How recent WA legislative changes could save you money on health care [The Seattle Times]

Jan. 26—It's no secret health care has gotten more expensive for Washingtonians in the last decade.

According to a recent preliminary report from the state Insurance Commissioner's Office, premiums rose 49% and deductibles rose nearly 79% between 2010 and 2020. The report pointed, in part, to a growing number of health care mergers and acquisitions — though state hospital leaders instead called out Washington's aging population, surging costs of medicine and government underfunding of public health insurance programs.

In 2022, a survey found 62% of Washington residents had trouble affording health care and had rationed their prescriptions, delayed care or depleted their savings to pay for medical expenses.

Rising health care costs have not gone unnoticed by state lawmakers, who last year passed a spate of bills aimed at lowering several types of out-of-pocket charges, while also trying to address some systems-level issues that have kept costs high, like updating Medicaid reimbursement rates for providers. While proponents of these bills have said the changes could save Washingtonians hundreds of dollars every year and increase access to care, critics worry they'll increase premiums for everyone.

The Association of Washington Healthcare Plans, which represents the state's major insurance plans, testified in last year's legislative session that eliminating cost-sharing for breast exams, for example, could increase expenses for health plans, which could then bump up premiums for all plan members.

On the other hand, reducing deductibles, copays or similar out-of-pocket charges incentivizes seeking care early — particularly important for lower-income families, people of color and youth, said Sarah Munro, a University of Washington assistant professor of health systems and population health who focuses on contraception and abortion research.

"Supporting access to abortion earlier, and with fewer barriers, actually prevents the need for more expensive health care later on," Munro said. "For instance, if an abortion is delayed, it has to happen at a later gestational age. So [Senate Bill 5242] could save insurers money in the long run."

Here are some of the changes lawmakers approved last session, many of which go into effect this year, that could save patients money on out-of-pocket expenses.

Hearing aids: Last year's House Bill 1222, which passed unanimously in the Senate and 88-8 in the House, required nongrandfathered, large group health plans and those for public employees to cover all hearing instruments or any devices that aid, improve or correct a person's hearing. The legislation, which applies to plans issued or renewed in 2024, means hearing aids for Washingtonians are now covered for up to $3,000 per ear every 36 months. Coverage includes the hearing aid, initial assessment, fitting, adjustment, auditory training and ear molds but not over-the-counter devices.

Breast exams: Senate Bill 5396, which went into effect at the beginning of January, eliminated cost-sharing for both supplemental and diagnostic breast exams, which are generally recommended every one to two years for women 40 and older to encourage early diagnosis of breast cancer. The legislation, which passed unanimously in the Senate and 90-6 in the House, will make diagnostic imaging free to patients with plans that cover breast exams, including those who saw an abnormality show up in a previous exam or who might have personal medical or family history that increases risk of breast cancer.

Colorectal screenings: As of this year, House Bill 1626 requires the state Health Care Authority to provide coverage for noninvasive, preventive colorectal cancer screening tests under medical assistance programs. The bill, which passed 39-9 in the Senate and unanimously in the House, requires programs to cover stool-based tests and direct visualization tests like colonoscopies.

Insulin: Senate Bill 5729, which passed unanimously in the Senate and 95-2 in the House, established a permanent, $35-per-month cap on the cost of insulin, a drug used to treat diabetes, for those with certain insurance plans. Prices on the medication, which have climbed in recent years, were capped at $100 for a 30-day supply in 2020, later falling to $35 in 2022 for those with certain state-regulated plans — a limit that was set to expire at the beginning of 2024. Last year's bill removed the expiration date and went into effect last July.

Abortion: Senate Bill 5242, one of five bills aimed at protecting access to abortions in the state, eliminated cost-sharing for abortion for Washingtonians with private insurance, meaning they will no longer have to pay copays or meet their deductible in order to access abortion services. The bill passed 29-19 in the Senate and 57-39 in the House and went into effect last July.

Birth/newborn and postpartum care: While the passage of Senate Bill 5581 did not immediately reduce or eliminate deductibles for prenatal/delivery services and postpartum care, the legislation required the state Office of the Insurance Commissioner to analyze how health plans define, cover and reimburse for these services — and make recommendations on how to limit cost-sharing. The OIC must submit its report by July 1, per the legislation, which passed unanimously in the Senate and the House.

What's in store for this session?

Saving on health care costs remains top of mind this year for state lawmakers, who kicked off 2024's short legislative session about three weeks ago.

One strategy the state Health Care Authority considers when balancing access to medical care and costs is to ensure at least one version of a drug is available at a lower copay cap but not necessarily require coverage of every version on the marketplace, said Evan Klein, the agency's special assistant for legislative and policy affairs.

"There may be some very high-cost alternatives that aren't any more clinically effective than the generic version, for example," Klein said. "So why pay for the higher-cost brand name?"

House Bill 1979, following the lead of recent efforts around the insulin-copay cap, aims to reduce the price of inhalers and epinephrine autoinjectors, used to treat severe allergic reactions.

The fight to make insulin more accessible returns with a push to create a program that would provide low-cost, emergency insulin to Washingtonians with less than a seven-day supply. If Senate Bill 5776 is approved, those eligible would be able to receive one emergency 30-day supply of insulin every year for $10.

"This is a good gap filler for people who don't have insurance coverage or access to low-cost insulin," Klein said.

Senate Bill 5986 would establish balance billing protections for certain ground ambulance services, and require health plans to cover transports to emergency behavioral health providers. If passed, the bill would protect patients from out-of-network charges for these types of services.

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