Frequently Asked Questions

The Basics

What's the Whole Washington Health Trust?

The Whole Washington Health Trust (as described in Initiative 1362 and Senate Bill 5204) would establish the first state-wide, publicly financed, not for profit, healthcare system in the U.S.

Instead of multiple private insurance companies and multiple programs, the Whole Washington Health Trust (WWHT) would be a single payer and pay the healthcare expenses of Washington State residents.

This legislation was written by citizens, for citizens, free from the influence of corporate and special interests. The ultimate and urgent goal is comprehensive healthcare, from cradle-to-grave, delivered to all.

 

Who Is Covered?

All residents of the Washington State are covered. Resident is defined by the HCA. See the Residency Flowchart

  • The unemployed are covered.
  • The homeless are covered.
  • Those traveling temporarily out of the state are covered.
  • Those living here for a temporary job are covered.

 

What's Covered?

The Whole Washington Health Trust is a single and comprehensive benefits package. It considers the following ESSENTIAL:

  • Inpatient / Outpatient Care
  • 24 Hour Emergency Services
  • Prescription Drugs
  • Medical Devices and Biological Products
  • Mental Health and Substance Abuse Treatment
  • Reproductive Care
  • Maternity, Newborn, Pediatric Care
  • Rehabilitative Care, Occupational and Physical Therapy
  • Palliative and End of Life Care
  • Dental
  • Audiology
  • Vision
  • Acupuncture, some massage and other healing therapies

 

What are the main benefits of this system?

Let's envision what universal healthcare means

  • You won't need to choose between confusing plans with horrible choices. High deductible or low deductible? We vote for neither.
  • You can see the doctor you want.  Insurance provider networks won't exist.
  • There are no co-pays! And no deductibles! You'll be able to see your doctor without any financial stress.
  • Most prescriptions are included. Generics are fully covered and for those that aren't, there's a yearly cap. The most you'll pay is $250 per person per year.
  • You and your family won't be punished for illness or injury. You can focus on healing.
  • You won't need to stay locked in a job you don't want, just for its health insurance. Your healthcare won't be tied to a job.
  • Our health won't be monetized or commodified. We won't be marketed to. Healthcare becomes simple, stable, and truly supportive.

This is real transformation.

Financial FAQs

How will we pay for it?

Funding will come from multiple sources, will by-pass the middle man--insurance companies, and will go directly into the Whole Washington Health Trust. 

The majority of the funding still comes from Employers through a Payroll tax; however, it's usually much less than what they currently pay. Instead of purchasing individual plans, they contribute to the Trust. This means individuals' healthcare is not tied to employment.

 Employers will contribute  8.5%
 of wages 
  • This is less than what most employers pay for insurance now 
  • It relieves a ton of the administrative burden and unpredictable costs for employers.
  • This is the biggest contribution into the Trust (about 70%)
 Employees may contribute  2.0%
 of wages
  • This is a payroll deduction
  • Employers may choose to cover it
 Sole-Proprietors will contribute  2.0%
 of earnings
  • The first $15,000 won’t be taxed
 Investors will contribute   8.5%
 of capital gains
  • The first $15,000 won’t be taxed
  • Home sales, retirement accounts and more are exempt
  • This helps correct Washington’s regressive tax system and ensures the wealthy pay their fair share.
Individuals over 19 will contribute         $200
 per month max
  • The Monthly Premium won’t apply if you earn less than $25K 
  • The exact amount will be determined by the Trust Board
  • It can NEVER be more than $200/month
  • It’s reviewed every year to be the lowest it can be. It can be eliminated.

Remember, these contributions are not in addition to what you pay now--they’re instead of. Any costs for private insurance (insurance premiums, payroll deductions for your current plan, deductibles, co-pays, or potential medical bills) go away!

Employers will collect a contribution for each employee.

After an exemption, the Employer Payroll Contribution is a total of 10.5% of gross pay.

