HOUSE BILL REPORT
HB 2408
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 preserving access to individual market health care coverage throughout Washington state.
Brief Description: Preserving access to individual market health care coverage throughout Washington state.
Sponsors: Representatives Cody, Jinkins, Goodman, Johnson, Slatter, Tharinger, Stanford, Macri, Ormsby, Doglio and Appleton.
Brief History:
Committee Activity:
Health Care & Wellness: 1/17/18, 2/2/18 [DPS].
Brief Summary of Substitute Bill |
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HOUSE COMMITTEE ON HEALTH CARE & WELLNESS |
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 11 members: Representatives Cody, Chair; Macri, Vice Chair; Clibborn, Jinkins, MacEwen, Maycumber, Riccelli, Robinson, Slatter, Stonier and Tharinger.
Minority Report: Do not pass. Signed by 3 members: Representatives Schmick, Ranking Minority Member; Graves, Assistant Ranking Minority Member; Caldier.
Minority Report: Without recommendation. Signed by 2 members: Representatives DeBolt and Harris.
Staff: Jim Morishima (786-7191).
Background:
Individual Market Coverage.
Individuals may purchase health insurance through the Washington Health Benefit Exchange (Exchange) or in the individual market outside of the Exchange. Most individual market plans are subject to a variety of federal and state requirements, including minimum actuarial values, rate review, and benefit mandates. Most individual plans must be offered in actuarial value tiers: Bronze (60 percent), Silver (70 percent), Gold (80 percent), and Platinum (90 percent).
Through the Exchange, individuals may compare and purchase individual coverage, access premium subsidies, and apply for Medicaid coverage. Premium subsidies are available to individuals between 100 percent and 400 percent of the federal poverty level. Cost sharing reductions are available to individuals between 100 percent and 250 percent of the federal poverty level. Carriers offering plans in the Exchange must offer at least one Silver and one Gold plan. Only health plans certified by the Exchange as qualified health plans (QHPs) may be sold on the Exchange.
The School Employees' Benefits Board.
The School Employees' Benefits Board (SEBB) is a nine-member board that is part of the consolidated school district employees' health benefits purchasing program in the Health Care Authority (HCA). The SEBB's responsibilities include developing benefit plans for school employees and participating with the HCA in coordination with the Public Employees' Benefits Board in the selection of carriers to provide health and dental plans.
The Washington State Health Insurance Pool.
The Washington State Health Insurance Pool (WSHIP) is Washington's high risk pool. The WSHIP provides coverage for:
individuals ineligible for Medicare who were enrolled in WSHIP plans prior to January 1, 2014;
individuals ineligible for Medicare who live in a county where individual health coverage is unavailable; and
individuals eligible for Medicare who do not have access to a reasonable choice of Medicare Advantage plans and provide evidence of rejection for medical reasons, restrictive riders, an uprated premium, preexisting condition limitations, or lack of access to a comprehensive Medicare supplemental plan.
The WSHIP is funded through premiums and assessments on health carriers, Medicaid managed care plans, stop-loss plans, and the state's Uniform Medical Plan (stop-loss plans and the Uniform Medical Plan pay a 1/10 assessment).
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Summary of Substitute Bill:
Individual Market Coverage.
For plan years beginning January 1, 2020, a health carrier must offer at least one Silver and one Gold QHP on the Exchange in any county where the carrier offers a SEBB-approved plan to school employees.
The Washington State Health Insurance Pool.
A person eligible for WSHIP coverage because individual health coverage is not available must have his or her premium rate reduced. The amount of the reduction is:
80 percent for a person whose current modified adjusted gross income is less than or equal to 200 percent of the federal poverty level;
60 percent for a person whose current modified adjusted gross income is greater than 200 percent, but less than or equal to 300 percent of the federal poverty level;
50 percent for a person whose current modified adjusted gross income is greater than 300 percent, but less than or equal to 400 percent of the federal poverty level; and
30 percent for a person whose current modified adjusted gross income is greater than 400 percent of the federal poverty level.
The reductions are funded through the WSHIP assessments.
Substitute Bill Compared to Original Bill:
The substitute bill:
removes the requirement that a health carrier offering a health plan to school employees offer a Silver qualified health plan (QHP) in counties where no health plans are offered on the Exchange;
requires instead a health carrier offering health plans to school employees to offer at least one Silver and one Gold QHP on the Exchange in any county in which the carrier offers a health plan to school employees beginning in plan year 2020; and
reduces a person's Washington State Health Insurance Pool premiums by a percentage based on his or her income, instead of basing the premium reduction on the average amount of federal premium subsidies available in the same geographic rating area.
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Appropriation: None.
Fiscal Note: Available.
Effective Date of Substitute Bill: The bill takes effect 90 days after adjournment of the session in which the bill is passed.
Staff Summary of Public Testimony:
(In support) All Washington residents should have access to affordable health care coverage. Last year, health plan offerings decreased dramatically, almost leading to two counties without any individual market coverage at all. This type of situation causes anxiety in communities and creates planning difficulties for hospitals. There needs to be a long-term solution to this problem. This bill uses a carrot and stick approach to make sure health insurance is available in every county. This bill will tie into School Employees' Benefits Board plans, which should be available in 2020. In the meantime, the Washington State Health Insurance Pool would provide coverage in counties with no coverage, but would only be utilized if carriers withdraw from those counties.
(Opposed) This bill adds new requirements on plans providing coverage to school employees, which is premature. This could lead to fewer carriers opting in and could increase costs, which would be passed down to educators. A working Health Benefit Exchange is important, but the means of achieving that goal in this bill could affect the price of coverage to educators.
Persons Testifying: (In support) Representative Cody, prime sponsor; Erin Dziedzic, Bleeding Disorder Foundation of Washington; Chris Bandoli, Washington State Hospital Association; and Sean Graham, Washington State Medical Association.
(Opposed) Julie Salvi, Washington Education Association.
Persons Signed In To Testify But Not Testifying: None.