By John Sobeck
The March 19, 2026, FTAC meeting advanced Washington State’s effort to build a universal healthcare system, with universal primary care as a possible first step. The approach emphasizes a phased, incremental strategy, using pilots in state programs before broader expansion. The goal is to improve access, control costs, and simplify administration while maintaining provider participation and system stability.
The Proposal Overview was presented by Jane Beyer, Sr. Policy Analyst for the Office of the Insurance Commissioner:
- Create a universal benefit package for primary care
- Primary care would be paid for and delivered distinct from health insurance coverage
- Health insurance wraps around and coordinates with primary care providers to cover all other services
- Build on evidence-based primary care models, such as UW AIMS Center Collaborative Care model, integrating behavioral health, primary care, and advanced primary care
- Payment goes directly to provider or provider organization—preferably on a pre-paid basis
- Insurance carriers provide supplemental coverage for other services
- System could be a platform for expanding universal coverage to other services
The proposed model centers on integrating behavioral health, primary care and advanced primary care in a team-based approach. Financing concepts include utilizing existing state spending for enrollees in publicly administered health care plans and potential federal support.
Key risks identified:
- Creation of a two-tiered system if supplemental access emerges
- Underfunding from flawed modeling approaches
- Unintended provider incentives affecting care delivery
- Rural system instability due to low volume and limited resources
- Concerns about privatization and fragmentation
- Who is the risk--bearing entity
Mitigation strategies include prospective payment models, standardized quality measures, and targeted rural pilots.
Provider Reimbursement and Implementation Pathway
The committee endorsed a stepwise transformation of provider payment, starting with:
- Reference-based pricing in public employee plans. Evaluate and if successful
- Out of network price caps for commercial market, evaluate
- Reference-based pricing for all commercial plans
- Potential transition to broader rate-setting and global budgets
There was strong emphasis on evaluating pilots before scaling, focusing on cost, access, and quality outcomes. The group also moved away from traditional financial “incentives,” favoring supportive, accountability-based models to reduce administrative burden and clinician burnout.
Financing and Modeling Priorities
A limited pool of funding will support modeling to inform system design. The central tension is between:
- Actuarial modeling for near-term payment and rate-setting
- Economic modeling for long-term system transformation
Priority areas include consumer costs, employer contributions, provider reimbursement design, and rural payment thresholds. These analyses are critical to advancing policy into actionable legislation.
Technical Design and Cost Control
Key technical discussions focused on:
- Prospective vs. retrospective payment models
- Risk adjustment methods and safeguards against ”gaming”
- Risk corridors to protect smaller and rural providers
- Bundled payments and global budgeting
Cost control strategy centers on incremental implementation, continuous evaluation, and expansion of reference-based pricing. There is also consideration of a future rate-setting or cost commission.
Stakeholder Engagement and Public Input
Public comment strongly supported prioritizing primary care, reducing reliance on managed care organizations, and ensuring equitable access. Stakeholders emphasized the need for clear communication, transparency, and collaboration, particularly in legislative drafting.
The committee plans to expand engagement through shared platforms, public input channels, and coordination with advisory groups and advocates.
Rural Health Considerations
Rural viability is a major constraint. Challenges include low patient volume, limited infrastructure, and risk of financial instability under new payment models.
Proposed approaches:
- Targeted rural pilots
- Payment adjustments and risk protections
- Expanded use of telehealth and collaborative care models
Key Decisions and Next Steps
Decisions:
- Advance universal primary care design
- Approve phased reimbursement reform strategy
- Expand tools for transparency and stakeholder engagement
Next Steps:
- Finalize modeling priorities and contracts
- Develop detailed policy proposals for upcoming meetings
- Launch and evaluate pilot programs
- Refine reimbursement principles and rural adaptations
- Prepare for key April and May commission milestones
Bottom Line
The committee is coalescing around a practical, phased path to universal coverage, possibly beginning with primary care and anchored in payment reform. Success depends on careful pilot execution, credible financing analysis, and managing risks—especially for rural providers and system fragmentation.
View the Meeting materials
Watch the Meeting Video
Next Meeting:
UHCC : Thursday, April 30, 2026, 2–5 p.m. - Details available here closer to the date.
FTAC: Thursday, May 14, 2026, 2-4:30 p.m. - Details available here closer to the date
Comment to the FTAC
- Speak during the designated public comment time at FTAC meetings. Sign up to provide public comment by 5 p.m. the day before the meeting occurs.
- Submit written comments at any time. If you submit your comments less than two weeks before a meeting, we’ll include them in the following meeting’s materials.
Comment to the UHCC
- Speak during the designated public comment time at UHCC meetings. Sign up to provide public comment by 5 p.m. the day before the meeting occurs.
- Email [email protected] at any time. If you submit your comments less than two weeks before a meeting, they will be included in the following meeting’s materials.
We urge our members to push for a single payer plan in their public comments.
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Note: AI was used to assist in summarizing a transcript and notes from the meeting. All AI-generated incorporated material was reviewed and corrected for accuracy and thoroughness.