  • Employers are able to deduct up to 2% from the employee’s wages.  See Employee Payroll Deduction.
    • If the employer deducts 2% from employee’s wages, the employer’s contribution would be 8.5%.
  • See page 41-footnote 79 of Dr. Gerald Friedman’s analysis for information on what employers currently pay.

The Employer Payroll Contribution would be assessed quarterly.

Exemption = $15,000 – (Gross Pay x 0.25)

  • The exemption does not come into play for any Gross Pay above $60,000.

Calculation Example

Miguel has two employees.

EMPLOYEE 1 makes $90,000/yr which does not qualify for an exemption.

  • Employer’s Contribution
    $90,000 x 8.5% = $7,650/yr or $638/mo
  • Employee’s Deduction
    (employer may pay on behalf of employee)
    $90,000 x 2% = $1,800/yr or $150/mo

EMPLOYEE 2 makes $50,000/yr which would qualify for an exemption.

  • $50,000 x 0.25 = $12,500
  • $15,000 – $12,500 = $2,500
  • Employer’s Contribution
    ($50,000 – $2,500) x 8.5% = $4038/yr or $337/mo
  • Employee’s Deduction
    (employer may pay on behalf of employee)
    ($50,000 – $2,500) x 2% = $950/yr or $79/mo

More Examples

 Gross Pay 

 Employer’s
Contribution 

 Employee’s 2% Deduction

Employer may pay
 on behalf of employee

$20,000 $71/mo $17/mo
$40,000 $248/mo $58/mo
$60,000 $425/mo $100/mo
$80,000 $567/mo $133/mo
$100,000 $708/mo $167/mo

Employers with less than 50 employees that experience a hardship due to the Payroll Contribution may be eligible for a waiver or reduction of this assessment.

NOTE: In the bill, the Payroll Tax Contribution is referred to as the Health Security Assessment.

Employers are assessed a Payroll Contribution and may choose to deduct a portion directly from employee’s wages. This is the Employee Payroll Deduction. 

After an exemption, the maximum amount an employer can deduct is 2% of the Employee’s Gross Pay.

  • The exemption is $15,000 – (Gross Pay x 0.25)
  • The exemption phases out for pay above $60,000.

The Employee Payroll Deduction does not apply to employees 65 years or older.

The Payroll Contribution would be assessed quarterly, and employers are responsible for its collection.

The employer may choose to pay some or all of the Payroll Contribution as a benefit of employment.

Calculation Examples

EMPLOYEE 1 grosses $90,000/yr and does not qualify for an exemption. If her employer chose to deduct the maximum amount her deduction would be:

  • Employee 1’s Payroll Deduction
    • $90,000 x 2% = $1,800/yr or $150/mo

EMPLOYEE 2 makes $50,000 GP which qualifies for an exemption. If his employer chose to deduct the maximum amount his deduction would be:

  • Employee 2’s Payroll Deduction
    • $50,000 x 0.25 = $12,500
    • $15,000 – $12,500 = $2,500
    • ($50,000 – $2,500) x 2% = $950/yr or $79/mo

In the bill, the Employee’s Payroll Contribution is referred to as the Personal Health Assessment.

Sole Proprietors will be assessed an annual contribution on their earnings.

After an exemption, the Self-Employment Contribution is 2% of Adjusted Net Earnings.

  • The exemption is $15,000 – (Adjusted Net Earnings x 0.25)
  • The exemption would not apply for Net Earnings above $60,000.

Calculation Example

SOLE PROPRIETER nets $55,000 per year.

  • Self-Employment Contribution
    • $55,000 x 0.25 = $13,750
    • $15,000 – $13,750 = $1,250
    • ($55,000 – $1,250) x 2% = $1,075/yr or approx. $89/mo

After an exemption, an 8.5% tax contribution will be assessed on Net Long-Term Capital Gains (LTCG), if the LTCG is over $15,000.

