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Q & A on 2SSB 5399, the Universal Health Care Commission 

Elaine Cox with contributions from Sarah Weinberg, MD

We’ve seen and heard a lot of questions and discussion about why HCFA-WA is endorsing 2SSB 5399,  Concerning the creation of a universal health care commission. We’d like to address some of these concerns using a Q & A format. (Click/tap here for a synopsis of the bill). Visit the Legislation page for our official positions on important health care bills this session.

Q: Where did this UHC Commission (UHCC) idea come from? 
A: The final report of the Universal Health Care Work Group was sent to the legislature on January 15, 2021.  It provides a transition plan to reach a state-based UHC system.  2SSB 5399 sponsors took up the recommendation from the report for a legislatively established commission to spearhead the work of transitioning. The report advises: ”The Universal Health Care Commission (UHCC) would be an action-oriented, focused group, supported by targeted Work Groups used to define specific topics. Stakeholder input is anticipated at multiple points during the process.”    

Q: What would this Commission actually do?  
A: The bill charges the UHCC to develop a plan “to create a health care system in Washington that provides coverage and access through a universal financing system including, but not  limited to, a single-payer financing system, for all Washingtonians.” 

Q: There are already such plans fully developed, for example SB 5204, the Whole Washington Health Trust, and the Washington Health Security Trust (WHST) are comprehensive legislation providing a guarantee for state-based publicly funded UHC.  Is this just another delay tactic underwritten by the private insurance industry? 
A: HCFA-WA and our allies worked very hard developing the legislation referenced above and we’re anxious to see it implemented. We are confident that it provides the necessary blueprint and we will push to use this legislation to guide the Commission’s work. We believe there will be a role for HCFA-WA and our allies on advisory committees created by the Commission.   

We would of course have preferred that the bill had required single payer as the basis for the plan’s financing.  The first substitute bill adds: “requires the Commission to synthesize existing analyses of the state's health care finance and delivery system.”  These analyses have showed time and again, as the actuarial analysis from the UHC Work Group did, that Washington will save billions every year from a Model A plan, and that we cannot afford NOT to do it.   

The substitute bill also adds developing recommendations for retraining displaced workers to the steps the state should take to prepare for a just transition to a unified financing system.”  The added language further empowers the Commission to develop a publicly funded and administered plan. 

Given that SB 5204 did not get a hearing in the Health and Long Term Care Committee, we believe the Committee does not think it will get enough support in the Senate this year. We believe our advocacy efforts are better spent on 2SSB 5399, which has now moved from Health and Long Term Care to Ways and Means.   

Having a group spearheading and overseeing the work to ensure implementation, and with a prescribed timeline, is a huge step forward to realizing universal affordable coverage. The Commission will be well positioned to obtain the waivers needed to sustain federal health care dollars.  It will also have to address how to raise the estimated $30+ billion that the state will need (on top of federal funds) to pay for the nearly $60 billion that it will cost to provide health care to every state resident. 

We can understand, given that no state yet has successfully implemented a comprehensive single payer health program, legislators would want to have a dedicated body with broad perspectives and expertise from state agencies, legislators, executive branch, academics, and stakeholders to ensure success of this transformative innovation. 

Q: What is the timeline for the Commission? Is it too long? 
A: The timeline is to complete the plan by November 2024 and begin implementation by 2026.  We share concerns that this is more time than is necessary.  We believe that the Commission could shorten the timeline by one year, especially if it uses the existing WHST or SB 5204 to develop the plan.  An advantage of this is that it would get the plan established prior to the 2024 elections which introduce uncertainty in support at both the state and federal levels. 

Nevertheless, there are time-consuming tasks that must be accomplished for a state universal coverage plan to work. Currently, more than $24 billion in federal funds per year help pay for health care in our state, and that’s not even counting coverage for federal employees, military families, and veterans using the Veterans Administration system. Corralling these funds into a state universal health care fund is essential to making the plan affordable, and requires multiple waivers and cooperation from the federal administration. 

HCFA-WA proposed an amendment to reduce the timeline for developing the plan by 2023 and implementing by 2025. 

Q: What about the people who are suffering and at risk now because they can’t afford coverage or even with coverage they cannot afford the care they need? 
A: HCFA-WA supports immediate efforts to expand access and make care and coverage affordable. We got legislation passed last year to make insulin more affordable for people with Type 1 diabetes. We are supporting legislation this session that will increase affordability of plans on the Health Benefit Exchange, lower drug costs, expand Medicaid eligibility, and will provide funds to health equity zones to improve the health of people in vulnerable communities. 

The bill requires recommendations for coverage expansions to be implemented in the interim, including expansion for full scope Medicaid coverage, regardless of immigration status.

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