Senator Bob Hasegawa Introduces Washington Universal Healthcare Bill

by Chetanya Robinson

Senator Bob Hasegawa, who represents Washington's 11th District (Renton, Tukwila, part of Kent, SoDo, the Industrial District, Georgetown, and South Park), introduced a bill that would create a healthcare trust allowing everyone in the state to access affordable healthcare, vision care, dental, and mental health care.

Hasegawa's bill, SB 5204, has six co-sponsors so far.

Hasegawa said in an interview with the Emerald that the multiple crises of the past year — the COVID-19 pandemic, the resulting economic downturn, and the need to address racial disparities — make universal healthcare an urgent priority. The Governor's Interagency Council on Health Disparities shows how intertwined healthcare is with disparities in housing, education, and more, Hasegawa said. "It's pretty clear that everything is related to health."

Polling from 2020 shows that 63% of Americans — and 88% of Democrats — believe the federal government should play a role in providing healthcare.

"Universal healthcare is one of the most fundamental systems changes we can, and we should be, looking at right now," Hasegawa said. "It's been constantly shuffled to the bottom of everybody's pile, and the point of this is to put it back on the top of the pile and put it front and center because the people want it."

Hasegawa has introduced universal healthcare bills in the past, including a similar bill in the 2019—2020 legislative session, which never received a hearing.

This year, Hasegawa hopes the healthcare bill will at least get that, and start conversations about universal healthcare. "The likelihood of it passing, frankly, is very small," Hasegawa said. "I think the more important piece for this bill is that it gets to the top of people's minds."

Cindy Jacobs, a board member of the Whole Washington coalition that helped draft the bill, is cautiously hopeful. "This is probably the most optimistic I've felt about its chances," she said.

The bill follows a plan for universal healthcare laid out by Whole Washington. If SB 5204 doesn't pass the legislature this session, the group will file the same text (with few small changes) as a ballot initiative to the legislature in March.

If passed, the bill would create a single, centralized nonprofit health care trust in which everyone in the state can enroll and access healthcare services. Monthly premiums would be capped at $200, and exempt for low-income residents. It would eliminate high deductibles and copays, and dramatically drive down the price of prescription drugs.

Washingtonians would be eligible for coverage by November 2023 and could go to any hospital, doctor, or provider they chose to.

The bill would create a board of trustees — appointed by the governor and nominated by the legislature and insurance commissioner — who would design an essential benefits package to cover Washington residents and manage the trust.

This benefits package is intended to provide primary, preventative care, and would constitute "minimum essential coverage" under the Affordable Care Act. The goal is that it would cover more than Medicare, including cheaper prescription drugs, dental, and vision coverage.

The board would negotiate the prices that residents would pay for pharmaceutical drugs so that they wouldn't need to pay more than $250 per year, and preventative drugs would be exempt.

The bill would not directly eliminate the private health insurance market. Employers could choose to pay into the Whole Washington Trust Fund or their employee's healthcare accounts. People could access additional health benefits beyond what the basic plan offers if their employer or another plan offers it.

This was intended to protect healthcare plans negotiated by unions, which may be better than the baseline universal plan, Hasegawa said. It's also to avoid running afoul of the Employee Retirement Income Security Act (ERISA) of 1974, a federal law designed to protect pensions that constrain the ability of employers to contribute to a healthcare plan.

The Whole Washington Trust Fund would be paid for by monthly premiums, employer contributions, federal money, and a state capital gains tax.

Hasegawa acknowledged that even if the legislature passes a capital gains tax this session, it would probably be used to fund priorities like education, maintaining social safety net programs, or child care instead of the Whole Washington Trust Fund. "The capital gains proposal we're actually talking about doesn't come near meeting the overall deficit the state is going to figure out how to raise money for," Hasegawa. For the Trust Fund, "the funding is gonna be difficult, there's no question about it," Hasegawa said.

The legislature may need to appropriate new funding in summer 2022 from the general fund for start-up costs for the Trust Fund, according to the text of the bill.

Currently, Washington has a healthcare system similar to many states — one that is "splintered" and inefficient, said Jacobs.

Many Washington residents buy private health insurance plans or get them from their jobs. Others are covered under Medicaid or Medicare administered by the state and funded by the federal government and payroll deductions. "Medicare does not cover a significant portion of what you would ideally want to have covered, which is why you have all these Medicare supplement plans," Jacobs said. A third group of people do not have health insurance and may be unable to pay for services they need.

