By HCFA-WA Board Member Marcia Stedman
At their Sept. 11th meeting, Commissioners heard a presentation on Section 1333 Insurance Compacts, at the request of Insurance Commissioner Patty Kuderer.
Section 1333 is part of the Affordable Care Act (ACA) and, like the ACA’s Section 1332 waivers, a state must have a law authorizing the Compact and the same guardrails around benefits and impact to the Federal budget apply. These Compacts, if authorized, would permit the sale of health insurance across state lines and allow multiple states to offer a joint Basic Health Plan. Unlike 1332 waivers that require CMS approval, the 1333 waivers also require Congressional approval, and the hurdles are many: there is no guidance from the Feds, they have never been used, and they leave the current multi-payer insurance landscape intact, raising the question of whether they are appropriate as a tool for pursuing universal coverage.
This program could cover a larger group of people and potentially offer opportunities for administrative simplification. However, after the hour-long presentation of limited information, Commissioners had significant questions, such as “where are the savings?” and “this would bring in more plans. Is that good for us?” Nevertheless, a few Commissioners expressed interest in meeting with their Oregon counterparts to learn more about this option.
Takeaway #1: Universal health care advocates wonder how devoting time to Section 1333 compacts will move the Commission’s work forward, given the Commission’s severely reduced staff support and the limited amount of information available on this program.
The federal threats to health care funding caused Commissioners to take a defensive posture and prioritize these Transitional Solutions for 2026:
- protect Washington’s coverage gains
- develop mitigation and stabilization strategies
- meet rural health care workforce needs
- open the Health Benefit Exchange to small businesses
- develop a Medicare Advantage plan for WA residents who qualify
Takeaway #2: The advocate community, on the other hand, is keeping its eyes on the prize: universal health care with single-payer financing. In public comments, they urged the Commission to prioritize governance, consider health care as a public utility, and build on studies done in past years that would build infrastructure for the new system and at the same time save money for the state:
- Consolidate and expand state purchasing of health care for PEBB and SEBB plans
- enroll local governmental entities in PEBB
- offer only standard plans on the Health Benefit Exchange
- Continue to simplify administrative requirements and prior authorizations
- offer supplemental (secondary) coverage for those health services not covered by Medicare
- take back Medicaid administration from the current Managed Care Organizations
Good News
Despite the severe federal cuts to health care funding, and the projected 21% increase in health insurance premiums for WA individuals, State agencies reported that:
- The Health Care Authority’s Rural Health Transformation Program will receive $50 billion in new federal funding.
- The West Coast Health Alliance of WA, CA, OR, and HI is providing trusted vaccine guidance to its residents.
- The Dept. of Health has issued a statewide standing order that all residents ages 6 months+ can obtain COVID vaccination without a provider prescription.
The Commission welcomed two new members:
- Democratic Sen. Annette Cleveland
- Dr. Tao Kwan-Gett, pediatrician, epidemiologist and universal health care advocate representing the Dept. of Health.
Three open seats remain:
- a Senator chosen by the Republican Caucus
- two Governor appointees. Individuals should have knowledge and experience regarding health care coverage, access, and financing, or other relevant expertise
- Apply to be appointed by the Governor
The FTAC also has an open seat. Interested individuals must have subject matter expertise in health care financing, which may include
- actuarial expertise
- federal health care financing
- unified health care financing
- health care cost expertise
- understanding how dollars flow through the health system
- and/or understanding of payer/provider contracting
Apply to be appointed by the Governor.
The next Commission Meeting is on Oct. 9th from 2-5 pm, when the Commission’s final version of its 2025 Report to the Legislature will be voted on. Details available here closer to the date
We encourage you to Sign up to provide public comment by 5 p.m. the day before the meeting occurs.
- 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