September UHCC: All about the financing - again!

by Marcia Stedman, HCFA-WA Board Member

The first hour of the Commission’s Sept. 3rd meeting was devoted to another Advocates Roundtable on Financing.  It was essentially a repeat of the 2025 inaugural Roundtable on the same subject. We are disappointed that so little progress has been made in the past year on this key element of our potential universal health care system. 

The 2025 recommendations that were proposed again this year:

• Progressive public financing as the primary funding mechanism
• Elimination of point-of-service costs to remove economic barriers to care
• Employer-worker assessment model similar to current premium structures but directed toward public healthcare
• Cost containment measures including global budgeting, price caps, bulk purchasing, and streamlined administration

But there were more recommendations this year, as the 4 advocacy organizations – Health Care for All-Washington, Washington Citizen Action Network, Northwest Health Law Advocates, and Whole Washington – spoke with one voice to call for reducing middle-man profits to direct the savings to care, de-coupling health insurance from profiteers, and tax reform, noting that  to make the system work, the way we buy insurance now needs improvement. 

HCFA-WA recommends referring to p. 35 of the Meeting Materials  for Cris Currie’s list of 24 other states that are also developing UHC plans and working on financing solutions. 

On a more positive note, the Commission’s Workplan now shows the FTAC completing their finance work by the 3rd quarter of 2027, and the Commission completing their enrollment, infrastructure and governance work by that date as well. (See p. 60 of the Meeting Materials)   The Commission may even be able to make their final plan recommendation to the Legislature by the end of 2027.  

The Roundtable was followed by a 2-hour full Commission meeting with a robust discussion indicating that they may be ready to meet this ambitious timeline.

Two new well-qualified Commission members have been appointed by the Governor

• Kumhee Ro, Seattle University Associate Professor, Family Nurse Practitioner at a Federally Qualified Health Center, with health workforce expertise
• Naisha Williams, MPH, Care Coordination Program Director for the City of Seattle, focusing on health equity, population health, barriers to care, epidemiology, and emergency and disaster management.

There is another open seat subject to appointment by the Governor.  Are you interested? Apply here

Two nearly unanimous votes, with Rep. Schmick casting the lone “nay”

• Support the Universal Primary Care Finance and Payment Model

Evidently as frustrated by the slow pace of the Commission as are the Advocates, OIC Commissioner Patty Kuderer explained that her Universal Primary Care request bill is meant to accelerate the Commission’s Workplan. This work is to be funded from the OIC Regulatory Account independently from UHCC work, with updates to the Commission, and with a due date of June 30, 2028.   

• Support FTAC’S Provider Reimbursement Proposal and Roadmap

See appendices B and C (pp. 93-115), respectively, for the Proposal and Roadmap.  The vote, again, was nearly unanimous, with only Rep. Schmick voting “no.”

Unanimous Agreement on 3 Foundational Questions

The Commissioners agreed that before proceeding to work on the enrollment, infrastructure, and governance elements, they will answer these 3 Foundational Questions:

• Will the universal system be single or multi-payer?
• Do commercial carriers play any role?
• Who bears the financial risk?

Health Care Authority Director Ryan Moran’s opening comments on Washington’s looming budget crisis, caused in large part by  the drastic cuts in federal support for health care in our state, set the stage for the Advocates Roundtable on Financing and the meeting that followed, making the creation of universal health care in WA more urgent than ever. 

4 Universal Health Care Advocacy Organizations

• Health Care for All-Washington, President Ronnie Shure and Policy Committee member Shari McEvoy
• Washington Citizens Action Network, Nathan Rodke
• Northwest Health Law Advocates, Emily Brice
• Whole Washington, Thomas Kennedy and Trish Russell

Questions from the Commission for Advocates

1: What Guiding Principles Should Inform the Discussion of Financing Mechanisms?

All four organizations spoke in solidarity, noting these principles:

• move now with a milestone-driven deep sense of urgency to develop a unified financing system and risk pool
• shift the cost burden away from the low- and middle-class
• reduce middlemen profits to direct the savings to care  
• a payroll tax and individual premiums, with the Legislature determining the exact revenue needs
• streamline administration
• adopt reference-based pricing and expense caps
• de-couple health insurance from profiteers
• explore reference-based, bulk, and active purchasing  
• business should contribute to the health of the state as infrastructure
• tax reform, as there is no expectation that health entities will contribute to the common good
• the way we buy insurance now needs improvement to make the system work.

2: What financing mechanisms do you hear about from WA communities?

