How WA’s recent legislative changes could save you health care costs

How WA’s recent legislative changes could save you health care costs

It’s no secret that health care has gotten more expensive for Washingtonians over the past decade.

According to a recent preliminary report from the state Insurance Commissioner’s Office, premiums increased by 49% between 2010 and 2020, and deductibles increased by nearly 79%. The report noted in part that health care mergers and acquisitions are on the rise — despite state hospital leaders to the contrary, who cited Washington’s aging population, soaring health care costs and the government’s underfunding of public health insurance programs.

A 2022 survey found that 62% of Washington residents struggle to afford health care and are filling prescriptions, delaying care or depleting their savings to pay for care.

Rising health care costs have not gone unnoticed by state lawmakers, who passed a series of bills last year aimed at lowering several types of out-of-pocket costs while also trying to address some of the system-wide issues that keep costs high, such as updating delivery Medicaid reimbursement rates for patients. While supporters of the bills say the changes could save Washingtonians hundreds of dollars each year and increase access to care, critics worry they will increase premiums for everyone.

The Washington Association of Health Plans, which represents the state’s major insurance plans, testified during last year’s legislative session that eliminating cost-sharing for breast exams could increase costs for health plans, potentially increasing premiums for all plan members.

On the other hand, reducing deductibles, copays, or similar out-of-pocket costs can incentivize seeking care earlier, which is especially important for low-income families, people of color, and young adults, said Shasha, assistant professor of health systems and health at the University of Washington. Sarah Munro said. Population Health, focusing on contraception and abortion research.

“Supporting early abortion and reducing barriers can actually prevent the need for more expensive health care later on,” Munro said. “For example, if an abortion is delayed, it has to be performed at a later gestational age. So [Senate Bill 5242] This saves the insurance company money in the long run. “

Here are some of the reforms lawmakers approved last session, many of which will take effect this year, that could save patients money on out-of-pocket costs.

Hearing aids: House Bill 1222, which passed the Senate unanimously last year and the House by a vote of 88-8, would require non-grandfathered large group health plans and public employee health plans to cover all hearing aids or any device that aids, improves or corrects an individual’s Hearing equipment. The legislation, which applies to plans released or updated in 2024, means Washingtonians will now be covered for up to $3,000 per ear every 36 months for their hearing aids. Coverage includes hearing aids, initial evaluation, fitting, adjustments, auditory training and earmolds, but does not include over-the-counter devices.

Breast examination: Senate Bill 5396, which took effect in early January, eliminates cost-sharing for supplemental and diagnostic breast exams, which are typically recommended for women 40 and older every one to two years to encourage early diagnosis of breast cancer. The legislation, which passed the House unanimously by a vote of 90-6 in the Senate, would provide free diagnostic imaging to patients scheduled for breast exams, including those who have experienced abnormalities during previous exams or who may have received personal medical treatment or exams . A family history that increases the risk of breast cancer.

Colorectal examination: As of this year, House Bill 1626 requires state health care administrations to provide coverage of non-invasive, preventive colorectal cancer screening tests under Medicaid. The bill, which passed the Senate 39-9 and passed the House unanimously, requires programs to cover stool-based tests and direct visual tests such as colonoscopies.

insulin: Senate Bill 5729, which passed unanimously 95-2 in the Senate and House of Representatives, puts a permanent cap of $35 per month on the cost of insulin, a drug used to treat diabetes. The price of the drug has climbed in recent years, with a 30-day supply capped at $100 in 2020 and later reduced to $35 in 2022 — a limit that was set to expire in early 2024. Last year’s bill eliminated the deadline and took effect last July.

abortion: Senate Bill 5242, one of five bills aimed at protecting abortion access in the state, eliminates abortion cost-sharing for Washingtonians with private insurance, meaning they will no longer have to pay copays or meet deductibles amount to obtain abortion services. The bill passed the Senate by a vote of 29 to 19 and the House of Representatives by a vote of 57 to 39 and took effect last July.

Birth/Newborn and Postpartum Care: While passage of Senate Bill 5581 does not immediately reduce or eliminate deductibles for prenatal/delivery services and postpartum care, the legislation requires the state Insurance Commissioner’s Office to analyze how health plans define, cover, and reimburse these services and develop Recommendations on how to limit cost sharing. Under the legislation passed unanimously by the Senate and House of Representatives, the OIC must submit its report by July 1.

What is this meeting about?

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

One strategy the state health care agency is considering when balancing care and costs is ensuring that at least one drug has a lower deductible cap, but not necessarily requiring coverage of every version on the market, Evan Klein said. The agency’s special assistant for legislative and policy affairs.

“For example, there may be some very high-cost alternatives that are not clinically more effective than generic drugs,” Klein said. “So why spend money on a higher-cost brand?”

The 1979 House bill follows recent efforts around insulin copay caps to lower the price of inhalers and epinephrine auto-injectors used to treat severe allergic reactions.

The fight to make insulin more accessible is paying off with a push to create a program to provide Washingtonians with low-cost emergency insulin in less than a seven-day supply. If Senate Bill 5776 is approved, eligible people will be able to get a 30-day supply of emergency insulin for $10 per year.

“This is a great gap to fill for people who don’t have insurance or don’t have 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 transportation to emergency behavioral health providers. If passed, the bill would protect patients from out-of-network charges for such services.

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