NoHLA’s Impact

Northwest Health Law Advocates is the consumer voice in the health care debate. For 25 years, we’ve been working to improve access to health care for all Washington residents to advance health as a human right. Here are some examples of our recent advocacy efforts:

Refining and Improving Health Reform

NoHLA is at the forefront of efforts to ensure Washington State’s new health system attracts enrollees and that it works for all residents, including those who are low-income. Our work includes:

• Ensuring effective state implementation of the ACA and addressing continuing barriers to access: NoHLA has played a key role in advocating for ensuring that people can easily enroll in Washington’s Medicaid expansion and Exchange, leading to better coordination and access and enabling many more people to become – and stay – insured.
• Advocating to guarantee full contraceptive coverage in insurance plans: NoHLA issued a groundbreaking “secret shopper” report finding that insurers gave women inaccurate information on contraceptives now covered at no cost. In response, many insurers took corrective action, improving access to coverage.
• Spurring improvements in equitable, affordable access for all: NoHLA has been instrumental in the push for the state to adopt policy options such as easier access to Medicaid, coverage for immigrants left out, lower premiums and cost-sharing for health insurance on the Washington Exchange, and reproductive health equity. NoHLA provides input into the policy choices that will create equitable coverage for all. We provided extensive comments as the Medicaid regulations were restructured to adapt to the ACA. We worked toward the creation of a family planning program for immigrants not eligible for Medicaid that was enacted and began in October 2019. More recently during the COVID-19 pandemic, we have engaged with state agencies on simplifying and liberalizing programs so people can gain coverage more easily and can access services via telehealth.
• Protect and defend our progress: In the face of threats at the federal level to eviscerate health programs – not only those created under the Affordable Care Act (ACA) but Medicaid itself and reproductive health programs – NoHLA has engaged in defensive work, which includes broadly informing the public and policymakers of the value and impact of these programs for Washington residents, and the importance of building upon them. In 2019, the Washington Legislature passed a bill to incorporate key provisions of the ACA into state law, with NoHLA providing input into the content of the law and then into the regulations that implement the legislation.

Supporting Legislation to Protect Patients from Surprise Medical Bills

NoHLA was a key consumer advocate in long-term efforts to “take consumers out of the middle” – a situation where insurers and health providers cannot reach agreement on payment and the provider ends up sending a bill for the balance of the charges to the patient. A person needing emergency care has no idea that they were seen by an out-of-network health provider, laboratory, etc., and has no ability to change to an in-network provider. They are later surprised by a separate, costly bill that far exceeds their insurance plan’s cost-sharing. A person getting care at an in-network health care facility can be similarly surprised.

After many years, in April 2019, the Washington Legislature enacted a law that prevents “surprise billing” and protects many Washington residents caught in this situation. The legislation limits what consumers are billed to in-network cost-sharing. Insurers and providers must work out payment between themselves. Recently, a federal surprise billing law passed that provides additional protections. NoHLA will continue to provide input as regulators, insurers, and providers take steps toward implementing these consumer protections.

Health Care for Immigrants:
Fighting for Coverage, Combating New Threats

In September 2011, NoHLA and co-counsel Riddell Williams, P.S. received a favorable ruling in a class action suit on behalf of low-income immigrants who challenged their disenrollment from Washington State’s Basic Health program. Federal District Court Judge James Robart issued a preliminary injunction, ordering the State to re-enroll thousands of immigrants whose coverage was terminated in March due to budget cuts. The judge ruled on two constitutional grounds:

• Disenrollment based on immigration status likely violated the plaintiffs’ Equal Protection rights.
• The notice of disenrollment that plaintiffs received was likely inadequate, violating their Due Process rights.

The Health Care Authority immediately restored coverage to all affected immigrants and sent them improved notices describing the new eligibility criteria, in order to give them an opportunity to pay their premiums and demonstrate a “lawfully present” immigration status in order to retain coverage in the future. (The Basic Health Program was superseded in 2014 by the ACA; lawfully present immigrants not eligible for Medicaid were offered QHP subsidized coverage through the Washington Health Exchange.)

The ACA did not preserve immigrant coverage that many Washington residents had through the now-expired state Basic Health Program, and in the past four years, federal policies threatened accessing even what does exist. NoHLA was actively involved in efforts to prevent these threats from interfering with immigrants’ access to care, but now that these policies were withdrawn, we are pivoting to more proactive strategies -  supporting to the restoration and expansion of coverage at the state level, especially to the populations disproportionally affected by COVID-19 – immigrant and BIPOC communities.

Monitoring Health Insurance Coverage Decisions

NoHLA successfully advocated for a searchable database of decisions when consumers appeal health insurers’ denials of coverage. It is now available at oic.wa.gov. We are seeking improvements in the quality of the data to make it even more user-friendly.

Promoting Language Access in the Exchange

When NoHLA learned that Washington’s new Health Benefit Exchange marketplace was not prepared to serve our state’s diverse population, we sprang into action. We partnered with the Washington State Coalition on Language Access to issue a report highlighting the 200 languages spoken in our state and legal obligations to serve all residents. Because of our efforts, the Exchange has developed a Language Access Plan that begins to address the interpretation and translation needs of immigrants. We also worked with the Exchange to develop outreach materials for uninsured immigrants. We continue our efforts with state agencies to translate more materials and provide interpreters when needed, including for COVID-19 testing and vaccination information through the Department of Health.

Other Milestones in NoHLA’s Fight for Health Care Justice

NoHLA works to ensure that the Affordable Care Act will be implemented in the best interests of women, vulnerable populations, and consumers generally – providing reproductive and preventive service, language access, appeal rights, and other important protections. Many of NoHLA’s recommended improvements to agency rules and procedures affecting consumer rights have been adopted.

In addition, NoHLA has:

• Worked with partner organizations to achieve the Medicaid expansion in Washington, protecting against cuts to the program, and improving access to coverage.
• Reached a legal settlement with the Washington Health Care Authority guaranteeing that Basic Health program enrollees are given adequate time to provide renewal documentation and avoid disenrollment.
• Monitored the adequacy of health insurance provider networks.
• Worked in partnership with the Health Coalition for Children and Youth toward Washington’s landmark “Cover All Kids” legislation, now considered a national model.
• Persuaded the state to protect Medicaid for newborns children of immigrant women. Based on our legal analysis, the state sued the federal government, who then backed down and reversed its original decision. Thanks to NoHLA’s advocacy, all states may now deem these newborns eligible for a year.

NoHLA’s Work Ahead

Our priorities over the next generation of advocacy include:

• Representing the interest of consumers as state agencies implement new laws.
• Eliminating disparities in health care access, ensuring that race, immigration status and language are never barriers.
• Informing our community and fighting back against threats to equitable health care access.
• Working toward universal, equitable, affordable health care access for all Washington residents.

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