CERTIFICATION OF ENROLLMENT
ENGROSSED SECOND SUBSTITUTE SENATE BILL 5399
Chapter 309, Laws of 2021
67th Legislature
2021 Regular Session
UNIVERSAL HEALTH CARE COMMISSION
EFFECTIVE DATE: July 25, 2021
Passed by the Senate April 19, 2021 CERTIFICATE
Yeas 28 Nays 21
I, Brad Hendrickson, Secretary of
the Senate of the State of
DENNY HECK Washington, do hereby certify that
President of the Senate the attached is ENGROSSED SECOND
SUBSTITUTE SENATE BILL 5399 as
passed by the Senate and the House
of Representatives on the dates
Passed by the House April 7, 2021 hereon set forth.
Yeas 57 Nays 40
BRAD HENDRICKSON
LAURIE JINKINS
Secretary
Speaker of the House of
Representatives
Approved May 13, 2021 11:56 AM FILED
May 13, 2021
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 ENGROSSED SECOND SUBSTITUTE SENATE BILL 5399
AS AMENDED BY THE HOUSE
Passed Legislature - 2021 Regular Session
State of Washington 67th Legislature 2021 Regular Session
By Senate Ways & Means (originally sponsored by Senators Randall,
Cleveland, Das, Dhingra, Frockt, Hunt, Kuderer, Liias, Lovelett,
Nguyen, Nobles, Robinson, Saldaña, Stanford, Van De Wege, Wellman,
and Wilson, C.)
READ FIRST TIME 02/22/21.
1 AN ACT Relating to the creation of a universal health care
2 commission; adding a new section to chapter 41.05 RCW; and creating a
3 new section.
4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
5 NEW SECTION. Sec. 1. (1) The legislature finds that:
6 (a) Healthy Washingtonians contribute to the economic well-being
7 of their families and communities, and access to appropriate health
8 services and improved health outcomes allow all Washingtonian
9 families to enjoy productive and satisfying lives;
10 (b) Washington and the United States are experiencing the deepest
11 economic crisis since the Great Depression, caused by a public health
12 crisis;
13 (c) Skyrocketing unemployment rates due to COVID-19 have exposed
14 the frailties and inequalities of the current health care system
15 while causing unsustainable strain to the state's medicaid system;
16 (d) Thousands of union and nonunion workers are unemployed and
17 without health insurance;
18 (e) Approximately 125,000 undocumented people live in the state
19 with no access to health care during a global pandemic;
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 1 (f) Multiple economic analyses show that a universal system is
2 less expensive, more equitable, and will produce billions in savings
3 per year; and
4 (g) While a unified health care financing system can provide
5 universal coverage, increase access to care, decrease costs, and
6 improve quality, implementing such a system in the state is dependent
7 on foundational legal, financial, and programmatic changes from the
8 federal government.
9 (2) The legislature intends to create a permanent universal
10 health care commission to:
11 (a) Implement immediate and impactful changes in the state's
12 current health care system to increase access to quality, affordable
13 health care by streamlining access to coverage, reducing
14 fragmentation of health care financing across multiple public and
15 private health insurance entities, reducing unnecessary
16 administrative costs, reducing health disparities, and establishing
17 mechanisms to expeditiously link residents with their chosen
18 providers; and
19 (b) Establish the preliminary infrastructure to create a
20 universal health system, including a unified financing system, that
21 controls health care spending so that the system is affordable to the
22 state, employers, and individuals, once the necessary federal
23 authorities have been realized.
24 (3) The legislature further intends that the state, in
25 collaboration with all communities, health plans, and providers,
26 should take steps to improve health outcomes for all residents of the
27 state.
28 NEW SECTION. Sec. 2. A new section is added to chapter 41.05
29 RCW to read as follows:
30 (1) The universal health care commission is established to create
31 immediate and impactful changes in the health care access and
32 delivery system in Washington and to prepare the state for the
33 creation of a health care system that provides coverage and access
34 for all Washington residents through a unified financing system once
35 the necessary federal authority has become available. The authority
36 must begin any necessary federal application process within 60 days
37 of its availability.
38 (2) The commission includes the following voting members:
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 1 (a) One member from each of the two largest caucuses of the house
2 of representatives, appointed by the speaker of the house of
3 representatives;
4 (b) One member from each of the two largest caucuses of the
5 senate, appointed by the president of the senate;
6 (c) The secretary of the department of health, or the secretary's
7 designee;
8 (d) The director of the health care authority, or the director's
9 designee;
10 (e) The chief executive officer of the Washington health benefit
11 exchange, or the chief executive officer's designee;
12 (f) The insurance commissioner, or the commissioner's designee;
13 (g) The director of the office of equity, or the director's
14 designee; and
15 (h) Six members appointed by the governor, using an equity lens,
16 with knowledge and experience regarding health care coverage, access,
17 and financing, or other relevant expertise, including at least one
18 consumer representative and at least one invitation to an individual
19 representing tribal governments with knowledge of the Indian health
20 care delivery in the state.
21 (3)(a) The governor must appoint the chair of the commission from
22 any of the members identified in subsection (2) of this section for a
23 term of no more than three years. A majority of the voting members of
24 the commission shall constitute a quorum for any votes of the
25 commission.
