This bill seeks to improve access and affordability of health insurance for Washington state residents by amending existing laws and establishing new criteria for health plan certification. It empowers the Washington health benefit exchange to develop additional market factor certification criteria that specifically target access and affordability challenges faced by consumers. The bill emphasizes the need for a stable insurance market and the exchange's ability to adapt to evolving market conditions, particularly in response to rising healthcare costs and federal regulatory changes. Key amendments include the introduction of annual criteria for health plan certification that ensure meaningful differences in cost-sharing, covered benefits, and provider networks, along with a structured consultation process involving stakeholders such as the insurance commissioner and healthcare providers.

Additionally, the bill introduces provisions that prevent market factor certification criteria from imposing network participation requirements or reimbursement limits on hospitals or providers, except as required by law. It allows carriers to offer health plans outside the exchange that do not meet certain criteria and mandates the exchange to submit an annual report to the legislature starting in 2030, detailing enrollment statistics and health plan premiums. The bill also requires collaboration between the exchange and the commissioner to introduce at least two carriers in counties with limited options, enhancing competition in underserved areas. The act is considered essential for the immediate preservation of public peace, health, or safety, and it takes effect immediately.

Statutes affected:
Original bill: 43.71.065
Substitute bill: 43.71.020, 43.71.065