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Washington Enacts Public Health Care Option

Monday, June 3, 2019
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On May 13, 2019, Washington state Governor Jay Inslee signed SB 5526 into law to establish a public option health care program in the state. This program, known as “Cascade Care,” is designed to create standardized individual health plans that will be offered through the Washington Exchange by private insurers.

Specifically, the new law requires the Exchange to establish up to three standardized individual health plans for each of the bronze, silver and gold levels of coverage. These standardized plans will become available through the Exchange in 2021. The law also requires health plans to reimburse medical providers and facilities at up to 160% of the federal Medicare rate.

ACTION STEPS

The Cascade Care program, which is intended to lower costs and increase insurance coverage in the state, is considered the first state law to take steps toward universal health care. Non-standardized health plans will continue to be available through the Exchange at least until 2025. However, the new law requires the Exchange to analyze the impact of offering only standardized plans beginning in 2025.

Overview

Known as Cascade Care, SB 5526 creates a public option health care program to offer standardized individual health plans through the Exchange by private insurers. Specifically, the law requires the state Exchange to establish up to three standardized individual health plans for each of the bronze, silver and gold levels of coverage. These standardized health plans must be designed to accomplish the following goals:

  • Reduce deductibles;
  • Make more services available before the deductible;
  • Provide predictable cost-sharing;
  • Maximize subsidies;
  • Limit adverse premium impacts;
  • Reduce barriers to maintaining and improving health; and
  • Encourage choice based on value; while
  • Limiting increases in health plan premium rates.

Under the law, qualified health plans (QHPs) will also be required to reimburse medical providers and facilities at up to 160% of the federal Medicare rate.
Beginning on Jan. 1, 2021, the law will require any carrier offering a QHP through the Exchange to offer:

  • One silver standardized health plan through the Exchange; and
  • One gold standardized heath plan through the Exchange.

If the carrier offers a bronze health plan through the Exchange, the law also requires the carrier to offer one bronze standardized health plan through the Exchange.

Impact

These standardized health plans will not be available through the Washington Exchange until 2021. Non-standardized health plans will continue to be available through the Exchange at least until 2025. 

© 2019 Zywave, Inc. All rights reserved.

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.

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