The tax will not apply to:

  • Residential or Home Sales
  • Agriculture Income
  • Retirement Accounts

Exemption Calculation = $15,000 – (LTCG x 0.25) (Exemption defined in section 301)

The exemption does not come into play for any LTCG above $60,000.

If the LTCG is $15,000 or less, the tax is not applied at all.

The Investment Profit Contribution will be assessed annually and submitted with the tax return.

Example

INVESTOR 1 is reporting a Net Capital Gains of $45,000 after selling stocks.

  • First, calculate the exemption: $45,000 x 0.25 = $11,250.
  • $15,000 – $11,250 = $3,750 is the exemption amount.
  • $45,000 – $3,750 = $41,250 is the non-exempt, taxable amount.
  • $41,250 x 8.5% = $3,506.26

Mary would contribute $3,506.26

More examples for illustration:

Long Term Capital Gains Contribution
$20,000 $850
$40,000 $2,975
$60,000 $5,100
$80,000 $6,800
$100,000 $8,500

See IRS topic for more info on Capital Gains.

General FAQs

Single payer healthcare refers to a publicly financed system with universal coverage for all medically necessary care.  Healthcare is financed by one entity or one payer. In this case, the Whole Washington Health Trust would pay the medical expenses for all enrolled Washingtonians. Healthcare delivery would remain largely in private hands.

Our current system is a multi-payer system, made up of multiple private insurance companies and multiple governmental programs.  

The Whole Washington Health Trust (WWHT) is as close to single payer as a bill can get on the state level.

Due to federal laws regarding Medicaid/Medicare/ERISA/VA/IHS, we need waivers to fold everyone in to one system. However, the initiative writing committee, along with Dr. Gerald Friedman, came up with a brilliant work around: allow anyone on those programs to opt-in to the WWHT. The much less expensive, more comprehensive, plan will attract individuals and businesses alike, making private insurance superfluous. 

Yes! In 2019, we are projected to spend nearly $80 billion on healthcare in Washington State alone under our current system. According to Dr. Gerald Friedman’s economic analysis, a universal public health trust covering all essential health benefits will cost less than $70 billion, a savings of more than $9 BILLION in healthcare costs for Washington state residents, even accounting for costs related to expanding and improving coverage. The public health trust saves on every aspect of public and private funded healthcare administration and improves the bargaining power for negotiating drug prices resulting in more than $9 Billion in savings compared to our current care being provided. Because of these savings, the public health trust has more money to fund expanding and improving public health benefits available for all Washington state residents. In addition, providers can expect to spend 10% less time on administrative work, and we all spend less on drug prices and fraud.

In order to put the necessary funding mechanisms in the initiative, Whole Washington needed to know how much the system would cost. Dr. Friedman has done these studies for many different states, to include in those states’ bills and initiatives. Without this study, the campaign would have been exposed to the criticism that there is no funding and detractors could have used it as an opportunity to come up with their own projections. This happened recently in California and was the excuse some used for not pushing the Single Payer bill out of committee.

Employers are averaging 12% of payroll for employee coverage currently. During transition, employers who offer ACA compliant coverage to employees may opt out of the health security assessment for those employees. Our proposed health security assessment of 8.5% with an exemption on up to $12,000 in pay per employee each year means the average employer will pay under 7% of payroll to participate. This will be an appealing option and many employers will simply be relieved to have a less expensive (and potentially free) option to provide quality coverage to their employees.

Employees will be able to opt in during the transition and decline their employer sponsored coverage by paying the health security assessment. Once 51% of residents in the state are enrolled in the Whole Washington Health Trust, many employers will no longer be able to opt out. Due to federal laws, employers maintaining health benefits under ERISA will be exempt for each employee if they offer ACA compliant coverage until the employer elects participation or an employee union negotiates a supplemental health benefits package and it becomes effective.

