Second Substitute Senate Bill 5399 as Recommended by Ways & Means


Section 1

  1. The legislature finds that:

    1. Healthy Washingtonians contribute to the economic well-being of their families and communities, and access to appropriate health services and improved health outcomes allow all Washingtonian families to enjoy productive and satisfying lives;

    2. Washington and the United States are experiencing the deepest economic crisis since the Great Depression, caused by a public health crisis;

    3. Skyrocketing unemployment rates due to COVID-19 have exposed the frailties and inequalities of the current health care system while causing unsustainable strain to the state's medicaid system;

    4. Thousands of union and nonunion workers are unemployed and without health insurance;

    5. Approximately 125,000 undocumented people live in the state with no access to health care during a global pandemic; and

    6. Multiple economic analyses show that a universal system is less expensive, more equitable, and will produce billions in savings per year.

  2. Therefore, the legislature intends that by 2026, all residents of the state have comprehensive, equitable, and affordable health care coverage under a publicly financed and privately and publicly delivered health care system.

  3. The resulting universal system should:

    1. Be built upon the success of existing publicly supported health insurance programs in the state;

    2. Streamline access to coverage, reduce fragmentation of health care financing across multiple public and private health insurance entities, reduce unnecessary administrative costs, and establish mechanisms to expeditiously link residents with their chosen providers; and

    3. Control health care spending so that the system is affordable to the state, employers, and to individuals over time.

  4. The state, in collaboration with all communities, health plans, and providers, should take steps to improve health outcomes for all residents of the state.

Section 2

  1. The universal health care commission is established to develop a plan to create a health care system in Washington that provides coverage and access through a universal financing system including, but not limited to, a single-payer financing system, for all Washingtonians.

  2. The commission includes the following voting members:

    1. Two members from each of the two largest caucuses of the house of representatives, appointed by the speaker of the house of representatives;

    2. Two members from each of the two largest caucuses of the senate, appointed by the president of the senate;

    3. The secretary of the department of health, or the secretary's designee;

    4. The director of the health care authority, or the director's designee;

    5. The chief executive officer of the Washington health benefit exchange, or the chief executive officer's designee;

    6. The insurance commissioner, or the commissioner's designee;

    7. The director of the office of equity, or the director's designee;

    8. The secretary of the department of social and health services, or the secretary's designee; and

    9. Eight members appointed by the governor with knowledge and experience regarding health care coverage, access, and financing, or other relevant expertise, including at least one invitation to an individual representing tribal governments with knowledge of the Indian health care delivery in the state.

  3. The director of the department of retirement systems, or the director's designee shall serve as a nonvoting member of the commission.

  4. A majority of the voting members of the commission shall constitute a quorum for any votes of the commission.

  5. The health care authority shall staff the commission.

  6. Members of the commission shall serve without compensation but must be reimbursed for their travel expenses while on official business in accordance with RCW 43.03.050 and 43.03.060.

  7. The commission may establish advisory committees that include members of the public with knowledge and experience in health care, in order to support stakeholder engagement and an analytical process by which key design options are developed. A member of an advisory committee need not be a member of the commission.

  8. By November 1, 2024, the commission shall submit a final report to the legislature and the governor, and post it on the department of health's website. The report must include:

    1. A complete synthesis of analyses done on Washington's existing health care finance and delivery system, including cost, quality, workforce, and provider consolidation trends and how they impact the state's ability to provide all Washingtonians with timely access to high-quality, affordable health care;

    2. Recommendations for key design elements of a universal health care system including:

      1. A unified financing system including, but not limited to, a single-payer financing system;

      2. Eligibility and enrollment processes and requirements;

      3. Covered benefits and services;

      4. Provider participation;

    3. Effective and efficient provider payments, including consideration of global budgets and health plan payments;

    1. Cost containment strategies;

    2. Quality improvement strategies;

    3. Participant cost sharing, if appropriate;

     ix. Quality monitoring and disparities reduction;
    1. Initiatives for improving culturally appropriate health services within public and private health-related agencies;
    1. Home and community-based services;

    2. Strategies to reduce health disparities including, but not limited to, mitigating structural racism and other determinants of health as set forth by the office of equity;

    3. Information technology systems and financial management systems;

    4. Data sharing and transparency; and

    5. Governance and administration structure, including integration of federal funding sources;

    6. Steps Washington should take to prepare for a just transition to a unified financing system, including a single-payer financing system. Recommendations must include, but are not limited to, administrative changes, reorganization of state programs, retraining programs for displaced workers, federal waivers, and statutory and constitutional changes;

    7. Recommendations for coverage expansions to be implemented prior to and consistent with a universal health care system, including potential funding sources. Recommendations shall include expansion for full scope medicaid coverage, regardless of immigration status;

    1. Recommendations for the creation of a finance committee to develop a financially feasible model to implement universal health care coverage using state and federal funds.
  9. The commission must submit an interim report to the governor and the legislature 12 months after its first meeting and every six months thereafter detailing the work of the commission.

  10. This section shall not be construed to authorize the commission to implement any provision of the reports until there is further action by the legislature and the governor.

  11. The commission must hold its first meeting within 90 days of the effective date of this section.

  12. The commission terminates December 31, 2024.

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