It’s almost the most wonderful time of the year: state legislative session! Governor Inslee released his proposed 2024 supplemental budget yesterday, marking the unofficial start to the 2024 legislative season. Here at NoHLA, we’re gearing up to advocate for key health care priorities when session launches January 8th, including priorities in 3 areas: 

• Equity: Expand capacity for Washington’s new immigrant coverage programs. 
• Access: Improve access to care, addressing benefit and cost gaps for Washingtonians who rely on Medicare, Medicaid, and Exchange coverage. 
• Affordability: Address the drivers of rising health care prices with proven solutions. 

The Washington Legislature will convene on January 8th. This is the second year in the biennial legislative cycle and a “short year,” lasting only 60 days. The Legislature will focus on passing a supplemental budget for the 2023-2025 biennium, and opportunities for new policies will be more limited. But political insiders say to expect the unexpected, as many legislators are up for re-election in fall 2024, and some aspire to statewide office when Governor Inslee, Attorney General Ferguson, and Insurance Commissioner Kreidler leave their seats in 2025. Here are some of the policy opportunities we’ll be prioritizing this session: 

Equity: Expand capacity for Washington’s new immigrant coverage programs. 

NoHLA played a key role in securing a historic victory last session: a commitment to make health coverage available for all Washingtonians, regardless of immigration status. As a result of this advocacy, Washington is launching new coverage options for immigrants in 2024. But the funds allocated to these programs fall far short of the need. We and other groups across the state are asking the Legislature to meet the need with: 

• Apple Health capacity. Funds to expand capacity for the new Apple Health program for undocumented adults. 
• Community engagement. Funds to provide additional support for community members to engage with the agencies and ensure public accountability. 
• Fair systems. Funds to establish fair waitlist systems until programs are fully funded. 
• Future needs. Direct the Health Care Authority and Exchange to study the cost of remaining capacity and affordability gaps. 

Access: Improve access to care, addressing benefit and cost gaps for Washingtonians who rely on Medicare, Medicaid, and Exchange coverage. 

Thanks to years of advocacy from NoHLA and allies, most Washingtonians now have health coverage. Unfortunately, many still can’t access care due to missing benefits, high out-of-pocket costs, and bureaucratic hurdles.  We are advancing proposals to the  Legislature to address these access challenges, including: 

• Medicare Affordability Cliff study. Many older adults and people with disabilities face disparities in benefits and affordability after they qualify for Medicare. NoHLA has led past efforts to address this Medicare Affordability Cliff, culminating in previous legislative changes to remove the asset test and expand eligibility for Medicare Savings Programs, which can help with Medicare costs. But progress has been limited. This session, we support a request to study the cost of additional state policy options that can lay the groundwork for future improvements. 
• Continuous Apple Health for Kids. We support budget funding to extend Children’s Health Insurance Program coverage continuously from birth to age 6, regardless of changes in household circumstances, to strengthen early childhood health. The state has already implemented this policy for children at a lower income level and it’s time to take the next step. 
• Apple Health vision hardware. We support budget funding to restore eyeglasses and contact lenses for over 1 million Apple Health adults. Eyeglasses were previously covered but coverage was eliminated in the Great Recession budget cuts.
• Preventive services. We support a bill that would codify the Affordable Care Act’s preventive services requirements in state law, so that federal attacks can’t harm Washingtonians who rely on preventive care such as contraception and HIV prophylaxis.

Affordability: Address the drivers of rising health care prices with proven solutions. 

NoHLA is a founding leader of Fair Health Prices WA, a statewide movement to address the root causes of the health care affordability crisis that is pricing Washington families and businesses out of health care. In the 2023 session, we won legislative direction for a joint study by the Insurance Commission and Attorney General of the big business of health care that is changing our health care landscape. Now we’re gearing up for legislative advocacy on a package of proven solutions that can start making a dent in the problem of health care prices: 

• Health spending benchmark. Increase spending transparency and accountability with the Health Care Cost Transparency Board (HB 1508). 
• Pre-merger review. Improve oversight of health care mergers with Keep Our Care Act (SB 5241). 
• Post-merger market behavior. Limit unfair price negotiations by big health systems (SB 5393). 
• Unreasonable billing. End unreasonable balance billing practices by ground ambulance companies (learn more). 

We’re also keeping an eye out for opportunities to expand Exchange affordability this year. NoHLA has been a leader in state efforts to improve the Exchange plans available to individuals and families through Washington Healthplanfinder. We and our allies were at the helm for ground-breaking efforts like the nation’s first public option and first 1332 waiver to open the Exchange to all Washingtonians. These efforts are working to improve affordability, but it’s time for the state to consider the next wave of Exchange reforms. We hope to see discussion of recent Exchange reports that offer new policy options, starting with:

• Affordability gaps study. Direction to study remaining Exchange affordability gaps, such as high out-of-pocket cost-sharing for immigrants and others. 
• Plan standardization. Make it easier to comparison-shop and reduce “choice overload” by standardizing cost-sharing for all Exchange plans.