Washington marketplace highlights and updates
- Washington has enacted legislation to create standardized plans and a public option that will be available by 2021.
- Legislation was enacted in 2018 to help ensure plan availability in the exchange; another bill was enacted in 2019 to protect consumers from surprise balance billing. Both bills take effect in 2020.
- Open enrollment for 2020 coverage in Washington will run from November 1, 2019 to December 15, 2019, but residents who have qualifying events can enroll outside of open enrollment.
- Short-term health plans can be sold with terms of up to three months in Washington, but no insurers are offering them as of 2019.
- More than 220,000 people enrolled for 2019, down from the exchange’s record high enrollment in 2018.
- All counties have plans available for 2019, but there are more counties with only a single insurer.
- Seven insurers offering exchange plans for 2019, plus four off-exchange insurers (same as 2018).
- Average rate increase for Washington exchange plans is 13.8 percent for 2019.
- Some counties still have no bronze plan options, making their least-expensive plans more costly than other areas.
Washington exchange overview
Washington runs its own exchange, Washington Healthplanfinder. Carrier participation in the exchange is robust, with seven insurers offering plans for 2019. The state also has a strong off-exchange market, but subsidies are only available through Washington Healthplanfinder. Washington expanded Medicaid (Apple Health) under the ACA, and residents can enroll via Washington Healthplanfinder.
Washington Healthplanfinder charges a per member per month fee to fund the exchange. For 2016 through 2018, the fee was $7.46 per member per month. So a family of four was paying almost $30/month in fees to fund the exchange, as part of their health insurance premiums. But because enrollment grew so much in 2018, and because the exchange has been working to improve its financial efficiency, the fee has been reduced by 55 percent for 2019, to just $3.36 per member per month. Although enrollment declined in 2019, the exchange is keeping the $3.36 per member per month fee in effect for 2020 as well (and reducing the fee on dental plans from $1.54 to $0.81 per member per month).
For the first two years it was in operation, Washington Healthplanfinder collected premiums from enrollees and sent them to insurers (enrollees had the option to send payments directly to the insurers, but about 80 percent opted to pay premiums to the exchange). But the exchange struggled with billing problems and ultimately decided to switch to the approach used in other states, in which enrollees pay their premiums directly to insurers, rather than the exchange. This change took effect in September 2015.
In 2019, Washingon implemented fairly strict rules for short-term health plans, and as a result, there are currently no short-term health plans for sale in Washington.
Washington also enacted legislation in 2019 to codify various ACA consumer protections into state law. As long as the ACA remains in effect, the legislation is essentially redundant. But if the ACA were to be repealed at the federal level, Washington’s new law would continue to provide extensive consumer protections in the state. Washington’s law requires insurers to cover pre-existing conditions and essential health benefits without any annual or lifetime benefit caps, and places limits on annual out-of-pocket costs.
Legislation to protect consumers from surprise balance billing
Governor Jay Inslee signed H.B.1065 into law in 2019, after similar bills failed in the two previous legislative sessions. The new law, summarized here by Insurance Commissioner Mike Kreidler’s office, takes effect in January 2020 and will provide strong consumer protections against surprise balance billing when a patient receives emergency treatment at an out-of-network facility, or visits an in-network facility but is treated there by an out-of-network provider.
- The law requires insurers to maintain adequate networks.
- Out-of-network providers will not be allowed to balance bill patients in emergency situations or in situations in which the out-of-network services were received at a facility that was in-network with the patient’s insurance.
- In these situations, insurers must pay out-of-network providers “a commercially reasonable amount, based on payments for the same or similar services provided in a similar geographic area.”
- If the provider and insurer disagree on what the payment amount should be, it is sent to binding arbitration. But the provider cannot bill the patient.
- H.B.1065 applies to plans that are regulated by the Washington Insurance Commissioner. This does not include self-insured group plans — which account for the majority of very large group plans — as those are regulated by the federal government instead, under ERISA. Self-insured group plans can choose to opt into the state’s balance billing protection rules.
