SAVE THE DATE!  December 10, 7-8:00 PST 
Jesus Sánchez
SEA MAR COMMUNITY HEALTH CENTERS
A community-based model that delivers bilingual and culturally appropriate health care and social services. 

Jesus Sánchez, a member of the Board of Directors of Sea Mar Community Health Centers, will share the story of Latino community leaders and health activists who dreamed of developing a comprehensive health center for the Latino community in Seattle, with satellite clinics in rural communities in western Washington. They began in 1978 with one small clinic in the South Park neighborhood of Seattle, and today Sea Mar provides a broad array of services and programs for low-income, underserved, and uninsured communities in 13 Washington counties, specializing in services to the Latino population.

November 6th UHCC Finance Technical Advisory Committee (FTAC) Discusses Provider and Hospital Pricing

Washington's Finance Technical Advisory Committee (subcommittee of Universal Health Care Committee) convened to advance implementation of universal health care, with key focus on hospital reference pricing and provider reimbursement strategy.

SB 5083 Reference Pricing (2027 Implementation)

The Health Care Authority briefed on SB 5083, which caps hospital payments at 200% of Medicare rates for public/school employee plans (PEBB/SEBB) covering 500,000+ employees and dependents. Simultaneously, the law establishes payment floors of 150% of Medicare for primary care and behavioral health—shifting resources from inflated hospital spending toward preventive and mental health services. Preliminary modeling projects 2–3% premium growth reduction and approximately $200 million in state savings over four years. Enforcement includes annual claim repricing, carrier repayment obligations, corrective action plans for repeat violations, and new balance-billing protections.

Provider Reimbursement Framework (In Development)

FTAC defined scope for its provider reimbursement straw proposal: guiding principles, hospital payment approach, physician/provider frameworks, and participation incentives are in-scope. Outside the initial scope are detailed rate-setting methodologies, delivery system choices (carrier-based vs. ASO vs. fee-for-service), and operational/administrative details—topics for separate tracks.

Two critical guiding principles emerged: (1) uniform reimbursement across all enrolled individuals (no separate Medicaid/Medicare rates), and (2) site-neutral payment (same compensation for same clinical services regardless of setting or provider type). Members cautioned against conflating administrative simplification with reimbursement design, noting these deserve their own governance path.

Incomplete Foundational Work & New Funding

Members flagged that benefit design costing remains unfinished—the selected UMP Classic Plus Dental was never fully costed, and cost-sharing principles lack detailed modeling. Since calculating per-member premiums requires knowing benefit costs, this must be completed in parallel with reimbursement work. $250,000 funding from the Office of the Insurance Commissioner (OIC) can address these analytic gaps; staff will identify priorities at the January meeting.

Next Steps

A working group (Bob and Roger leading) will refine reimbursement principles and scope before the next full meeting on January 15, 2026, aiming for more efficient deliberation. The Commission expects FTAC to integrate Milliman analyses, SB 5083 findings, and rural/administrative work into its recommendations—though expectations for high-level guidance versus detailed financial modeling still require clarification.

View Meeting materials here

View Meeting Video Here

The next FTAC meeting is Thurs., Jan 15, 2026 from 2-4:30 pm.  Details available here closer to the date. 

There are two ways to share input:

• 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.

The next UHCC meeting is Thurs., Dec 11, 2025 from 2-5:00pm.  Details available here closer to the date. 

There are two ways to share input:

• 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.

We urge our members to push for a single payer plan in their public comments.

• Read our take on past UHCC and FTAC meetings

• Subscribe to Health Care Authority (HCA) for updates

ARE YOU INTERESTED IN SERVING ON THE UHCC? 

There is currently one open seat on the Commission, subject to appointment by the Governor. Candidates should have knowledge and experience regarding health care coverage, access, and financing, or other relevant expertise.  Apply to Serve here

Annual Meeting Recap

Incoming HCA Director Dr. Ryan Moran Addresses HCFA-WA’s November 15th Annual Conference

At their recent Annual Meeting, HCFA-WA members were privileged to hear from Dr. Ryan Moran, the newly appointed Director of the Washington Health Care Authority.