"It's really a bad system," said Jacobs, who has worked in healthcare for 40 years, including as a nurse provider and clinician and a healthcare regulatory lawyer. "If you tried to dream up the worst model for healthcare, it would be insurance. And the reason for that is that you buy insurance expecting not to have to use it, generally. Everybody uses their healthcare insurance."

In addition to being wasteful and convoluted, Jacobs said, many coverage carriers are for profit. And to make a profit, they have to keep a certain loss ratio. As a result, people pay high monthly premiums, get hit with high deductibles and copays, and even medical bankruptcies.

Hasegawa has advocated for universal healthcare for decades. When he was head of the Teamsters Union before being elected to the legislature, he remembers the "almost impossible challenge" of bargaining wage increases on top of maintaining healthcare coverage, with healthcare inflation rising every year. "It's just taking money straight out of the pockets of workers and putting it into profits for healthcare companies and insurance companies," Hasegawa said.

The goal of Hasegawa's bill is to treat healthcare like infrastructure instead of insurance.

Healthcare economist Dr. Gerald Friedman conducted a study for Whole Washington showing that if the state switched to a single-payer system, the total cost of healthcare for the state and individuals would be reduced by $9 billion per year.

This is because the plan gives the state bargaining power to keep costs low, Jacobs said.

While people might worry about paying more taxes for healthcare coverage, they will pay less in total than they do now, she said.

"Everybody's individual costs, almost universally, would go down," Jacobs said — with the exception of those who already have high-quality private plans.

When drafting the bill, Jacobs and others felt it was important to include a funding package for the bill — any legislation without it would be unlikely to go anywhere.

A movement for universal healthcare on a national level has long been championed by U.S. Senator Bernie Sanders. Recently, U.S. Representative Pramila Jayapal, who represents much of the Seattle area, introduced a federal universal healthcare bill in the House to match Sanders' Senate bill.

Jayapal and Sanders's bills, if passed, would roll Medicare into national coverage and amend ERISA, so states wouldn't have to worry about where federal dollars would come from.

U.S. Representative Ro Khanna of the San Francisco area introduced a slightly different House bill that does not mandate universal healthcare at the federal level but makes it easier for states to implement their own programs and receive federal Medicaid and Medicare funding. It amends the ERISA law, which is otherwise an obstacle for states wanting to implement their own universal healthcare programs.

Whole Washington supports these and all universal healthcare efforts, Jacobs said. If Jayapal and Sanders's bill is passed, there would be no need for the Whole Washington Trust, she said. Until then, the statewide bill could be a beneficial stop-gap.

"The advantage to our bill is that we can go ahead," Jacobs said. "Any old time that the federal program kicks in, we're good," she said, noting that the state program would be amended and folded into the federal one.

Jacobs hopes the COVID-19 pandemic, which has cost people jobs and health insurance, will inspire lawmakers and Washingtonians to push for a universal healthcare bill. People will see that "healthcare coverage that's tied to your employment is not too secure," Jacobs said.

Hasegawa pointed out that pandemic or no pandemic, the social contract that employers provide healthcare coverage has always been flawed, as 3.5% unemployment is counted as "full employment."

"If you're part of that three and a half percent, you're still struggling," Hasegawa said. "You don't have healthcare coverage, and you're just as human as the person who's making a billion dollars and deserve that same dignity and respect for your person."

Chetanya Robinson is a freelance journalist and managing editor at the International Examiner newspaper in the Chinatown International District. He enjoys reporting on the rich variety of life in Seattle, including the hyper-local stories of individual communities and neighborhoods. Born and raised in Seattle, he earned a degree in journalism from the University of Washington. His work has also appeared in Real Change News, Crosscut, Seattle Weekly, The Stranger, and the Muckleshoot Messenger, and he reported for Awoko Newspaper in Freetown, Sierra Leone as a student journalism fellow. Chetanya currently serves as vice president for the Society of Professional Journalists Western Washington Chapter. In his spare time he enjoys exploring nature and the city, learning languages, reading, and cooking. You can find him on Twitter at @chetanyarobins.

Featured image: State Senator Bob Hasegawa (photo: Alex Garland.)