Legislation to protect plan availability in the exchange
In 2018 there were nine counties in Washington with only one insurer offering plans, and in 2019 there are 14 counties with only one participating insurer. And when rates were initially filed for 2018, there were two counties where no insurers had proposed plans. That was eventually remedied before the start of open enrollment, but lawmakers also wanted to address the issue in the 2018 legislative session.
H.B. 2408 (signed into law in March 2018) mandates that as of 2020, any insurer that offers coverage to school employees must also offer at least one silver and one gold plan in the individual market via Washington Healthplanfinder in any areas where the insurer offers coverage for school employees. In the meantime, if necessary, the legislation would have made coverage in the Washington state health insurance pool more affordable for people who live in counties where no insurers offer exchange plans. But all areas of the state have continued to have plans available in the exchange from at least one insurer.
Standardized plans and a public option available starting in 2021
Washington has enacted legislation (S.B.5526; the House version was H.B.1523) calling for the creation of standardized health plans, additional premium subsidies, and a “public option” health plan that will be available in at least some areas of the state starting in 2021.
The term “public option” is generally used to describe Medicaid buy-in programs and new coverage options that are administered by the government, although no such proposals have been successfully implemented thus far in any other states (and the proposal to include a public option in the ACA was off the table almost as soon as lawmakers began to debate the ACA). Nevada lawmakers passed a Medicaid buy-in public option in 2019, but the governor vetoed it. Colorado has enacted legislation in 2019 that directs the state to explore a public option but that does not specify exactly how the program would have to work. Washington’s public option would thus be the first in the nation, although some have argued that its design will be different from what people tend to think of as a “public option.”
Under the terms of the final version of S.B.5526, which was signed into law by Governor Jay Inslee in May 2019, Washington will design up to three standardized plan designs at the bronze, silver, and gold metal levels (several states already have standardized plans, but Washington is not among them). Insurers that offer plans in the exchange would have to offer at least one standardized plan at the silver and gold level starting in 2021 (if an insurer offers plans at the bronze level, they will have to offer at least one standardized bronze plan, but some Washington insurers choose to not offer bronze plans). Insurers would be able to continue to also offer non-standardized plans, but the state will have to analyze what the expected impact would be if all plans were required to be standardized starting in 2025, with a report that has to be delivered to the legislature by 2023. California requires all plans to be standardized, but all of the other states with standardized plan designs also allow insurers to offer non-standardized plans.
Also starting in 2021, Washington’s “public option,” which is called “Cascade Care,” will involve the state contracting with one or more private health insurance companies to offer standardized qualified health plans at the bronze, silver, and gold levels in the Washington exchange starting in 2021. For most services, the plans will cap provider reimbursements at 160 percent of the Medicare reimbursement amounts, at least initially (there are exceptions for rural hospitals and primary care, and also for situations in which the plan can’t maintain an adequate network under the prescribed reimbursement constraints). The legislation went through several iterations, and the cap on provider reimbursements changed each time, but lawmakers ultimately settled on 160 percent of Medicare rates — a middle-of-the-road approach designed to keep pricing at least a little lower than other comparable plans (the state is aiming for 5-10 percent lower), while still ensuring adequate provider participation.
The idea behind S.B.5526 is to provide additional plan options to individual market enrollees. But the legislation does not require the Cascade Care plans to be available statewide. An insurer’s contract with the state would be to offer the plans “in a single county or in multiple counties.” There might be Cascade Care plans available statewide in 2021, but not guaranteed.
S.B.5526 also calls for the state to “develop a plan to implement and fund” premium subsidies for people with modified adjusted gross income up to 500 percent of the poverty level. The federal government provides ACA premium subsidies to people with MAGI up to 400 percent of the poverty level, but people with income between 400 and 500 percent of the poverty level are not eligible for federal subsidies, and are thus often impacted by the subsidy cliff. S.B.5526 is an effort to help make coverage more affordable for people in this income range, and calls for net premiums to be capped at 10 percent of MAGI.
