Washington: Gov. Inslee signs bill fully locking in Blue Leg Protections!

I don't know if I'm just asleep at the wheel when it comes to healthcare happenings in Washington State lately, but this one caught me by surprise as well:

Today I signed a bill that protects Affordable Care Act health care insurance practices in WA state. This bill assures Washingtonians that regardless of what happens in D.C., we’re protecting your access to care here here at home. #waleg #ACAhttps://t.co/e3g35Fch68

— Governor Jay Inslee (@GovInslee) April 17, 2019

From the official press release:

Gov. Jay Inslee signed a bill Wednesday that will reinforce significant number of consumer protections in the Affordable Care Act, including the much-discussed right that no person will be denied health coverage because they have a pre-existing medical condition. Dziedzic and her son stood with the governor during the signing, along with Insurance Commissioner Mike Kreidler (who made brief remarks) and primary bill sponsor Rep. Lauren Davis.

“This bill assures Washingtonians that regardless of what happens in D.C., we’re protecting your access to care here at home,” Inslee said. “This means you can’t be denied insurance after surviving cancer, it means you can’t be forced into bankruptcy because of a lifetime cap, and it means you can’t be forced to pay for basic and essential health benefits such as contraception and mammograms.”

Inslee released a statement in March against the Trump administration’s push to repeal healthcare for millions of Americans. Inslee and Kreidler warn that although this new law helps Washington consumers, the state still needs ACA protections on the federal level. 800,000 people who have health care coverage in Washington are still at risk if the ACA is repealed because it would eliminate Medicaid expansion and low-income subsidies.

The new law addresses unfair practices against consumers, and protects a variety of benefits connected to private health insurance coverage offered in Washington. Among other things, the law includes a requirement that the state offers and explains health plans to any resident regardless of health status. The law also continues open enrollment periods, adds limitations to coverage cancellations, prohibits annual or lifetime limits as well as waiting periods and maintains coverage of the 10 essential health benefits introduced in the Affordable Care Act.

I took a look at the text of the bill itself. It looks like at least six of the eight "Blue Leg Protections" listed below are locked in at the state level. Of the other two, Washington State apparently already allowed young adults to stay on their parents plans until age 25 before the ACA anyway, so I guess they didn't think it was worth the fuss of tacking on one extra year. I'm not sure about the no-cost preventative services requirement, however.

The bill signed by Inslee today actually covers a couple of items which I haven't seen done in other "shore up the ACA" states like New Mexico, New Jersey and Maryland (although I could have missed some). For instance:

PART V -- COST SHARING

NEW SECTION. Sec. 10. A new section is added to chapter 48.43 RCW to read as follows:

(1) For plan years beginning in 2020, the cost sharing incurred under a health plan for the essential health benefits may not exceed the following amounts

(a) For self-only coverage:

(i) The amount required under federal law for the calendar year; or

(ii) If there are no cost-sharing requirements under federal law, eight thousand two hundred dollars increased by the premium adjustment percentage for the calendar year.

(b) For coverage other than self-only coverage:

(i) The amount required under federal law for the calendar year; or

(ii) If there are no cost-sharing requirements under federal law, sixteen thousand four hundred dollars increased by the premium adjustment percentage for the calendar year.

In other words, it locks in the ACA's "Maximum Out-of-Pocket" limit for deductibles, co-pays and coinsurance.

It even locks in another "Blue Leg" protection which I don't have listed on the graphic:

PART III - PROHIBITING UNFAIR RESCISSIONS

NEW SECTION. Sec. 8. A new section is added to chapter 48.43 RCW to read as follows:

(1) A health plan or health carrier offering group or individual coverage may not rescind such coverage with respect to an enrollee once the enrollee is covered under the plan or coverage involved, except that this section does not apply to a covered person who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. The plan or coverage may not be canceled except as permitted under RCW 48.43.035 or 48.43.038.

(2) The commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.

In addition, as noted in Inslee's statement, the bill also locks in portions of the Red and Green leg...namely the WA Health Benefit Exchange itself (remember, Washington established their own ACA exchange) and the time-limited Open Enrollment Period to go with it.

The bill doesn't include a state-level individual mandate penalty like New Jersey, DC and Massachusetts have...but the federal mandate penalty was already repealed, so nothing would change there.

The biggest concern, of course, is that it's the federal financial subsidies which make up most of the Green leg...and without those, the unsubsidized premiums would of course be unaffordable for most people, which goes back to the whole point of the 3-legged stool framework in the first place.

Hopefully it won't come to that...the 5th Circuit Court should shoot down the idiotic #TexasFoldEm lawsuit this July and all of this will hopefully be moot until either ACA 2.0, Medicare for America or Medicare for All are passed in the near future.