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
- 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 Is 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
- Acupuncture, some massage and other healing therapies
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.
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.
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).
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.
Yes! Dental & vision will be covered.
No. There will be no co-pays.
- Hospice and end of life care.
- 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.
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! 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.