Employers may pay premiums for employees and their spouses (if they owe them) and may pay all or a portion of an employee’s personal health assessment. The few employers offering quality health benefits at little or no cost to employees currently, can continue to offer quality benefits at little or no cost as a benefit of employment while still benefiting from reduced administrative expenses, equitable costs, and lower drug prices available through the trust.

Our proposal doesn't restrict employers from offering additional insurance coverage or any residents from purchasing other insurance coverage.

Yes! Sec. 123 on page 25 creates a “DISPLACED WORKER TRAINING ACCOUNT” which states: “The displaced worker training account is created in the custody of the state treasurer. Expenditures from the account may be used only for retraining and job placement of workers displaced by the transition to the trust.“

We would not lose access to any current federal funds. The Whole Washington Health Trust will contract to administer Medicaid and Medicare, which allows them to receive the funding they do today.  

In fact, federal contributions could increase. All residents would be assessed for Medicaid eligibility as part of enrollment to the trust. With significant loss of employer-based insurance, more residents are eligible, which results in more contributions to the trust.  

Additionally, the bill provides legal instructions to obtain all waivers to fully integrate federal funds into the trust. While this achievement will improve efficiency in administration, it’s not necessary to start or stay solvent. We can proceed with urgency.

Section 113 Summarized

See Section 113 of SB 5204

No. The Health Security Assessment tax on payroll would not apply to sole proprietors earnings from self employment. However, sole proprietors will owe an annual personal health assessment of 2% of net earnings from self-employment (Net profit/loss ​Line 31 on Schedule C​) in order to enroll in the trust for coverage. Starting in 2022 self-employed residents would be required to be enrolled in minimal essential coverage as defined by the ACA ​or​ pay the annual personal health assessment to the trust.

I-1362 creates new taxes and a universal healthcare system.

Will this be an issue for passing the measure? No. As long as there is a rational connection between the component parts of a law which serve a related purpose, the initiative will satisfy the Constitution. The revenue components of I-1362 are tied directly to implementing the universal healthcare plan.

See Lee v. State, 185 Wn.2d 608, 374 P.3d 147 (2016).

Universal Healthcare is the only viable solution.

Better Health

  • One third of Americans don’t complete doctor’s orders due to cost concerns
  • Providers spend too much time doing paperwork related to coverage
  • Providers should decide what to do based on what is best for patient, not what will be covered
  • People shouldn’t have to worry about money when they're sick

Savings

  • No deductibles or co-pays. Current deductibles are too high and can easily wipe out hard-earned savings.
  • Almost all prescriptions are covered with very little out of pocket cost. There will be a small co-pay with an annual per-person maximum of $250 per year (only when brand name drugs are used instead of generics for non-preventative conditions).
  • Costs should be predictable, controlled and the same for everyone. The cost of current plans may vary based on age or medical condition of recipient, or overall health of other people enrolled in plan.
  • 90-95% of Washington residents are expected to pay less

Social Justice & the Greater Good

  • Racism is a public health crisis. Universal healthcare is a required first step
  • Healthcare is a human right. Profit doesn’t belong in healthcare
  • Medical debt is the number one cause of bankruptcy and homelessness
  • Residents of WA counties with poor access to healthcare have shorter life expectancy
  • Crowdfunding healthcare is immoral
  • Inadequate access to mental health and addiction services is a public safety issue
  • Almost every other comparable country uses this system and has better health outcomes that cost less
  • People end up in hospitals or die from conditions that could have been controlled without hospitalization

Individual Freedom

  • Your ability to be healthy should not depend on what kind of job you have
  • People shouldn't stay in jobs they would otherwise leave to secure healthcare coverage
  • People shouldn't stay in relationships to maintain access to healthcare
  • Artists and innovators shouldn’t be held back by fear of losing benefits

Fiscal Sustainability

  • Whole Washington Health Trust will save billions each year
  • Employers and people spend too much time trying to figure out which plan to buy
  • The 8.5% payroll tax imposed is less than what employers pay now to offer benefits. Rising costs make it difficult for businesses to compete.
  • Insurance and financial processing jobs lost will be replaced by jobs created in the healthcare sector when more patients seek the care they need
  • The money families save on healthcare can be reassigned to other segments of our state economy

Join us in this fight

Fill out the Volunteer Form and check out Things You Can Do Right Now.

