Nearly two years into the pandemic, many Washingtonians still don’t have access to affordable health coverage and care. Despite seismic shifts in our health care system, too many Washington residents lack health care access due to historical and ongoing inequities related to income, immigration status, disability status, race/ethnicity, age, and gender/sexual identity. 

On a state level, NoHLA is gearing up for the start of Washington State’s legislative session. This session, we hope to advance health equity by calling on the Legislature to:

• Expand health coverage to immigrants. As a key supporter of the Health Equity for Immigrants Campaign (HEIC), we aim to ensure that all Washington residents have access to health coverage and care, regardless of immigration status. Over the interim, our campaign has worked with state agencies as they develop a Washington state program to cover undocumented immigrants who currently lack health options. Our efforts just received a boost from Governor Inslee’s supplemental budget, which included initial funding to launch a Medicaid-like program for immigrants with incomes up to 138% FPL by  2024 (see p. 30). The campaign is now preparing to seek full funding for the program’s launch. Learn more about the Health Equity for Immigrants campaign. 

• Address the Medicare affordability cliff. Today, many older adults and people with disabilities in Washington State lose affordable, comprehensive health coverage when they qualify for Medicare. Most lower-income adults can get subsidized health coverage if they are under age 65. But after people start Medicare when they turn 65 or experience a permanent disability, they lose the coverage they had before and counterintuitively have to pay more for health care, experiencing the “Medicare Cliff.” Governor Inslee’s budget included an initial step to address this issue (see p. 27) by removing the onerous “asset test” that bars Medicare enrollees from affordability assistance programs if they have even small savings for retirement or emergencies. NoHLA hopes to build on this step by calling for a comprehensive study of options the state could take to expand affordability assistance programs with help from federal funds, as 34 other states have done. 

In addition to these top priorities, we expect to support a range of important policy proposals that would expand health care access for Washington residents, including:

• Reinforcing state protections against surprise medical bills when people get needed care out of their health plan’s provider network.

• Enhancing state oversight of health care entity mergers and acquisitions to ensure that such consolidations do not reduce care, impact equity, or increase cost. (Learn more about the “Keep Our Care Act” at a January 5th event).  

• Increasing Medicaid’s personal needs allowance to allow people who need in-home long-term services and supports to meet their basic household needs. 

• Improving prescription drug affordability through a new state oversight board and protections against high cost-sharing.

• Maintain Apple Health for Kids from birth to age six continuously, regardless of changes in income, to strengthen early childhood health.

• Strengthening hospital charity care requirements so that more Washington residents can avoid falling into medical debt for needed care.

• Building a health care workforce that can meet community needs, including dental therapists. Learn more from Dr. Sarah Hill of the Seattle Indian Health Board.

• Expanding reproductive health, including measures to deliver reproductive care more equitably. 

We’ll be watching many other priorities this session, including the possibility of important legislative proposals related to care for individuals with behavioral health and intellectual or developmental disabilities, state agency transitions to new eligibility & enrollment technology, and social determinants of health. 

Outside of legislative session, we are monitoring the ongoing impacts of the COVID-19 public health emergency on health care access. As we look ahead to 2022, we are focused on ensuring that when the public health emergency eventually ends, Washington winds down the current protections for residents that have been in effect during the pandemic. This will be a massive task since many enrollees’ eligibility has not been reviewed since the beginning of the pandemic. To avoid disruptions in coverage and care, it is essential for the Health Care Authority to conduct a careful and gradual review process. 

On a national level, Congress has a once-in-a decade opportunity to start ameliorating inequity with the Build Back Better package. While the specific content is still under debate, NoHLA is watching provisions that would advance equity by: 

• Addressing maternal and child health, including extending Medicaid postpartum coverage for all states
• Improving health insurance affordability for people who buy their own coverage on the Exchange by increasing premium assistance
• Closing the coverage gap for people with low incomes  in states that haven’t expanded Medicaid
• Expanding Medicaid’s home and community-based care for older adults and people with disabilities, including workforce investments
• Improving Medicare, including adding hearing aid coverage and capping some prescription drug costs

Please stay tuned for more federal news and our first legislative update coming up in the  new year!