2019 enrollment, plus a look back at enrollment since 2014
Open enrollment for 2019 coverage began on November 1, 2018, and it technically ended on December 15, 2018. But two days later, the exchange announced that people who still wanted to enroll in coverage for 2019 could do so by contacting the exchange no later than December 20 (coverage was still effective January 1, 2019 for people who took this option).
By the time open enrollment for 2019 coverage ended, 220,765 people had purchased coverage. That was about 9 percent lower than it had been in 2018 — when enrollment in Washington’s exchange had reached a record high — although the enrollment window was considerably shorter for 2019. Nationwide, there was an average decline in enrollment, although it was only about 2.4 percent. And among state-run exchanges, average enrollment increased slightly in 2019. Washington Healthplanfinder was one of just four state-run exchanges (out of 12 total) where enrollment declined in 2019.
As of February 2019, Washington Healthplanfinder reported that more than 201,000 people had effectuated their coverage.
For perspective, here’s a look back at enrollment in Washington Healthplanfinder since the exchange opened for business in 2014:
- 2014: As of April 2019, 163,207 people had enrolled in private health plans through Washington Healthplanfinder and paid their premiums to effectuate their coverage. In addition to the private plan enrollments, 909,752 people had enrolled in Medicaid through the Washington exchange by mid-April (nearly half of those people were already enrolled previously, but renewed their Medicaid coverage through the exchange).
- 2015: Total enrollment in qualified health plans through Washington Healthplanfinder amounted to 160,732 people by the end of open enrollment. On April 22, Washington Healthplanfinder announced that total private plan enrollment for 2015 had reached 170,101 people. This was the third-highest total (behind California and New York) of any of the state-run exchanges. All of these enrollees had paid for their coverage; Washington only reported enrollments in 2014 and 2015 if they were paid-up.
- 2016: HHS announced that Washington Healthplanfinder’s total enrollment for 2016 was 200,691 as of February 1 (this was the first year that Washington switched to reporting all enrollments — instead of only effectuated enrollments — bringing them into line with how most other states’ enrollments are reported). In June 2016, Washington Healthplanfinder reported that 169,182 people had effectuated their coverage for 2016.
- 2017: By the time 2017 open enrollment ended on January 31, more than 225,000 people had enrolled in private plans (QHPs) through the exchange. This was a 13 percent increase, which was notable given that total enrollment among states using HealthCare.gov was slightly lower in 2017 than it was in 2016 (the Trump Administration reduced advertising for HealthCare.gov in the final week of enrollment, while state-run exchanges like Washington Healthplanfinder were able to continue their advertising efforts as planned). By April 2017, effectuated enrollment in Washington Healthplanfinder QHPs stood at 204,334. In addition to QHP enrollments, Washington Healthplanfinder had enrolled a total of 1,555,778 people in Apple Health (Medicaid) by February 2017, including renewals (Medicaid enrollment continues year-round). Roughly 600,000 of the Apple Health enrollees are eligible as a result of Medicaid expansion.
- 2018: Enrollment in Washington’s exchange reached a record high in 2018, with 242,850 people enrolled in private plans (CMS reported a slightly higher official enrollment total of 243,227). Although HealthCare.gov switched to a much shorter enrollment window (just over six weeks long) for 2018 coverage, Washington Healthplanfinder was one of ten state-run exchanges that opted for a longer enrollment window that year, allowing people to enroll until January 15, 2018.
All counties have 2019 exchange coverage, but 14 (up from 9 in 2018) have only one insurer. Plus a look at insurer participation since 2014
In late May 2018, the Washington Office of the Insurance Commissioner announced that 11 insurers had filed a total of 74 individual market plans for 2019, with coverage slated to be available in all 39 counties. (Seven of those 11 insurers are offering on-exchange plans, as was the case in 2018.)
