Universal Health Care.

In 2019 the Legislature directed the Health Care Authority (HCA) to convene a Universal Health Care Work Group (Work Group) to make recommendations to the Legislature related to the creation, implementation, maintenance, and funding of a universal health care system that is sustainable and affordable to all Washington residents.  The Work Group considered three models for realizing universal health care:  (1) a state-governed and administered program; (2) a state-governed, and health plan administered program; and (3) a program for undocumented residents to access coverage.  The final report was issued on January 15, 2021 and provided analysis of each with respect to expected costs, access, equity, governance, quality, administration, affordability, and feasibility.

In 2021 the Legislature further directed the HCA to convene a Universal Health Care Commission (Commission) to make the health care system more accessible by increasing access to quality, affordable health care.  The role of the Commission is to prepare the state for the creation of a health care system that provides coverage and access for all Washington residents through a unified financing system, once the federal government approves the new health care system.

The State-Based Universal Health Care Act of 2021.

House Resolution 3775, introduced in the 117th Congress, establishes the option for states, or groups of states, to apply to waive certain federal health insurance requirements and provide residents with health insurance benefits plans through a state-administered program.  Such programs must cover 95 percent of the residents in the state within five years and plan benefits must be at least as comprehensive and affordable as the coverage under the equivalent federal program.

State programs are supported with funds from the federal programs the state programs replace, which may include Medicare, Medicaid, the Children's Health Insurance Program, the Federal Employee Health Benefits program, certain federal tax credits, and premium-assistance funds.

Several findings are made in this memorial related to the health care system and universal health care:

• that costs in the current health care system continue to rise along with certain negative health outcomes;
• that the current system of fragmented private health insurance is the main obstacle to expanding access to health care because it promotes waste and inefficiency;
• that the current system most harms marginalized communities, and creating a system of universal access, free point-of-service care and standardized reimbursement would make the health care system more equitable and less expensive;
• that replacing the current system with a fair system will promote efficiency, better health, and good public policy;
• that a national universal health care program is the most efficient and cost-effective means of providing access to health care and would eliminate hardships experienced by many Americans due to either lack of timely access to health care or debt incurred, or both;
• that a single-payer health plan in the state would replace the current multi-payer system;
• that a single-payer health plan would establish a state agency to finance all medically necessary health care with substantial savings;
• a single-payer health plan would reduce financial barriers to access care and inadequate coverage; and
• that workers and businesses would benefit from a single-payer health plan by lowering the cost of health care, removing the burden of unfunded and inadequate coverage, and allowing businesses to be more competitive in the markets.

The Legislature requests the federal government to either create a universal health care program or, absent federal action, partner with the state to implement a single-payer health system.  To allow the state to implement a single-payer health system, Congress could pass House Resolution 3775 or grant the state the appropriate waivers.