wa-law.org > bill > 2025-26 > SB 5948 > Original Bill
The universal health care commission is established to create immediate and impactful changes in the health care access and delivery system in Washington and to prepare the state for the creation of a health care system that provides coverage and access for all Washington residents through a unified financing system once the necessary federal authority has become available. The authority must begin any necessary federal application process within 60 days of its availability.
The commission includes the following voting members:
One member from each of the two largest caucuses of the house of representatives, appointed by the speaker of the house of representatives;
One member from each of the two largest caucuses of the senate, appointed by the president of the senate;
The secretary of the department of health, or the secretary's designee;
The director of the health care authority, or the director's designee;
The chief executive officer of the Washington health benefit exchange, or the chief executive officer's designee;
The insurance commissioner, or the commissioner's designee;
The director of the office of equity, or the director's designee; and
Six members appointed by the governor, using an equity lens, with knowledge and experience regarding health care coverage, access, and financing, or other relevant expertise, including at least one consumer representative and at least one invitation to an individual representing tribal governments with knowledge of the Indian health care delivery in the state.
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The governor must appoint the chair of the commission from any of the members identified in subsection (2) of this section for a term of no more than three years. A majority of the voting members of the commission shall constitute a quorum for any votes of the commission.
The commission's meetings shall be open to the public pursuant to chapter 42.30 RCW. The authority must publish on its website the dates and locations of commission meetings, agendas of prior and upcoming commission meetings, and meeting materials for prior and upcoming commission meetings.
The health care authority shall staff the commission.
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.
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.
By November 1, 2022, the commission shall submit a baseline report to the legislature and the governor, and post it on the authority's website. The report must include:
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;
A strategy for developing implementable changes to the state's health care financing and delivery system to increase access to health care services and health coverage, reduce health care costs, reduce health disparities, improve quality, and prepare for the transition to a unified health care financing system by actively examining data and reports from sources that are monitoring the health care system. Such sources shall include data or reports from the health care cost transparency board under RCW 70.390.070, the public health advisory board, the governor's interagency coordinating council on health disparities under RCW 43.20.275, the all-payer health care claims database established under chapter 43.371 RCW, prescription drug price data, performance measure data under chapter 70.320 RCW, and other health care cost containment programs;
An inventory of the key design elements of a universal health care system including:
A unified financing system including, but not limited to, a single-payer financing system;
Eligibility and enrollment processes and requirements;
Covered benefits and services;
Provider participation;
Effective and efficient provider payments, including consideration of global budgets and health plan payments;
Cost containment and savings strategies that are designed to assure that total health care expenditures do not exceed the health care cost growth benchmark established under chapter 70.390 RCW;
Quality improvement strategies;
Participant cost sharing, if appropriate;
ix. Quality monitoring and disparities reduction;
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;
Information technology systems and financial management systems;
Data sharing and transparency; and
Governance and administration structure, including integration of federal funding sources;
An assessment of the state's current level of preparedness to meet the elements of (c) of this subsection and steps Washington should take to prepare for a just transition to a unified health care 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;
Recommendations for implementing reimbursement rates for health care providers serving medical assistance clients who are enrolled in programs under chapter 74.09 RCW at a rate that is no less than 80 percent of the rate paid by medicare for similar services;
Recommendations for coverage expansions to be implemented prior to and consistent with a universal health care system, including potential funding sources; and
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.
Following the submission of the baseline report on November 1, 2022, the commission must structure its work to continue to further identify opportunities to implement reforms consistent with subsection (7)(b) of this section and to implement structural changes to prepare the state for a transition to a unified health care financing system. The commission must submit annual reports to the governor and the legislature each November 1st, beginning in 2023. The reports must detail the work of the commission, the opportunities identified to advance the goals under subsection (7) of this section, which, if any, of the opportunities a state agency is implementing, which, if any, opportunities should be pursued with legislative policy or fiscal authority, and which opportunities have been identified as beneficial, but lack federal authority to implement.
By December 1, 2027, the commission shall submit a report with its final recommendations for a universal health care system, including eligibility, benefit design, provider reimbursement, financing, governance, and any other component necessary to implement the system.
By December 1, 2028, the commission shall establish the following advisory committees:
A finance committee consisting of financial experts from the office of financial management, the office of the state treasurer, the employment security department, and the office of the insurance commissioner. The finance committee shall recommend specific details for major budget decisions and for appropriations, taxes, and other funding legislation necessary to conduct the operations of a universal health care system;
A citizen committee consisting of balanced representation from people with relevant knowledge in health, business, labor, tribal governments, disability needs, body size, and consumers, specifically including representation from populations where health care disparities are known to exist. The citizen committee shall hold public hearings on priorities for inclusion in the set of health services to be offered in a universal health care system, survey public satisfaction, investigate complaints, and identify and report on health care access and other priority issues for residents; and
A provider committee consisting of members with broad experience in and knowledge of health care delivery, research, and policy, as well as public and private funding of health care services. The provider committee shall make recommendations to the commission on issues related to scope of covered benefits, quality improvement, continuity of care, resource utilization, and other issues as requested.
By December 1, 2029, the commission shall draft legislation to establish a universal health care system in the state. The legislation must meet the objectives for a universal health system as set forth in this section and Senate Joint Memorial No. 8004 (2025).
Subject to sufficient existing agency authority, state agencies may implement specific elements of any report issued under this section. This section shall not be construed to authorize the commission to implement a universal health care system through a unified financing system until there is further action by the legislature and the governor.
The commission must hold its first meeting within 90 days of July 25, 2021.