A year earlier, initial filings for 2018 coverage hadn’t included any plans for Klickitat and Grays Harbor counties, and Insurance Commissioner Mike Kreidler had to step in and work with insurers to get coverage available in those areas. For 2019, Premera had already told the state that it would step in to offer coverage in any counties that would otherwise have been without coverage, but that situation did not arise, as all counties were accounted for in the initial filings.
But 14 of the state’s 39 counties only have one insurer offering exchange plans in 2019 (which is part of the reason the state has enacted legislation — described above — to implement a public option plan starting in 2021). This is an increase from nine counties with just one exchange insurer in 2018. Both Premera and Lifewise reduced their coverage areas for 2019. Premera offered exchange plans in 23 counties in 2018, and that has dropped to 14 counties for 2019. And Lifewise, which offered on-exchange plans in 20 counties in 2018, has reduced their on-exchange coverage area to just 12 counties for 2019.
The Office of the Insurance Commissioner has clarified that federal actions are creating instability and uncertainty in the individual market, and insurers tend to want to avoid that sort of uncertainty. The federal actions include the elimination of the individual mandate penalty in 2019 (under the terms of the GOP tax bill that was enacted in late 2017), the elimination in late 2017 of federal funding for cost-sharing reductions, and the regulations that expanded access to short-term health plans and association health plans (although Washington stepped in with new regulations for short-term plans, and there are no longer any for sale in the state).
For perspective, here’s a look at how insurer participation in Washington’s exchange has changed over time (a detailed list of the counties where each carrier offered plans is available here):
- 2014: Plans were available from eight insurers in 2014: BridgeSpan, Community Health Plan of Washington, Coordinated Care (Ambetter/Centene), Group Health Cooperative, Kaiser Foundation Health Plan of the Northwest, LifeWise, Molina, and Premera.
- 2015: Plans were available from 10 insurers in 2015, with Moda and Columbia United Providers joining the exchange, along with the eight insurers that had offered plans in 2014. But both insurers’ forays into the exchange were short-lived.
- 2016: On October 28, 2015, Moda Health announced they were exiting the Washington market in order to focus on Alaska and Oregon (Moda subsequently left Alaska’s market as well, but remains in Oregon). Effective immediately, they ceased sales and renewal of health plans in Washington, and 47,000 existing policy-holders had to select coverage from a different carrier for 2016.
In November 2015, Columbia United Providers also announced that they would exit the individual market in Washington. Their plans were only available in Clark County, and they only had about 100 enrollees. But Regence Blue Cross Blue Shield, United Healthcare of Washington, and Health Alliance Northwest all joined the exchange for 2016, resulting in 11 insurers offering plans.
- 2017: For 2017, United Healthcare exited the exchanges in nearly every state where they participated in 2016, including Washington (United had 2,978 enrollees in the Washington exchange in 2016, or about two percent of the total exchange enrollments). And Health Alliance Northwest also exited the exchange, although the impact of that was minimal, as they only had nine on-exchange enrollees in 2016. There were no new entrants in 2017, so nine insurers offered plans in the exchange that year.
- 2018: For 2018, BridgeSpan and Regence BlueShield had both initially said they would discontinue their exchange participation and would only offer off-exchange plans after 2017. And Community Health Plan of Washington planned to exit the individual market altogether at the end of 2017. At that point, no individual market insurers had filed plans for 2018 in Klickitat County or Grays Harbor County.
So Washington Insurance Commissioner Mike Kreidler began working with insurers to fill in the bare counties. Kreidler’s first success was in Grays Harbor County; he announced on June 19 that Premera had stepped up and agreed to offer coverage there. And on June 26, Kreidler announced that two insurance companies had agreed to offer exchange plans in Klickitat County, including BridgeSpan. This was particularly notable given that BridgeSpan had initially intended to exit the Washington exchange altogether at the end of 2017. But thanks to Kreidler’s negotiations, BridgeSpan and Molina both agreed to offer plans in the exchange in Klickitat County in 2018.