• Progressive public funding
• capital gains and Millionaires’ taxes
• income tax
• business taxes
• a public trust supported by public funds, publicly managed, not for-profit
• global budgeting
• public banking
• wealth caps
• state-funded insurance  

Advocates’ Questions to the Commission

1: Would you consider a Public Trust funded by employer assessments and individual premiums?

• HCA’s Mary Franzen– A public trust, among others, will be considered. Expect an initial plan in mid-2027.
• Rep. Parshley supports the Washington Health Trust, considering the Walmart bill and the insurance surplus fund
• Ingrid Ulrey, Insurance Commission – administrative simplicity is “paramount”
• Vicki Lowe – pay directly to caregivers, no cost-sharing at point of service. She noted the negative impact on the Indian delivery system of working with insurers.

2: What is the timeline for the final deliverable?

• Mary Franzen– The end of 2027 for infrastructure and financing, however the bill creating the Commission did not have a date for a final deliverable.
• Rep. Parshley -  referenced Sen. Hasegawa’s deadline bill, which she is sponsoring in the House, as the original 2026 plan deadline was removed from the bill that created the Commission due to political considerations.
• Vicki Lowe – calls for support from the advocate community on this issue

3: Has the Commission identified any potential sources of revenue, such as the Washington Health Trust and Washington Health Security Trust bills propose?

• Vicki Lowe – the Commission and FTAC are beginning to identify revenue streams and looking at other states’ experiences. Nothing has been adopted or dismissed at this point.

The regular Commission meeting opened with public comments that included a plea from the Washington State Hospital Association to not reduce hospital reimbursements, and a recommendation from Jamie Keenan deVargas, LD 22 candidate for the House of Representatives, to repeal the property tax exemption on financial intangibles in order to fund a single-payer system.

3 Foundational Questions – unanimous agreement

On a positive note, the Commission unanimously agreed that before proceeding to work on the Commission’s final 3 topics in their Work Plan: enrollment, infrastructure, and governance, these 3 Foundational Questions must first be answered:

1. Will the universal system be single or multi-payer?
2. Do commercial carriers play any role?
3. Who bears the financial risk?

View Meeting Materials - The Draft 2026 Annual Report can be viewed on pp. 121-153

Watch Meeting Recording

Next UHCC meeting:  Thurs., Oct. 15 – 2-5 pm -  Information here closer to the date

ARE YOU INTERESTED IN SERVING ON THE UHCC? 

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

September FTAC: FTAC Launches Financing Work - all 9 members present!

Washington’s Universal Health Care Commission Finance Technical Advisory Committee (FTAC) devoted its September 24 meeting to launching the financing work needed for a universal health plan. FTAC outlined a four-stage process: establish principles and assess nonfederal revenue sources; document current health-system costs and revenues; estimate the universal plan’s cost; and assemble revenue-package options. Draft criteria for judging financing mechanisms include stability, adequacy, equity, legal viability, and simplicity. 

FTAC Members reviewed possible payroll, income, gross-receipts, sales, and other taxes, but endorsed no particular tax or package. They stressed examining who ultimately bears each tax, how proposals compare with today’s premiums and out-of-pocket costs, and whether low-income residents could pay more than under Medicaid. Analysis must also address federal funding, waivers, ERISA, transition costs, reserves, and cost containment. FTAC aims to complete its initial financing design around the second quarter of 2027, with Commission work continuing through late 2027. 

The group agreed to convene a smaller Finance Work Group consisting of Matthew Morrissey (Dept. of Revenue), Roger Gantz (experience in health care financing), Sarah Huling (expertise in health care financing), and Eddy Rauser (Office of Financial Management), to meet monthly starting in early October 2026. 

For HCFA-WA, this is a critical advocacy window. We should press for progressive, unified public financing; minimal cost-sharing; transparent distributional analysis; and a funded, auditable actuarial study. Universal primary care should remain a bridge—not a substitute—for comprehensive universal coverage. Advocates should engage FTAC’s new financing workgroup early, before assumptions and evaluation criteria become fixed.

Meeting Materials

View Meeting Video

Next Meetings:

UHCC: Thursday, October 15th  2–5 p.m., Join on Teams

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 to use OIC proviso funds for economic analysis focused on the entire single-payer universal healthcare system, rather than universal primary care, in their public comments.  

FTAC: Thursday, November 12th 2-4:30 p.m., Join on Teams

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.

We urge our members to push to use OIC proviso funds for economic analysis focused on the entire single-payer universal healthcare system, rather than universal primary care, in their public comments.  

• Read our take on past UHCC and FTAC meetings
• Subscribe to Health Care Authority (HCA) for updates

Now Available, the Universal Health Care Commission 2025 Annual Report

ARE YOU INTERESTED IN SERVING ON THE UHCC? 

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