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 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:

• an analysis of Washington's existing 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 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.