Every area of the state had on-exchange options available in 2018, although nine counties (out of 39 in the state) had just one insurer offering plans: Chelan, Douglas, Ferry, Grays Harbor, Island, Pend Oreille, San Juan, Skagit, and Skamania. And there are seven counties in Washington where there were no bronze plans available in the exchange for 2018: Chelan, Douglas, Ferry, Lincoln, Pend Oreille, Skamania, and Stevens.
In a June 2017 statement about the shrinking insurer participation and coverage areas, Kreidler stated that
“the uncertainty the Trump administration and the GOP-controlled Congress has sowed for months is sabotaging the progress we’ve made. Their actions, including failing to commit to fund the cost-sharing subsidies, not enforcing the individual mandate, and continuing to push in secret the severely flawed American Health Care Act are eroding confidence health insurers have in the market here and across the nation. These actions only increase premiums and decrease insurer participation.”
14% average 2019 rate increase for on-exchange plans
Health insurers had to submit rate and form filings for 2019 plans to the Washington Office of the Insurance Commissioner by May 24 2018. On June 4, the Office of the Insurance Commissioner published the proposed rate filings for 2019, noting that the average proposed rate increase was just over 19 percent (for on-exchange insurers, it was 19.8 percent). Although high, that was only a little more than half of the average increase that applied for 2018. The actual rate filings can be found here (select individual market, choose a company, and then scroll down to the 2019 filings).
The four insurers that only offer off-exchange plans have limited coverage areas (three of them offer coverage in three or fewer counties, and one offers coverage in 11 counties, out of 39 in the state), and their total market share is less than 3 percent of the state’s total ACA-compliant individual market. But those four insurers proposed fairly small average rate increases, ranging from 2.6 percent to 7.5 percent.
The rates were reviewed by the Office of the Insurance Commissioner, and approved rates were announced in September 2018. The approved rates were a little lower than the insurers had proposed, with an average rate increase of 13.8 percent. The following average rates were approved:
- Coordinated Care Corporation (Ambetter): 14.37 percent increase (slightly higher than proposed)
- Kaiser Foundation Health Plan of Washington: 18.61 percent increase (significantly lower than proposed)
- Kaiser Foundation Health Plan of the Northwest: 14.03 percent increase (slightly lower than proposed)
- Lifewise Health Plan of Washington: 6.51 percent increase (slightly higher than proposed)
- Molina Healthcare of Washington: 7.18 percent increase (a little lower than proposed)
- Premera Blue Cross: 2.18 percent increase (about half as much as the insurer had proposed)
- BridgeSpan: 0.3 percent increase (slightly lower than proposed)
As was the case for 2018, the cost of cost-sharing reductions (CSR) has been added to on-exchange silver plans for 2019 (this is the best possible scenario for consumers, given the fact that the federal government is no longer funding CSR). And the insurers also noted that the impending elimination of the individual mandate penalty was expected to result in a smaller, sicker risk pool. This increased morbidity was a driving factor in the proposed rate increases.
Four insurers are continuing to offer plans only outside the exchange, with the following average rate increases for 2019:
- Asuris Northwest Health: 5.15 percent increase (slightly lower than proposed)
- Health Alliance Northwest: 7 percent increase (approved as filed)
- Regence Blue Shield of Oregon: 6.9 percent increase (a little lower than proposed)
- Regence Blue Shield: 1.99 percent increase (a little lower than proposed)
How rates changed for an average enrollee in 2019
As of 2018, 63 percent of Washington’s exchange enrollees were receiving premium subsidies, while the other 37 percent were paying full price. Nationwide, 87 percent of enrollees were receiving subsidies, so while subsidies are less common in Washington, they still apply to the majority of the enrollees there. Let’s take a look at how an enrollee’s after-subsidy premiums changed for 2019 in a couple of different areas of the state.
