Overview
Washington is a leader in state initiatives for healthcare price and competition and enacted several market reform initiatives in recent sessions. In 2019, it became the first state to enact legislation to implement a public option health insurance plan to bring its residents a step closer to universal health care. Washington operates its own health insurance marketplace, Washington Health Plan Finder, under the Affordable Care Act. State law protects against discrimination of pre-existing conditions and provides essential health benefits in case of repeal of the Affordable Care Act. In addition to existing coverage parity for telehealth services, Washington also expanded telehealth use by establishing a telemedicine payment parity pilot program to provide parity in reimbursement for certain healthcare services and requires certain health care professionals to complete telemedicine training.
Mandated by the state legislature in 2014, the Office of Financial Management established the Washington State All-Payer Claims Database (WA-APCD) to promote price transparency in healthcare services. The public face of the WA-APCD program, named Washington HealthCareCompare, is operated by the Washington State Health Care Authority (HCA) and collects member eligibility and enrollment data and medical, dental, and pharmacy claims from commercial payers and Medicaid. Washington also earns top grades for surprise and balance billing protections of fully insured consumers. The state enacted legislation to promote transparency in network adequacy and requires carriers and out-of-network providers to negotiate out-of-network payments in good faith to keep consumers from billing disputes. Additionally, the state has a pharmaceutical price transparency law that requires the HCA to oversee prescription drug price increases through advanced notice and to report annually to the legislature.
In healthcare antitrust legislation, Washington restricts noncompete agreements including those of physicians. The state has robust merger review authority laws that provide the state attorney general must receive at least a 60-day notice of any merger, acquisition, or contracting affiliation between hospitals, hospital systems, and provider organizations, whether they are for-profit or nonprofit entities. The AG must also approve the merger or acquisition of any non-profit hospital. To receive approval, parties to the transaction must properly safeguard the charitable assets involved and ensure that any resulting proceeds will apply to charitable health purposes. The state also requires a certificate of need (CON) for the sale, purchase, or lease of any portion of a hospital sold, purchased, or leased by a health management organization (HMO). The review criteria for CON applications include the consideration of the affected population’s need for services, the availability of less costly or more effective methods for providing such services, the financial feasibility, and likely cost impacts for providing the services. In a notable antitrust enforcement action, the Washington AG filed suit to thwart and unwind Franciscan Health System’s consummated 2016 acquisition of two physician practice groups. The case settled with favorable terms for the state that promise to restore competition and choices for healthcare services.
See below for an overview of existing Washington state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/9/2023 - 4/21/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1047 – Washington
Introduced: 2021 Status: Inactive / Dead
Requiring coverage for hearing instruments for children and adolescents.
HB 1052 – Washington
Introduced: 2021 Status: Enacted
Concerning group insurance contract performance standards. The Health Care Authority’s group contracts will have performance standards to ensure that the policy holders are getting the benefit for their coverage. Requires performance standards included in group …
HB 1085 (see companion bill SB 5469) – Washington
Introduced: 2019 Status: Inactive / Dead
Concerning premium reduction for medicare-eligible retiree participants in the public employees’ benefits board program.
HB 1099 – Washington
Introduced: 2019 Status: Enacted
Providing Notice About Network Adequacy to Consumers – Requires the Insurance Commissioner’s rules to be amended to require each health carrier to include in its electronic provider directory a notation of any mental health or …
HB 1104 – Washington
Introduced: 2019 Status: Inactive / Dead
REQUIRING THE SUBMISSION OF A WAIVER TO THE FEDERAL GOVERNMENT TO CREATE THE WASHINGTON HEALTH SECURITY TRUST. The people of the state of Washington declare their intention to create a single health financing entity called the …
Wash. Rev. Code §§ 48.41.010 through 48.41.920: Health Insurance Coverage Access Act – Washington
Introduced: Status: Enacted
Provisions governing the Washington state health insurance pool.
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Wash. Rev. Code §§ 48.42.010 through 48.42.100: Personal Coverage, General Authority – Washington
Introduced: Status: Enacted
Notwithstanding any other provision of law, and except as provided in this chapter, any person or other entity which provides coverage in this state for life insurance, annuities, loss of time, medical, surgical, chiropractic, physical …
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Wash. Rev. Code §§ 48.47.005 through 48.47.030: Mandated Health Benefits – Washington
Introduced: Status: Enacted
The legislature finds further, however, that the cost ramifications of expanding health coverages is of continuing concern; and that the merits of a particular mandated benefit must be balanced against a variety of consequences which …
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Wash. Rev. Code §§ 48.49.003 through 48.49.900: Balance Billing Protection Act – Washington
Introduced: Status: Enacted
It is the intent of the legislature to ban balance billing of consumers enrolled in fully insured, regulated insurance plans and plans offered ot public employees under chapter 41.05 RCW for the services described in …
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Wash. Rev. Code §§ 48.68.005 & 46.68.010: Health Care Savings Account Act – Washington
Introduced: Status: Enacted
In response to these increasing costs in health care spending, the legislature intends to clarify that health care savings accounts may be offered as health benefit options to all residents as incentives to reduce unnecessary …
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Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
State of Washington v. Franciscan Health System, et al. – Washington
District Court: W.D. Washington Status: Decided
In August 2017, the Washington State Attorney General filed suit to thwart and unwind Franciscan Health System’s consummated 2016 acquisition of two physician practice groups, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In re: EPIPEN (Epinephrine Injection, USP) Marketing, Sales Practices, and Antitrust Litigtion – Illinois, Kansas, New Jersey, Washington
District Court: District of Kansas Status: Pending
The plaintiffs in the case allege Mylan N.V. created and exploited an EpiPen monopoly by providing aggressive rebates and incentives to pharmacy benefit managers to …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Washington enacts budgets on a two-year cycle. The biennial budget takes effect on July 1 of each odd-numbered year and is valid through June 30 of the next odd-numbered year.
STATE LEGISLATURE
The Washington state legislative session begins session annually on the second Monday in January. In odd-numbered years the Legislature meets for 105 days, and in even-numbered years for 60 days. The state has 49 Senators, and 98 members of the House of Representatives. Senators serve four year staggered terms, Representatives for two year terms, and there are no term limits. Washington carries over bills from odd to even years.