Why supporters of Washington’s long-term care program are worried

With a looming ballot initiative threatening to upend the finances of Washington's long-term care benefit, the state is looking at contingency plans.

But these may not be enough to save the fledgling program.

The tax that funds the program, known as WA Cares, is now automatically deducted from the paychecks of most workers in Washington. Analyses of Initiative 2124, which would make paying into WA Cares voluntary, show that if voters approve the measure, it would push the program toward insolvency and make it unsustainable in the long term.

With six months until Election Day, WA Cares supporters are sounding the alarm.

"Making this program voluntary is essentially a vote to end the program. It just is not financially feasible as a voluntary insurance program," said Norma Coe, former University of Washington professor and current director of research at the University of Pennsylvania's Leonard Davis Institute of Health Economics.

Coe, along with other experts and long-term care advocates, spoke last week at a press briefing for We Care for WA Cares, a group that advocates for the program. Among the group's backers are the Washington State Budget and Policy Center, AARP and SEIU 775 — a labor union that represents about 50,000 long-term care workers providing services across Washington, Montana and Alaska.

WA Cares applies a 0.58% tax on Washington workers' paychecks. Beginning in July 2026, those who qualify can access a $36,500 lifetime benefit for expenses like caretaking, equipment or meals.

The tax went into effect last year. The program has been controversial since state lawmakers approved it in 2019.

Opponents say too many people are required to pay the tax who may never use the full benefit or even qualify for it. They also question the longevity of the program at the current tax rate and how much the limited benefit will help recipients afford care.

Brian Heywood, founder of Let's Go Washington and chief funder of the signature-gathering effort that got Initiative 2124 on the ballot, said when the measure was filed late last year that all it does is "give people a choice" about participating in the program.

An analysis of the initiative released earlier this year found that making the program completely voluntary could make its finances unworkable.

It found that those with anticipated long-term care needs will be more likely to participate, but other workers, especially those earning higher wages, will likely opt out. In this scenario, the program would become more expensive for everyone left in it — a smaller pool of participants with the greatest needs.

Raising the premium to cover promised benefits would likely only drive away more people, worsening the decline, according to the analysis.

"If the cycle repeats without intervention, the program could become financially unstable and unsustainable with an inability to collect premiums that are high enough per person to cover benefits," State Actuary Matthew Smith told the Long-Term Services and Supports Trust Commission last week.

Smith recommended the commission begin looking at risk-management strategies from other voluntary programs and to consider forming a separate work group to look at contingency planning, if the initiative passes.

That could include how the Employment Security Department, which collects the premiums, will handle an influx of people planning to opt out. After election results are finalized, the department will likely have 30 days to set up a process for people to opt out, said Cami Feek, a commission member from the Employment Security Department. Details of what that process would look like are still being determined.

Some commissioners were skeptical that any planning could save the program if voters approve the initiative.

"This seems like it will be a huge mountain to climb in sustaining the program in some kind of viable form," Commissioner Mark Stensager said.

Advocates argue that the program is essential to help fund long-term care for thousands of Washingtonians who don't already have a plan to pay for it. The initiative would "destroy" the program, said Bonnie Burns, a national expert on long-term care financing and consumer advocate with California Health Advocates.

"People don't understand long-term care," Burns added. "They don't understand the need for financing. It's a giant issue that's going to show up later."