First, in Wenatchee, where Coordinated Care is the only insurer offering plans: A 40-year-old earning $30,000 will get a premium subsidy of about $195/month. After the subsidy is applied, the available plans (eight different options offered by Coordinated Care) range from $191/month to $262/month. There are no bronze plans available, so the lowest-priced plan is silver.
In 2018, a 40-year-old in Wenatchee earning $30,000 was eligible for a premium subsidy of about $122/month, but the after-subsidy premiums were fairly similar to 2019’s prices, ranging from $194/month to $274/month. There were 10 Ambetter plans available in that area for 2018, but again, all silver and gold, with no bronze options. (Washington was one of a handful of states where some counties had no bronze plans available starting in 2018, and that situation was the impetus for new HHS and IRS rules allowing people to qualify for an affordability exemption based on the lowest-cost plan, rather than the lowest-cost bronze plan in a given area.)
Now let’s consider the same 40-year-old earning $30,000 but living in Seattle. For 2018, this applicant was eligible for a premium subsidy of about $134/month. There were 21 plan options available from Kaiser, Premera, Molina, and Coordinated Care, with after-subsidy premiums ranging from about $130/month to $472/month (including mostly silver plans, as well as four gold plans and four bronze plans).
For 2019, a 40-year-old applicant earning $30,000 in Seattle can choose from among 19 plans, and qualifies for a premium subsidy of about $177/month. After the subsidy is applied, the premiums range from about $142/month to $435/month.
As described above, the exchange fee (which is built into the premiums) is 55 percent lower for 2019 than it was for 2018. That helps to keep premiums a little lower than they would otherwise have been, but adjustments in the cost of the benchmark plan (and the resulting adjustments in premium subsidies) tend to have more of an impact.
Rate changes in Washington’s exchange in previous years
When the exchange began offering health plans for 2014, premiums were essentially an educated guess, as there was no ACA-compliant individual market claims experience on which to base rates.
- 2015: Washington Healthplanfinder’s rates increase by an average of just 1.9 percent for 2015.
- 2016: The average rate increase for 2016 was 4.2 percent. A Kaiser Family Foundation analysis determined that the benchmark plan for a 40-year-old in Seattle was $254 in 2015, and dropped to just $227 in 2016 (the benchmark plan isn’t necessarily from the same carrier that offered it the year before — it’s just the second-lowest-cost silver plan in a given year). That’s more than a 10 percent decrease, which means that premium subsidies (which are based on the cost of the benchmark plan) were smaller in 2016.
- 2017: The average premium increase in the individual market in Washington was 13.6 percent for 2017 (nationwide, the average premium increase, before any subsidies were taken into consideration, was about 25 percent). Premera had the largest segment of Washington Healthplanfinder market share in 2016, at 22 percent. And their approved rate increase for 2017 was the highest of any of the state’s plans, at 18.9 percent.
- 2018: In September 2017, Washington Healthplanfinder announced that the exchange had finished certifying plans for 2018, with an average rate increase of 24 percent for plans sold in the exchange (final rate changes available here). At that point, the approved rates were still based on the assumption that CSR funding would continue, but the exchange noted that the premium increases were due to “cost trend and federal uncertainty, particularly enforcement of individual mandate” (the individual mandate penalty was eventually eliminated altogether, at the end of 2018).
The exchange also explained that the state was taking a unique approach to the CSR funding issue: Regulators approved rates that assumed CSR funding would continue, and those were the rates they intended to implement when open enrollment began on November 1. But they also approved a backup set of rates for silver plans sold in the exchange (including the off-exchange versions of those plans), which were high enough to make up for the loss of federal CSR funding. They noted that if CSR funding were to be cut off at some point during 2018, Washington regulators would use their authority to implement the higher on-exchange silver plan rates at that point.
Ultimately, the Trump Administration announced just two weeks later, on October 12, that CSR funding would end immediately. At that point, Washington regulators had to switch to the backup rates, and they announced on October 26 that the higher rates for on-exchange silver plans had been finalized, driving the overall average rate increase up to 36.4 percent.
