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.
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! Dental & vision will be covered.
Yes! All adults residents earning under 200% FPL (Federal Poverty Level) will be eligible to enroll with no premium, regardless of employment.
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.
Yes! Pending approval of a federal waiver to integrate Medicare, Medicare premiums will be reimbursed by The Whole Washington Healthcare Trust to Medicare recipients who earn under 200% of FPL and would be exempt from owing premiums for enrollment in the trust’s expanded coverage. Medicare enrollees with incomes over 200% FPL will owe the premium established by the trust until federal waiver is granted integrating Medicare in Washington, but would be eligible to have their Medicare premiums reimbursed IF they enroll in the trust as their Medicare Advantage coverage. The board is instructed to reduce the premium owed by higher earning adults (including Medicare recipients) to the fullest extent possible, so improved administrative savings achieved result in a lower and lower premium over time even if the federal waiver is not granted to integrate Medicare directly. There are also temporary costs that we've accounted for like a "Displaced Worker" program and temporary waivers for businesses. Over time these costs will be reduced and the savings will also result in further reducing the premium (ideally to zero). For more details, see the Medicare page
No. There will be no co-pays.
Yes! All Children under the age of 19 are covered with no premiums or out-of-pocket costs.
Yes! The public health trust created by SB 5222 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.
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 on their pay themselves. Once 51% of residents in the state are enrolled in a state-administered health insurance and 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 their 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. So 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.
- Hospice and end of life care.
- Long term care benefits and eligibility at least as generous as Medicaid coverage as it exists now.
- "Subject to ongoing and consistent funding..." our plan proposes including long term care benefits beyond this after January 1, 2023.
Also, our proposal doesn't interfere with any benefits related L&I, Veterans benefits, or Indian Health Services or their funding. We do expect these federal programs to experience reduced spending for all essential health benefits provided to residents covered by the plan.
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.
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! 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! 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.“
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.