26 (b) The commission's meetings shall be open to the public
27 pursuant to chapter 42.30 RCW. The authority must publish on its
28 website the dates and locations of commission meetings, agendas of
29 prior and upcoming commission meetings, and meeting materials for
30 prior and upcoming commission meetings.
31 (4) The health care authority shall staff the commission.
32 (5) Members of the commission shall serve without compensation
33 but must be reimbursed for their travel expenses while on official
34 business in accordance with RCW 43.03.050 and 43.03.060.
35 (6) The commission may establish advisory committees that include
36 members of the public with knowledge and experience in health care,
37 in order to support stakeholder engagement and an analytical process
38 by which key design options are developed. A member of an advisory
39 committee need not be a member of the commission.
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 1 (7) By November 1, 2022, the commission shall submit a baseline
2 report to the legislature and the governor, and post it on the
3 authority's website. The report must include:
4 (a) A complete synthesis of analyses done on Washington's
5 existing health care finance and delivery system, including cost,
6 quality, workforce, and provider consolidation trends and how they
7 impact the state's ability to provide all Washingtonians with timely
8 access to high quality, affordable health care;
9 (b) A strategy for developing implementable changes to the
10 state's health care financing and delivery system to increase access
11 to health care services and health coverage, reduce health care
12 costs, reduce health disparities, improve quality, and prepare for
13 the transition to a unified health care financing system by actively
14 examining data and reports from sources that are monitoring the
15 health care system. Such sources shall include data or reports from
16 the health care cost transparency board under RCW 70.390.070, the
17 public health advisory board, the governor's interagency coordinating
18 council on health disparities under RCW 43.20.275, the all-payer
19 health care claims database established under chapter 43.371 RCW,
20 prescription drug price data, performance measure data under chapter
21 70.320 RCW, and other health care cost containment programs;
22 (c) An inventory of the key design elements of a universal health
23 care system including:
24 (i) A unified financing system including, but not limited to, a
25 single-payer financing system;
26 (ii) Eligibility and enrollment processes and requirements;
27 (iii) Covered benefits and services;
28 (iv) Provider participation;
29 (v) Effective and efficient provider payments, including
30 consideration of global budgets and health plan payments;
31 (vi) Cost containment and savings strategies that are designed to
32 assure that total health care expenditures do not exceed the health
33 care cost growth benchmark established under chapter 70.390 RCW;
34 (vii) Quality improvement strategies;
35 (viii) Participant cost sharing, if appropriate;
36 (ix) Quality monitoring and disparities reduction;
37 (x) Initiatives for improving culturally appropriate health
38 services within public and private health-related agencies;
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 1 (xi) Strategies to reduce health disparities including, but not
2 limited to, mitigating structural racism and other determinants of
3 health as set forth by the office of equity;
4 (xii) Information technology systems and financial management
5 systems;
6 (xiii) Data sharing and transparency; and
7 (xiv) Governance and administration structure, including
8 integration of federal funding sources;
9 (d) An assessment of the state's current level of preparedness to
10 meet the elements of (c) of this subsection and steps Washington
11 should take to prepare for a just transition to a unified health care
12 financing system, including a single-payer financing system.
13 Recommendations must include, but are not limited to, administrative
14 changes, reorganization of state programs, retraining programs for
15 displaced workers, federal waivers, and statutory and constitutional
16 changes;
17 (e) Recommendations for implementing reimbursement rates for
18 health care providers serving medical assistance clients who are
19 enrolled in programs under chapter 74.09 RCW at a rate that is no
20 less than 80 percent of the rate paid by medicare for similar
21 services;
22 (f) Recommendations for coverage expansions to be implemented
23 prior to and consistent with a universal health care system,
24 including potential funding sources; and
25 (g) Recommendations for the creation of a finance committee to
26 develop a financially feasible model to implement universal health
27 care coverage using state and federal funds.
28 (8) Following the submission of the baseline report on November
29 1, 2022, the commission must structure its work to continue to
30 further identify opportunities to implement reforms consistent with
31 subsection (7)(b) of this section and to implement structural changes
32 to prepare the state for a transition to a unified health care
33 financing system. The commission must submit annual reports to the
34 governor and the legislature each November 1st, beginning in 2023.
35 The reports must detail the work of the commission, the opportunities
36 identified to advance the goals under subsection (7) of this section,
37 which, if any, of the opportunities a state agency is implementing,
38 which, if any, opportunities should be pursued with legislative
39 policy or fiscal authority, and which opportunities have been
40 identified as beneficial, but lack federal authority to implement.
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1 (9) Subject to sufficient existing agency authority, state
2 agencies may implement specific elements of any report issued under
3 this section. This section shall not be construed to authorize the
4 commission to implement a universal health care system through a
5 unified financing system until there is further action by the
6 legislature and the governor.
7 (10) The commission must hold its first meeting within 90 days of
8 the effective date of this section.
Passed by the Senate April 19, 2021.
Passed by the House April 7, 2021.
Approved by the Governor May 13, 2021.
Filed in Office of Secretary of State May 13, 2021.
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