Small business coverage no longer available through the exchange
Washington Healthplanfinder Business, the state-run SHOP exchange, reported in June 2015 that more than 100 small businesses had enrolled in small group plans for 2015. They also announced that they would make coverage available for businesses with up to 100 employees starting in November 2015. But that changed in October 2015 when President Obama signed HR1624 (the PACE Act) into law. The law repealed the ACA provision that would have expanded the definition of “small group” to include businesses with up to 100 employees. States are free to independently define small groups as businesses with up to 100 employees, but in Washington, Insurance Commissioner Mike Kreidler announced that the state would go along with the PACE Act and continue to define small group plans as those with up to 50 employees.
By March 2016, a total of 174 employers had enrolled in coverage through Washington Healthplanfinder. The plans were covering 606 employees, and 164 dependents. UnitedHealthcare offered small group plans statewide through Washington Healthplanfinder Business in 2016, and Kaiser offered plans in Clark and Cowlitz counties (Moda had planned to offer small business plans state-wide as well, but their last-minute exit from the Washington market at the end of 2015 meant that there was just one state-wide SHOP option in 2016).
And for 2017, United’s exchange exit left Washington Healthplanfinder’s SHOP exchange limited to only Kaiser, and only in Clark and Cowlitz counties. The state noted however, that there continued to be a robust off-exchange market for small businesses, with 11 insurers offering plans in 2017 — although the small business health insurance tax credit is only available through the exchange.
By 2018, even Kaiser had stopped offering SHOP plans in Washington, so there are no longer SHOP plans for sale in the state. Small businesses can select from a wide range of off-exchange small group plans, however, all of which are compliant with the ACA.
Washington Healthplanfinder history
Washington was one of the first states to move ahead with a state-run health insurance marketplace as envisioned by the Affordable Care Act. Former Gov. Chris Gregoire signed legislation creating the state exchange in May 2011. In March 2012 Gregoire signed additional legislation, which further defined how the exchange would be governed and operated.
The Washington Health Care Authority (HCA) helped establish the Washington marketplace. HCA transitioned governing authority to an 11-member board of directors in March 2012. The governor appointed eight voting members and a board chairperson who votes only if needed to break a tie. In addition, the insurance commissioner and the administrator of the Health Care Authority are non-voting members.
In March, 2014, Washington legislators tried to pass a bill that would have created much more transparency in the state’s health insurance industry, providing consumers with data on how much insurers are paying for services in each region of the state. It had widespread support, but opposition from Premera Blue Cross — the state’s largest insurer — sank the bill and Washington did not join the 11 other states that had all-payer claims databases by 2014. But lawmakers persisted, and in 2015, SB5084 was signed into law, advancing the process of creating an all-payer claims database in Washington state (S.B.5741 was enacted in 2019, and will improve the state’s all-payer claims database).
The federal government funded the Washington Healthplanfinder in 2014. In 2015, marketplace operations were funded by the state with $21 million that was previously earmarked for the state’s high-risk insurance pool, and with an additional tax on premiums on plans sold through the exchange.
No grandmothered plans
Washington Insurance Commissioner Mike Kreidler and Governor Jay Inslee took a strong progressive stance with regards to consumer protections: existing plans that did not meet ACA standards were cancelled at the end of 2013 and needed to be replaced in January 2014 with new, ACA-compliant policies. Following President Obama’s announcement that carriers could extend existing plans into 2014 if states allowed it, Kreidler and Inslee were quick to declare that Washington would not allow non-compliant plans to continue into 2014. Thus, the only non-ACA-compliant individual and small group plans in Washington are grandfathered plans; there are no grandmothered plans.
Contact the Washington exchange
More Washington State health insurance exchange links
Washington Health Benefit Exchange
Information about marketplace planning and development
State Exchange Profile: Washington
The Henry J. Kaiser Family Foundation overview of Washington’s progress toward creating a state health insurance exchange.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.