured undocumented immigrants. 

The universal health care commission is established to develop a plan to be implemented by 2026, that provides comprehensive, equitable, and affordable health care coverage under a publicly financed and privately and publicly delivered health care system to all state residents.

The commission shall include the following voting members:

• two members from each of the two largest caucuses of the house of representatives and two members from each of the two largest caucuses of the senate;
• the secretary of the Department of Health, or the secretary's designee;
• the director of the Health Care Authority, or the director's designee;
• the chief executive officer of the Washington Health Benefit Exchange, or the chief executive officer's designee;
• the Insurance Commissioner, or the commissioner's designee;
• the secretary of the Department of Social and Health Services, or the secretary's designee;
• the director of the Office of Equity, or the director's designee; and
• eight members appointed by the Governor with knowledge and experience regarding health care coverage, access, and financing, or other relevant expertise, including at least one appointee from tribal governments with knowledge of the Indian health care delivery in the state.

 The director of the Department of Retirement Systems, or the director's designee shall serve as a nonvoting member of the commission.

The commission may establish advisory committees that include members of the public with knowledge and experience in health care, in order to support stakeholder engagement and an analytical process by which key design options are developed.  A member of an advisory committee need not be a member of the commission.

By November 1, 2024, the commission must submit a report including:

• a synthesis of existing analyses of Washington's health care finance and delivery system, including cost, quality, workforce, and provider consolidation trends and how they impact the state's ability to provide all Washingtonians with timely access to high-quality, affordable health care;
• recommendations for key elements of a universal health care system, including: 

1. 1. a financing system;
   2. eligibility and enrollment processes;
   3. covered benefits;
   4. provider participation;
   5. efficient provider payments;
   6. cost containment and quality improvement strategies;
   7. initiatives for improving culturally appropriate health services within public and private health-related agencies;
   8. home and community based services;
   9. strategies to reduce health disparities;
   10. information technology systems and financial management systems;
   11. data sharing and transparency; and
   12. governance and administrative structure;

• recommendations for steps Washington should take to prepare for the just transition to a unified financing system; and
• recommendations for the creation of a finance committee to develop a financially feasible model to implement universal health care coverage using state and federal funds.

The commission must hold its first meeting within 90 days of the effective date of the act and must submit an interim report to the Governor and the Legislature 12 months after its first meeting and every six months thereafter.

• Adds the Secretary of Department of Social Health and Services to the commission.
• Requires the commission to synthesize existing analyses of the state's health care finance and delivery system.
• Adds developing recommendations for retraining displaced workers to the steps the state should take to prepare for a just transition to universal coverage.

The committee recommended a different version of the bill than what was heard.  PRO:  There are over 500,000 people uninsured in Washington.  The state has the responsibility to continue to develop a path to provide universal coverage.  There is still more planning to do to determine what the best path is to achieve the goal.  The lower costs of universal system will increase options for the uninsured and allow access to needed treatment.  This bill is not just another study, it will give the Legislature what it needs to implement universal coverage.  Discussions are underway to facilitate pathways for federal waivers to assist in financing.  Incrementalism is not ideal, but this bill imposes a deadline for the state.  Universal coverage is good for the economy and this is a fiscally responsible approach.  Lives should be treated with dignity regardless of income level.  Delaying care leads to more costs later.

CON:  A single payer system is the best option for coverage.  A bill already exists to provide coverage through this process, but is being ignored.  This bill just pushes the issue down the road.  There should be a hearing on SB 5204.  The universal health care work group already did this work and now is the time to implement.  This bill is designed to kill single payer coverage.

OTHER:  The commission should be focused on more short term issues, including affordability, gaps in coverage, an individual mandate, pharmaceutical pricing, and value based purchasing.  Those affected by change in coverage from federal programs to a state system need have a voice in the process.

PRO:  People are struggling with increased costs on the Exchange.  Months are spent navigating the system.  A healthy Washington is a prosperous Washington.  To achieve an equitable system, we need to address barriers for marginalized communities.  We would spend less on health care if we invested in preventative care rather than sending people to the emergency room.  Small business is also feeling the impact of the high cost of health care.  They can not compete for employees with big businesses because it is an uneven playing field.  Catastrophic plans leave people without the ability to get health care they need and without money to buy essentials.  This will help reduce business costs, which will also help employees, both in productivity and well being.  A cost savings not contemplated by this bill is in workers compensation.  This does not cover comorbidities.  Universal coverage would help in saving these costs.  The dates in the bill should be moved forward by one year.  Like the commission that developed the Basic Health Plan, the first year of savings could be $1.2 billion.

CON:  I started out pro, but now I am con. I ended up losing my insurance during a pandemic and had serious health needs.. We need universal health care now, 2026 is too late.  All the major countries in the world have universal coverage.  SB 5024 does this.  We do not need another bill that find ways to divert dollars to middlemen.  A single payer system is the best option for coverage.  A bill already exists to provide coverage through this process, but is being ignored.  This bill just pushes the issue down the road.  There should be a hearing on SB 5204.  The universal health care work group already did this work and now is the time to implement.  We do not have the time and money to waste on this.  The challenge is finding the money for single payer.
 
OTHER:  The commission should be focused on more short term issues, including affordability, gaps in coverage, an individual mandate, pharmaceutical pricing, and value based purchasing.  Those affected by change in coverage from federal programs to a state system need to have a voice in the process.