The Washington Health Trust (as described in Initiative 1471) 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 Washington Health Trust (WHT) would pay the healthcare expenses of Washington State residents.
This legislation was written by citizens, for citizens, free from the influence of corporate interests. Our goal is comprehensive universal healthcare, from cradle-to-grave with no one left out.
All residents of Washington State are eligible.Resident is defined by the Health Care Authority. 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.
Some non-residents are also eligible.Eligible non-residents will be defined by the Washington Health Trust Board and include:
- nonresident students attending college within the state
- nonresidents employed within the state
- spouses or domestic partners and dependents of eligible nonresidents.
The 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
Universal Healthcare means
- There are no co-pays, deductibles, premiums, or medical bills.
- You'll be able to seek care 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 adult / per year.
- There is no charge for those under 19 and those making less than 200% of the Federal Poverty Level.
- Healthcare isn't tied to a job.
- You aren't locked in a job you don't want to maintain health insurance.
- You can see the doctor you want. Insurance provider networks won't exist.
Peace of Mind
- There are no confusing plans with horrible choices. High deductible/low premium or low deductible/high premium? Neither applies with the Washington Health Trust.
- Focus on healing.
- You and your family won't be punished for illness or injury.
Universal Healthcare is simple, stable, and truly supportive
Universal healthcare doesn’t require new funds in addition to what we’re paying now. Instead, we shift what we're paying in private insurance costs to predictable quarterly or annual taxes.
We'd no longer pay premiums, co-pays, or deductibles. There would be no out-of-network charges or medical bills of any kind.
|Employers will contribute||10.5%
|Relieves administrative burden and unpredictable costs for employers
Biggest contribution to the Trust (about 70%)
|Employees may contribute|| up to 2.0%
|This is a payroll deduction, not out-of-pocket
Employers may choose to cover all or any portion of the amount
|Self-employed individuals will contribute|| 2.0%
|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, agriculture, retirement accounts and more are exempt
Employers will collect a contribution for each employee.
After an exemption, the Employer Contribution is a total of 10.5% of gross pay.
- Employers are able to deduct up to 2% from the employee’s wages.
- The Employer 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.
Employer elects to deduct the full 2% from the employee's paycheck.
EMPLOYEE 1 makes $90,000/yr (does not qualify for an exemption).
- Employer’s Contribution
$90,000 x 8.5% = $7,650/yr or $638/mo
- Employee’s Deduction
$90,000 x 2% = $1,800/yr or $150/mo
EMPLOYEE 2 makes $50,000/yr (qualifies 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
Employee’s 2% Deduction
Employer may pay
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.
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 Deduction does not apply to employees 65 years or older.
Payroll Contributions are 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.
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
- The exemption is $15,000 – (Adjusted Net Earnings x 0.25)
- The exemption would not apply for Net Earnings above $60,000.
Calculation ExampleIndividual 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)
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.
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
More examples for illustration:
|Long Term Capital Gains||Contribution|
See IRS topic for more info on Capital Gains.
Yes, the Washington State Constitution allows a "uniform" taxation with a max exemption of $15,000. We wrote our ballot measure and bill with those restrictions in mind.
Reference: Article VII, Revenue and Taxation on page 61
No. The Employer Contribution would not apply to sole proprietors earnings from self employment. However, sole proprietors will owe 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 2026 self-employed residents would be required to be enrolled in minimal essential coverage as defined by the ACA or pay the annual Self-Employment Contribution to the trust.
The Washington Health Trust is as close to single payer as possible at the state level.
Due to federal laws regarding Medicaid/Medicare/ERISA/VA/IHS, we need waivers to fold everyone in to one system. However, anyone using those programs can enroll in the Washington Health Trust.
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.
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 Employer Contribution for those employees. Our proposed Employer Contribution of 10.5% with an exemption for employees making under $60K. This will be an appealing option that significantly reduces administration costs and resources.
Employees will be able to opt in during the transition and decline their employer sponsored coverage. Once 51% of residents in the state are enrolled in the 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 all or a portion of an employee’s contribution. 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! The initiative creates a “DISPLACED WORKER TRAINING ACCOUNT” which can only be used for retraining and job placement of workers displaced by the transition to the trust.
Actions at the federal level could make transitioning to universal healthcare much easier; however, it's not necessary, and we wouldn't lose access to any current federal funds.
The Washington Health Trust will contract to administer Medicaid and Medicare, which allows them to receive the funding they do today.
Federal contributions may even increase. All residents are assessed for Medicaid eligibility as part of enrollment. With loss of employer-based insurance more residents are eligible, which results in more contributions to the trust.
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.
I-1471 creates new taxes and a universal healthcare system. There's a rational connection between the component parts of a law, which serve a related purpose. The revenue components 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.
- 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 can 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
- No premiums, 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 (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
- 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
- The Washington Health Trust will save billions each year
- Employers and people spend too much time trying to figure out which plan to buy
- Rising costs make it difficult for businesses to compete. The Employer Contribution is predictable
- Insurance and financial processing jobs lost will be replaced by jobs created in the healthcare sector when more patients seek the care they need
Yes. You have the option to enroll in the 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 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.
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 residents can enroll, regardless of employment.
Absolutely! All children under the age of 19 are covered with no out-of-pocket costs.
Yes! Dental, vision, and more are considered essential and will be covered.
No. There will be no co-pays.
- Hospice and end of life care.
- Long term care benefits at least at the standards of Medicaid coverage
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 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 required to accept the reimbursements negotiated by the trust.
Yes! There are no networks with the Washington Health Trust. There are no restrictions to 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.