Eligibility FAQs

Yes. You have the option to enroll in the Whole Washington Health Trust.

If you’re happy with Medicare, you can continue as is and use any supplemental Medicare Advantage Plan available to you.

If you want to change, you can enroll in the Whole Washington Health Trust for full or supplemental coverage.

  • You'll receive expanded benefits, like vision, dental, audiology, and prescription drug coverage.
    • Most prescriptions are fully covered, including all generics. The most you’ll pay for prescriptions that aren’t covered is $250/per person, per year.
  • You'll eliminate out-of-pocket costs like co-pays, deductibles, or medical bills.
  • You'll be able to see the provider of your choice.

If your household earns more than 200% of the federal poverty level, you will pay a Monthly Premium. The amount will be determined by the WWHT Board and can never be more than $200/month.

If your household earns less than 200% of the federal poverty level, you will not pay a Monthly Premium.

For more information, see Medicare & the Whole Washington Health Trust

 

Yes! ​Qualified out-of-state providers can negotiate for reimbursements, but providers are not required to accept reimbursement from the new trust. Enrolled residents who are temporarily out-of-state will be covered to see out-of-state providers for emergency services because of current state and federal laws regulating essential health insurance coverage, but the new public trust has the authority to include out-of-state providers beyond emergency services.

Yes! All adults residents earning under 200% FPL (Federal Poverty Level) will be eligible to enroll with no premium, regardless of employment.

Yes! All Children under the age of 19 are covered with no premiums or out-of-pocket costs.

No. There will be no co-pays.

Not long! Residence status for healthcare is defined by Medicaid in Washington: https://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/residency.

Immediately, if employed, or an employer moves an employee to Washington.

Benefits FAQs

Yes! Dental & vision will be covered.

No. There will be no co-pays.

Some. ​ The coverage will include limited long term care benefits, such as:
  1. Hospice and end of life care.
  2. Long term care benefits and eligibility at least at the standards of Medicaid coverage as it exists now.

The Whole Washington Health Trust proposes including long term care benefits beyond these levels after January 1, 2023, subject to ongoing and consistent funding.

Note: the WWHT does not interfere with benefits related to Labor & Industries (L&I), Veterans Affairs (VA), or Indian Health Services (IHS) or their funding.

The universal healthcare trust created will have to cover at least the coverage required for our states “benchmark health plan” in order to qualify for federal funding. Here is our state’s current benchmark coverage: https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/Updated-Washington-Benchmark-Summary.pdf Additional coverage may be considered essential by our trust based on medical evidence and provider feedback.

Sometimes. There will be a prescription drug schedule to incentivize generic use, but which can’t limit effective care or be applied to preventative medicine. The copays only apply to adults earning over 200% FPL and can’t exceed $250 annually.

Yes! The public health trust will negotiate the lowest possible prices with pharmaceutical companies for Washington residents using all available methods including bulk purchasing with Washington’s Tribes.

Yes.

Provider FAQs

Yes! The public health trust created by the Whole Washington Health Trust will negotiate rates with all qualified providers who wish to participate for reimbursement. The trust is obligated to negotiate global budgets with non-profit community health providers in each Washington state county, but all qualified providers will be able to collectively negotiate traditional fee-for-service reimbursements. Providers will not be not required to accept the reimbursements negotiated by the trust.

Yes! There are no networks with the Whole Washington Health Trust. There are no restrictions in the providers you are able to see. 

Yes! Under the new trust, provider reimbursement rates will be negotiated by the trust based on several factors, including discussion with provider groups, making it more likely that providers will be happier with trust rates than they are with current Medicaid and Medicare rates. Additionally, provider costs will decrease due to a significant reduction in administration.