As 2020 comes to a close, NoHLA and our partners are in high gear, finalizing our policy priorities for 2021. This year, we expect to defend against potential cuts to the health safety net and work to expand affordable coverage for Washington residents who are immigrants, post-partum, or buying individual coverage on their own. To support these urgently-needed health investments for Washington State residents, we are calling on the Legislature to raise progressive revenue. Specifically, we expect to work this session to:

• Defend against any cuts to health safety net programs.
  After months of threatened budget cuts to critical health safety net services, we were relieved to see that the proposed budget Governor Inslee released last week maintained services and included new revenue for public health priorities. As the pandemic rages on, pushing many Washington residents to the brink, we cannot afford to slide backward in our quest for universal coverage. But the fight is not over: the Governor’s budget relies on the use of existing “Rainy Day” funds, as well as an optimistic revenue forecast which may not yet reflect the economic impact of recent COVID-related restrictions. Olympia insiders caution that the budget taken up by the Legislature could still reflect significant cuts if the revenue forecast and pandemic worsen. NoHLA will remain vigilant, emphasizing the need to avoid all cuts to health services during a pandemic that has made the need for universal health care even more apparent. 

• Expand equitable coverage for immigrants.
  Thanks to advocacy for the Affordable Care Act and state reforms, 93% of Washington residents have coverage, and many lower-income individuals can access programs that help with affordability. However, there is one group of Washington residents that has been left behind: the estimated 240,000 immigrants who live, work, pay taxes, and make essential contributions in our state, but lack formal immigration status. These  are our neighbors and members of our community, but too often live paycheck to paycheck, without insurance, and without sick leave at work. If the pandemic has taught us anything, it is that we’re all in this together when it comes to health care: cancer, COVID-19, and medical bills don’t check to see if you have a green card. Now NoHLA and a coalition of immigrant-led organizations are calling on the Legislature to extend parity in health coverage, recognizing that we should all have access to affordable health care, regardless of our color, wealth, or immigration status. 
  
  This session, we are asking the Legislature to invest in community health by extending existing health programs without regard to iimmigration status. This isn’t a new idea: a decade ago, NoHLA helped secure Washington’s landmark “Cover All Kids” law, ensuring that no child in Washington State needs to go without a check-up or immunization. Now it is time to make sure their parents and family members can get a breast lump checked, seek care for a worrisome cough, or get help with back pain from a life of hard work. We’ll be advocating for immediate expansion of the emergency medical program (known as AEM) to make sure low-income immigrants can access COVID-related care without fear, as one crucial step,  but beyond that, we need to build parity with Washington’s Medicaid and Health Benefit Exchange programs. Read more about this campaign below.

• Extend coverage in the critical post-partum period.
  This year has shone a much-needed spotlight on disparities in our health care system. One of the most glaring inequities arises in the critical postpartum year following a pregnancy, when Washington’s Maternal Mortality Review Panel found that 30% of all pregnancy-related maternal deaths and most suicides and accidental overdoses occur. Yet today, Apple Health coverage for pregnant people ends just 60 days after birth, abruptly cutting coverage off at a time that is essential for screening and treatment of postpartum depression, breastfeeding issues, and post-delivery complications. This is a racial justice issue, considering data from the Centers for Disease Control and Prevention and many others showing Black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women. 
  
  Last year, the Legislature took steps to resolve this issue, passing legislation that would extend Apple Health coverage to a full year postpartum. Due to COVID-19 related uncertainties, however, the Governor vetoed this bill and other needed health investments. Now NoHLA is working to support community leaders in calling for a revival of this important piece of legislation. 

• Enhance affordability for individual coverage. 
  Even for those with coverage today, far too many Washington State residents are burdened with health care costs they can’t afford. The Affordable Care Act built a floor on what insurance companies had to cover, eliminating discrimination based on pre-existing conditions and requiring companies to cover life-saving care. But since the health care industry couldn’t lower the floor we built, they sent health care costs through the roof. It’s past time for our country to reckon with health care costs, but in the meantime we need immediate steps to make sure Washington residents aren’t hit with monthly premiums or medical bills that are more than their budgets for rent, food, and other necessities. 
  
  That is why NoHLA will advocate this session for an expansion of state financial assistance for people buying individual coverage through the state’s Health Benefit Exchange, Washington Healthplanfinder. Today, some people buying coverage through the Exchange face costs up to 30% of their household income. And other Washington residents are sitting out coverage altogether or dropping it mid-year, citing cost as the greatest barrier to coverage and care. The Washington Health Benefit Exchange has submitted a legislative report that proposes a new “Cascade Care” state premium and cost-sharing subsidy program to help people earning incomes up to 500% of the Federal Poverty Level. NoHLA is following this proposal closely and expects to support affordability enhancements, particularly for lower-income people who are highly price-sensitive due to their limited budgets. 

• Promote progressive revenue to expand coverage and affordability.  
  We recognize that the health investments we are prioritizing this year will require revenue. Along with many other partners in the Balance Our Tax Code Coalition, we are calling for the Legislature to raise the progressive revenue that is needed to fix a health system that has been starved by the most broken, upside down tax code in the country. We are calling for a dedicated health trust fund that can support needed coverage expansions, in addition to shoring up other priorities such as public health investments. This long-term revenue source could be used to fund NoHLA’s 2021 priorities, as well as future investments, such as efforts to address affordability for lower-income Washington residents who face a cost “cliff” when they gain access to Medicare at age 65. NoHLA continues to identify and develop policy solutions for these affordability gaps, to ensure that all Washington residents can get the care they need.

–Emily Brice, NoHLA Senior Attorney & Policy Advisor