2018 Legislative Priorities
The Exchange is seeking limited updates to RCW 43.71, so state-defined operations can continue in the event of a full or partial repeal of the Affordable Care Act (ACA). Proposed changes include removal/replacement of ACA references; removal of obsolete references; and alignment to current Exchange operations. The bill does not change the Exchange’s public-private status, governance, self-sustaining requirement, or revenue sources.
More bill information available here.
The Exchange is seeking an increased appropriation of $3.7M to support competitive re-procurements for our Call Center and system integrator. The request includes one-time funding authority to cover projected costs associated with implementing a Call Center vendor (depends on apparently successful vendor) and technical assistance to re-procure a system integrator (2019-21 biennium). No increase in carrier assessment is expected to cover this expenditure. The Exchange will also submit its annual Cost Allocation Update, a maintenance level, net-zero adjustment to reflect the updated federal Advanced Planning Document.
No new General Fund – State dollars are being requested, only an increase in spending authority
More detailed budget information available here
The Exchange is supporting and informing efforts to stabilize the individual health insurance market in 2019. This market is smaller and more volatile than other markets, and the past year has brought uncertainty and change. Carriers have responded by raising rates, withdrawing from some rural counties, and narrowing provider networks leaving unsubsidized consumers paying dramatically higher premiums. Nine counties in Washington have only one carrier offering coverage.
Bills being advanced that would help stabilize the individual health insurance market include:
Reinsurance (HB 2355 and SB 6062 “Addressing the establishment of an individual health insurance market claims-based reinsurance program”)
Individual Mandate (SB 6084 “Requiring maintenance of minimum essential health care coverage”)
Bare County Solution & Public Option (HB 2408 “Preserving access to individual market health care coverage throughout Washington state”)
Below is a summary of the steps the state legislature has taken to establish and implement the Washington Health Benefit Exchange (“Exchange”):
- In 2011, the legislature established the Exchange as “a public-private partnership separate and distinct from the state” governed by a bipartisan board. The Exchange is subject to public meetings and public disclosure laws. See SSB 5445.
- In 2012, the legislature established implementation guidelines for the Exchange, including essential health benefits, market rules, and other requirements for Qualified Health Plans (QHPs). The legislature also established that the Exchange must be self-sustaining. See ESSHB 2319.
- In 2013, the legislature established that “self-sustaining” means “capable of operating with revenue attributable to the operations of the exchange.” Revenue sources identified by the legislature include, but are not limited to, charges to health carriers, premiums paid by enrollees, and premium taxes attributable to Exchange enrollees in QHPs and stand-alone dental plans. The legislature also changed the Exchange account from a non-appropriated account to an appropriated account and included a performance audit requirement. See ESHB 1947.
- In 2014, the legislature established additional requirements relating to the grace period, including that the Exchange submit an annual grace period report. See ESSB 6016.
- In 2015, the legislature established additional reporting requirements for the Exchange, including:
- Annual Strategic Plan
- Annual 5-Year Spending Plan
- Quarterly Reporting on Spending Metrics
- Quarterly Financial Reports
See 2ESB 6089.
- In 2016, the legislature established a financing mechanism so family dental products can be offered through the Exchange. See HB 2768.
- In 2018, the legislature updated the Exchange enabling statutes to ensure that in the event of significant federal changes to the Affordable Care Act (ACA), the Exchange can continue operating as the state’s eligibility and enrollment portal for the 1 in 4 residents currently using Healthplanfinder to obtain health and dental coverage. The legislature also updated outdated provisions, consolidated reporting requirements, and made other changes to align the statutes with Exchange operations. See HB2516
The U.S. Department of Health & Human Services continues to provide guidance and rules for the establishment and implementation of state-based exchanges. View a full list of guidance and regulations.