A group that has spent years pushing an initiative that would bring single-payer health care to Washington state hopes to get its measure in front of the state legislature in the 2023 session, which began Jan. 9.
Activists with Whole Washington are building momentum in their campaign to pass a single-payer, universal health care program in the state. Launched in 2018, the mostly volunteer-run organization has started several initiatives to establish a publicly managed Washington Health Trust to ensure free-at-the-point-of-use coverage for all of the state’s residents.
In 2022, the campaign gathered nearly 80,000 signatures, substantially less than the 325,000 required for an initiative to make it onto the ballot. Advocates are now looking to the 2023 legislative session to introduce a bill in both the state House and Senate.
According to Whole Washington Campaign Director Andre Stackhouse, the Washington Health Trust is inspired by Canada’s single-payer health care system. If passed, the trust would assume the role of the state’s only health care insurer, eliminating the need for private or employer-provided health insurance.
The health trust would also replace Apple Health (Medicaid) and Medicare while expanding coverage to include things such as dental care, vision, reproductive health care and most prescription drugs. The system would allow patients to go to the doctor without worrying about payment, which is covered through taxation.
When fully implemented, the state would pay for the program by imposing a 10.5 percent payroll tax on employers — 2 percent of which can be passed down to employees — as well as a 2 percent tax on self-employed people and an 8.5 percent tax on capital gains or investment income of more than $15,000. Offsetting the tax increases is the fact that people would no longer have to pay private health insurance premiums, co-pays and deductibles.
In a 2021 study commissioned by the campaign, economist Gerald Friedman argued that a fully set up Washington Health Trust would save more than $11 billion in net costs versus the current system because it would eliminate redundant administration and lower provider costs.
Unlike the United States’ current multi-payer system — in which each insurance company must individually negotiate its rates with hospitals and drug companies — a single-payer system has the government negotiate all the rates. Because it is the only health care purchaser, providers that refuse to negotiate would effectively go out of business. This bargaining power is part of how many wealthy industrialized nations are able to spend far less on health care per capita than the U.S.
In recent years, the campaign to implement single-payer, universal health care has gathered momentum. In the 2021-2022 Congress, Independent democratic socialist Sen. Bernie Sanders got 14 cosponsors to establish a Medicare for All program. Congressional Rep. Pramila Japayal, who represents Seattle, received 122 cosponsors on a corresponding bill in the House of Representatives.
Seattle politicians have also made strides on the issue. The City Council voted in 2019 to support efforts to establish a single-payer, universal health care system, and on Dec. 6, 2022, the council endorsed statewide efforts such as Whole Washington as well.
In 2021, the state legislature passed SB 5399, which established the Universal Health Care Commission, made up of experts and stakeholders appointed by the governor, state legislature and related government agencies. The commission recently released a report outlining the path to universal health care implementation, finding that a single-payer system would save about $2.5 billion annually. Under the Whole Washington proposal, the commission would oversee the establishment and governance of the Washington Health Trust.
One key stumbling block in the implementation of the Whole Washington proposal is the requirement for a federal waiver to allow the state to fold existing public programs such as Apple Health into the Washington Health Trust. The state recently got a similar waiver to expand health care coverage to undocumented people. However, a waiver for universal health care may be more contentious. In his 2020 campaign, President Joe Biden refused to support single-payer health care, even though the majority of Democrats support the proposal.
In a March 2021 Morning Consult poll, 55 percent of respondents said they supported the Medicare for All proposal compared to 32 percent who opposed it. Democratic support was overwhelming — 79 percent of Democrats were for the policy, with only 8 percent opposed to it.
Democratic state Sen. Bob Hasegawa said he plans to reintroduce the Whole Washington proposal as a bill in this legislative session. In the 2021-2022 legislative session, the bill received six cosponsors but did not make it out of committee.
Hasegawa isn’t too optimistic that the legislature will pass the Whole Washington legislation, but he hopes it will help boost an initiative campaign so that it can make it on the ballot. He also said that the Democrats should be cognizant about the urgency of passing universal health care.
“We need it now,” Hasegawa said. “There are people really suffering and it’s dragging people into bankruptcy and homelessness. And I mean, it’s just — there’s so many collateral consequences.”
Stackhouse sees promise from other countries’ experiences in achieving single-payer health care. He pointed to Saskatchewan, which established a provincial single-payer system that later led to the health care system being implemented nationally. The campaign hopes that this “laboratories of democracy” approach, as dubbed by the late Supreme Court Justice Louis Brandeis, will eventually prove successful in bringing about a national single-payer health care system that guarantees free medical care to all.
Stackhouse believes that, if people learn about universal health care and how the proposal would work, they would support the Whole Washington campaign. The group is committed to establishing the Washington Health Trust, whether it’s through the legislature or the initiative process.
“So many people have never really heard about a universal health care system before,” Stackhouse said. “A ton of people in Washington have never heard about the ballot initiative process.”
Read more of the Jan. 11-17, 2023 issue.