Key health takeaways from WA's 2024 legislative session

Lawmakers from both parties could not ignore the fact health care has gotten more expensive for Washingtonians the past few years — but many argued it has also become more costly to provide for a multitude of reasons.

Last year, hospitals lost $1.2 billion between January and September, with main expenses going toward employee salaries and benefits, and items like utilities, purchased or contracted services, supplies, pharmaceuticals and "costs of capitol," which include interest paid on bonds and depreciation of equipment and buildings. In 2022, losses totaled more than $2 billion, according to the Washington State Hospital Association.

Legislators spent the short 60-day session trying to figure out how to best help hospitals and providers out of these financial holes, debating how staffing, reimbursement rates for public health insurance plans and long-term impacts of health care consolidations, among other factors, play a part.

"Overarching health care priorities from my perspective are always increasing access to coverage and affordability," said Sen. Annette Cleveland, D-Vancouver, who's chaired the Senate Health & Long Term Care Committee since 2018. "I feel as if we made some tremendous progress again toward all those priorities."

Bolstering the region's health care workforce has long been a focus of politicians and medical leaders, particularly after burnout and staffing levels worsened during the COVID-19 pandemic. This year, lawmakers approved bills that established licensure for anesthesiologist assistants and created a certification for MRI technologists, both areas of medicine that have seen "significant demand," said Sean Graham, the director of government affairs for the Washington State Medical Association. During testimony, lawmakers heard from many patients whose procedures were canceled because of a lack of anesthesiologists, Cleveland added.

Legislators also increased state funding for physicians residency programs by $69 million, hoping to keep more medical students in state after they graduate; expanded access for psychologists, clinical social workers and mental health therapists; and created a medical assistant-EMT certification.

Other bills that would have expanded scope of practice for other providers, however, died during the session, including ones that would have broadened or established prescriptive authority for pharmacists, psychologists and naturopaths.

Health care affordability has also remained a big topic, reflected in some successful bills around prohibiting surprise billing in specific settings (in this case, ground ambulances) and adding extra requirements for the state's health care cost transparency board. In addition, health insurers must also now cover the same preventive services without cost-sharing, as is required by federal law.

Affordability and access to care were also at the center of debate around the Keep Our Care Act, a highly debated bill that would have increased state oversight of health care mergers and acquisitions had it passed. While hospital and medical leaders argued the bill would have imposed too burdensome of requirements for health care facilities hoping to consolidate, legislation supporters worried an increase in these types of transactions would lead to higher costs and decreased access to care, particularly for reproductive, end-of-life and gender-affirming services.

It's left many independent or smaller physicians groups feeling caught in the middle, Graham said.

"Independent groups want to remain independent, but sometimes their hand is forced in having to consolidate to remain open to continue to provide care in their community," he said.

Rep. Marcus Riccelli, D-Spokane, who chairs the House Health Care and Wellness Committee and supported the Keep Our Care Act, said he's looking forward to working on it again next year.

Riccelli was disappointed to see the bill run out of time, and said he felt lawmakers could have done more to address cost transparency and rising prices of care.

"We're in a dire situation with the costs of health care becoming unsustainable," Riccelli said. The updates to the health care cost transparency board were a "step in the right direction," he said, but he still wonders "why we can't get more bipartisan coalition support around cost transparency."

Like last year, Medicaid rates came up in conversations around health care affordability and staffing levels.

Hospitals won an increase in Medicaid rates during last year's legislative session — which is expected to receive federal approval in April and will pay them closer to Medicare rates.

But physicians, physician assistants and advanced registered nurse practitioners who don't work in hospitals, instead staffing places like independent practices or physicians' groups, did not ultimately win the same gains this year.

"As Medicaid enrollment has expanded, rates have not increased," Graham said. "It puts more pressure on independent physicians' groups across the state, and puts folks in an untenable position of having to serve patients in their community who have needs for all specialties and services."

Last fall, the Centers for Medicare & Medicaid Services also finalized a 3.4% decrease in Medicare rates for physicians. The reduction, coupled with an expansion of Medicaid enrollees in the state, means the "situation is going to get worse before it gets better for independent physicians," Graham said.

A number of additional health-related investments were approved that provided more than $270 million in behavioral health programs and services; $200 million in fentanyl and substance-use treatment programs; $28 million for the state's Apple Health look-a-like program for undocumented immigrants; and more funding for workforce education and hospitals in financial distress, especially those at risk of losing labor and delivery services.

Other key health legislation that passed

* House Bill 2295: Allows the state to continue offering its version of the federal hospital at-home program, which allows a hospital-based team to provide acute-care services to patients at home.

* House Bill 1954: Increases protection of providers offering reproductive health or gender-affirming care.

* House Bill 1979: Reduces the cost of inhalers and EpiPens.

* Senate Bill 6228: Expands requirements for insurers or managed-care organizations when covering substance-use treatment, and clarifies other medication and treatment options.

* Senate Bill 5821: Establishes a standard of audio-only telemedicine services.

* Senate Bill 5213: Creates a regulatory structure for pharmacy benefit managers, which contract with pharmacies on behalf of an insurer or third-party payer.

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