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Universal Health Care Commission

In 2021, Washington state took the lead by creating the Universal Health Care Commission.

The purpose of the commission is to:

  • Create immediate and impactful changes in the health care access and delivery system in Washington.
  • Prepare the state for the creation of a health care system that provides coverage and access for all Washington residents through a unified financing system, once the necessary federal authority has become available.
  • Submit a baseline report by November 2022.

Our impact:

  • We actively support the work of the UHCC through our relationships with allied organizations and UHCC members.
  • We recommended five of the six public members of this 15-member body, including the Chair, Vicki Lowe. Click here to learn more about Commission members.
  • We submit live and written public comments.
  • We encourage our members to tell their personal stories.
  • We provide links and updates and recaps of the meetings.

Meet the Commission members at our 2nd Wednesday Speakers Series.


Universal Health Care Commission 

HCA Universal Health Care Work Group 2021

The Latest

FTAC Meeting 2: Transitional Solutions, Medicare Questions, and Lessons from the Indian Health Care Delivery System
By Marcia Stedman

If the devil is in the details when it comes to funding universal health care, members of the FTAC (the Committee) showed they were ready to deal with the ogre in the room. At meeting #2, they tackled two important topics: sorting through transitional solutions to achieve the goal of universal health care and discussing options for including Medicare enrollees in Washington’s universal health care system. They also heard a solution-packed presentation on Washington’s Indian Health Care Delivery System

1. Transitional Solutions Toward Universal Health Care

Consolidated purchasing for state programs generated the widest-ranging discussion and general agreement that this solution be recommended to the full UHCC (the Commission) for further study. Because the state currently controls 30 percent of the insured market through the Medicaid, Exchange, and Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) benefit programs, this would be a high-impact (although somewhat resource-intensive) solution that would prepare Washington for a universal health care system. 

Auto-enrollment of those not eligible for Medicaid to the no-premium plans on the Health Benefits Exchange. Currently being done in other states, this high-impact and less resource-intensive solution also generated interest, particularly as the end of the public health emergency will result in many Washingtonians losing their Medicaid coverage within the next six months.  

Out-of-network price caps on providers is another high-impact and less resource-intensive solution that has led to lower in-network reimbursement rates in other states.

Regulated hospital global budgets would have the highest impact of the solutions discussed, but would be resource-intensive due to the current fractured payment system and the political challenge of obtaining the necessary legislation.   

2. Medicare: To Include or Not To Include?  

The Committee had plenty of questions:

  • How would Washington even do this, absent a consolidated system?
  • What cost/benefit analysis is needed? 
  • How would payment work? What would the benefits be? Would it be feasible?
  • Would this be a state plan, contracted through a managed-care organization? 
  • Would it be offered as an option to current Medicare patients?
  • Can we afford it?
  • Can we get per-capita trend data?
  • Can we pursue a waiver at this time?
  • Should we take Medicare off the table?

In the end, the Medicare question seemed a bit like a hot potato lobbed between the full Commission requesting options for including it in our state plan and the FTAC needing direction from the Commission around its vision for the system and benefit design.  Clearly, this topic needs further discussion, especially because it threatens to drain energy away from developing an achievable system that works for everyone who is not yet on Medicare. This topic is sure to be on the agenda for the next FTAC meeting on Thursday, May 11, 3-5 p.m. and at the upcoming UHCC meeting on Tuesday, April 11, 2-4 p.m.

3. Washington’s Indian Health Care Delivery System Is a Universal System

During this discussion, which was sandwiched between the transitional solutions and Medicare discussions, Vicki Lowe, Executive Director of the American Indian Health Commission (AHIC) and Chair of the Universal Health Care Commission, explained that by enrolling all tribal members in the state’s Medicaid program and providing wrap-around services as needed, they can deliver the same quality of affordable healthcare to all enrollees, regardless of age, income, or employment status. There are challenges, notably around funding, but this model can inform the Committee’s work and help our state achieve its goal of affordable, high-quality healthcare for every Washington resident.

Following are the meeting materials and a video recording of the meeting:

Mark your calendar for these upcoming meetings:

  • FTAC - Thurs., May 11 - 3-5 p.m.
  • UHCC - Tues., June 13 - 2-4 p.m.

Got comments to share with the FTAC or the UHCC? Get Engaged!

All UHCC and FTAC meetings are open to the public, and public comments are encouraged. Sign up to provide public comment during a meeting by 5 p.m. the day before the meeting. If you want your written comments to be included in an upcoming meeting, email your comments two weeks before that meeting by contacting the Health Care Authority (HCA) at any time. Subscribe here to receive meeting notices in your own inbox

Read past recaps:

Other Boards and Commissions

Health Care Cost Transparency Board

Total Cost of Insulin Work Group

Take action: Attend upcoming UHCC and FTAC meetings and add your voice

The UHCC and FTAC meet every two months on Zoom. Meetings are open to the public and your voice is needed.

Mark your calendar:

  • FTAC - Thurs., May 11 - 3-5 p.m.
  • UHCC - Tues., June 13 - 2-4 p.m.

To view UHCC and FTAC meetings materials and to receive updates, see the following resources:

Connect with us

Stay informed about our work. Join our email list to receive action alerts, e.Bulletins, and meeting recaps.

Our challenge

Overview of Models A, B, and C developed from the UHC Work Group.


Model A

  • State administered health care that covers everyone
  • Most cost effective saving
    • $1.56 billion statewide the 1st year
    • $5.5 billion each year after

This is the system that HCFA WA has been advocating for years

Model B

Privately administered by health insurance companies that cover their enrollees limited reduction in administrative costs, saving approximately $783 million the first year.

Model C

  • Privately administered
  • Covers the currently uninsured including undocumented immigrants
  • Would cost the state $617 million in the first year.

Click here to learn more about these models at the Health Care Authority.

Assessment criteria

Each model was assessed by the following criteria

  • Access:
    • comprehensive medically necessary health care for everyone.
  • Equity:
    • quality care for everyone.
  • Governance:
    • transparent, accountable and highly responsive governance that includes Tribal Sovereignty
    • patient voices to ensure person-centered care
  • Quality:
    • measurable improvements and transparency
  • Affordability:
    • affordable to consumers, health care professionals and the state.
  • Administration:
    • manages costs effectively and drives out waste.
  • Feasibility:
    • politically, financially, and administratively achievable system.

Lack of political will

Even though Model A surpassed the other models in 6 of the 7 criteria, it was found to be the least feasible politically even though it saved the state millions in administrative and real costs.

What they mean by least feasible is a lack of political will.

This is our challenge!

Add your voice to make universal health care feasible for all Washingtonians.

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