AN ACT Relating to comprehensive health care coverage; amending RCW 70.47.010 and 70.47.030; adding a new section to chapter 74.09 RCW; adding new sections to chapter 50.24 RCW; and creating new sections.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. Section 3, chapter 5, Laws of 1987 1st ex. sess. and RCW 70.47.010 are each amended to read as follows:

(1) The legislature finds that:

(a) A significant percentage of the population of this state does not have reasonably available insurance or other coverage of the costs of necessary basic health care services;

(b) This lack of basic health care coverage is detrimental to the health of the individuals lacking coverage and to the public welfare, and results in substantial expenditures for emergency and remedial health care, often at the expense of health care providers, health care facilities, and all purchasers of health care, including the state; and

(c) The use of managed health care systems has significant potential to reduce the growth of health care costs incurred by the people of this state generally, and by medical assistance recipients and low-income pregnant women who are an especially vulnerable population, along with their children, ((~~and~~)) who need greater access to managed health care.

(2) The purpose of this chapter is to provide necessary basic health care services in an appropriate setting to working persons and others who lack coverage, at a cost to these persons that does not create barriers to the utilization of necessary health care services. To that end, this chapter establishes a program to be made available to those residents under sixty-five years of age not otherwise eligible for medicare with gross family income at or below two hundred percent of the federal poverty guidelines who share in the cost of receiving basic health care services from a managed health care system.

(3) It is not the intent of this chapter to provide health care services for those persons who are presently covered through private employer-based health plans, nor to replace employer-based health plans. Further, it is the intent of the legislature to expand, wherever possible, the availability of private health care coverage and to discourage the decline of employer-based coverage.

(4) The program authorized under this chapter is strictly limited in respect to the total number of individuals who may be allowed to participate and the specific areas within the state where it may be established. All such restrictions or limitations shall remain in full force and effect until quantifiable evidence based upon the actual operation of the program, including detailed cost benefit analysis, has been presented to the legislature and the legislature, by specific act at that time, may then modify such limitations.

(5) By enrolling medical assistance recipients within managed health care systems, the state goal is to ensure that medical assistance recipients receive at least the same quality of care as they currently receive.

Sec. 2. Section 5, chapter 5, Laws of 1987 1st ex. sess. and RCW 70.47.030 are each amended to read as follows:

The basic health plan trust account is hereby established in the state treasury. All funds appropriated for this chapter, including moneys received from the tax levied in section 4 of this 1989 act, shall be deposited in the basic health plan trust account and may be expended without further appropriation. Disbursements from other moneys in the account shall be made pursuant to appropriation and upon warrants drawn by the Washington basic health plan administrator. Moneys in the account shall be used exclusively for the purposes of this chapter, including payments to participating managed health care systems on behalf of enrollees in the plan and payment of costs of administering the plan. The earnings on any surplus balances in the basic health plan trust account shall be credited to the account, notwithstanding RCW 43.84.090. After January 1, 1988, the administrator shall not expend or encumber for an ensuing fiscal period amounts exceeding ninety percent of the amounts anticipated to accrue in the account during the fiscal period.

NEW SECTION. Sec. 3. A new section is added to chapter 74.09 RCW to read as follows:

(1) No physician who agrees to treat medicaid patients in need of emergency obstetrical care shall be subject to civil liability for treatment of emergency medicaid patients so long as the physician acts in good faith without gross negligence.

(2) The department of social and health services shall indemnify physicians who provide obstetrical care to medicaid recipients for a claim for damages resulting from negligence for amounts over five thousand dollars.

NEW SECTION. Sec. 4. A new section is added to chapter 50.24 RCW to read as follows:

(1) Contributions shall accrue and become payable by each employer for each calendar year in which the employer is subject to this chapter at a rate of two percent.

(2) For rate year 1990, the amount of wages subject to tax for each individual shall be eighteen thousand dollars. For each subsequent rate year, the amount of wages subject to tax shall be determined by multiplying the amount in effect for the preceding rate year by the ratio obtained by dividing the average annual wage for the second preceding rate year by the average annual wage for the third preceding rate year. The ratio shall be carried to the third decimal place, with the remaining fraction, if any, disregarded. The amounts used for average annual wage shall be those determined in RCW 50.04.355. The amount of wages subject to tax shall be the calculated amount rounded to the next lower one hundred dollars.

(3) Contributions shall become due and be paid by each employer to the basic health plan trust account in accordance with such rules as the commissioner may prescribe, and shall not be deducted, in whole or in part, from the remuneration of individuals in employment of the employer. Any deduction in violation of this section is unlawful.

(4) In the payment of any contributions, a fractional part of a cent shall be disregarded unless it amounts to one-half cent or more, in which case it shall be increased to one cent.

(5) It is the intent of the legislature that the application and collection of the tax imposed by this section shall be identical, insofar as possible, to employer contributions under the unemployment compensation laws of the state, Title 50 RCW.

NEW SECTION. Sec. 5. A new section is added to chapter 50.24 RCW to read as follows:

(1) An employer may deduct from the tax owing under this section any amounts actually expended by the employer for health care, including amounts expended for:

(a) Health care insurance premiums or similar fees; and

(b) Direct health care services provided by the employer.

(2) If the amount deductible under subsection (1) of this section exceeds the tax due for any period, the excess deduction may be applied to the tax due in any future period.

NEW SECTION. Sec. 6. The insurance commissioner shall recommend by January 1, 1990, a reasonable plan for the establishment of a nonprofit, joint underwriting authority for long-term care insurance.

NEW SECTION. Sec. 7. This act shall be known and cited as the Washington comprehensive health care act.