Dr. Moran brings a wealth of experience to Washington State from his leadership in Maryland's acclaimed health care system, where he helped hospitals shift from volume-driven, acute care to patient-centered, community-based models. In Maryland, he worked toward capping hospital costs and rewarding quality.  This experience offers Washington proven strategies to improve care while controlling spending.

In his keynote address, Dr. Moran demonstrated that he understands how to transform complex systems: prioritizing both immediate coverage for all and long-term foundational reforms. With federal healthcare funding in flux and fiscal pressures mounting, Moran’s dual focus is vital. First, he’s committed to keeping as many Washington residents insured as possible by maximizing enrollment in existing programs. Second, he’s laying groundwork to expand coverage and quality in the future—preparing now so Washington is ready to seize opportunities when circumstances improve.

He supports the two most important issues on the path to universal health care in Washington:

1. Protecting and expanding access: Ensuring current programs reach every eligible resident, maintaining coverage despite economic and policy shifts.
2. Building a sustainable, value-based future: Developing community-based primary care and innovative payment models that reward outcomes, not just volume—driving better results for patients and smarter use of resources.

Moran’s open-door approach and call for partnership invite all stakeholders to help build a fairer, more resilient healthcare system. Click the link to watch his compelling vision for Washington’s path forward—this is a pivotal moment you won’t want to miss.

Watch now on YouTube!

An unsolicited comment about the conference from a long-time supporter:

• I was impressed by the complexity of all the recorded and live messages from legislators and healthcare champions and from the incoming board. Ronnie Shure was welcoming and well spoken and graciously managed the technical aspects...
• My key takeaway is to stay hopeful and keep in place the progress made. We need to stay ready for the door to open again for healthcare for all because it's still broken...
• The conference changed my mind about reducing my monthly contribution. I'm reducing my giving to many and ending a few, but not to HCFA.

HCFA-WA Member David Merz Writes OP-ED in La Conner Community News

Summary of OP-ED

The piece argues that despite advances in medical capability, the U.S. remains uniquely inefficient because its complex insurance landscape creates coverage gaps and massive administrative waste. Nearly half of healthcare labor is absorbed by marketing, billing, and coding, with private insurance overhead reaching 30–40%, compared to Medicare’s sub-5% levels seen in other countries’ systems. It concludes that expanding Medicare to everyone from birth—not tweaking ACA details—would eliminate this waste, stabilize coverage, and restore efficiency.

Where Do Our Health Insurance Premiums Go?

Where half a trillion dollars in health insurance profits went instead of your care—and why your premiums keep rising anyway. Spoiler alert: your money went right into shareholders' pockets, and they still want more.

How Big Insurance Got So Big

Giant health insurers grew massively largely by using taxpayer-funded programs like Medicare Advantage and Medicaid as reliable revenue engines while consolidating power through acquisitions and vertical integration.

Action Item #1: Preserve the Enhanced Premium Tax Credits  

Congressional approved ACA Tax Credits will expire at the end of the year unless Congress extends them soon. This is the key issue over the current government shut-down. Congress enhanced the tax credits that over 200,000 Washingtonians use to get health coverage on Washington Healthplanfinder. Small business owners, part-time and gig workers, middle-income families, early retirees, and young adults use tax credits to afford their health coverage. 

Learn how this would affect Washington State

Tell your Members of Congress to protect health coverage for working families and stop these enhanced premium tax credits from expiring

Action Item #2:  Oppose Expanding Prior Authorization Into Traditional Medicare

Congress is weighing action to stop the Trump administration’s WISeR pilot, set to begin in January 2026 in Washington and five other states. WISeR would raise denial rates and restrict access to needed services. Now is the moment to push back before these harmful changes take root. Email Congress about Trump’s plan to let Artificial Intelligence (AI) decide which Medicare patients get care.

THANK YOU FOR TAKING ACTION TO SAVE THE HEALTHCARE SAFETY NET!