Washington Legislature Considers Affordable Health Option

Cascade Care will lower cost and preserve quality and choice

Washington legislators are considering a plan to make health care more affordable to families and individuals who struggle to pay premiums, then face a high deductible when they need medical care.

Jed Whittaker, a Kitsap father of two and small business owner, shared his family’s dilemma at a hearing for Cascade Care, House Bill 1523, held by the House Health Care and Wellness Committee on January 30. His 5-year-old son has hemophilia, a rare genetic blood disorder that requires expensive treatment and medication. The family pays $9,000 a year in insurance premiums, even with federal subsides offered through the Washington Health Benefit Exchange, and must pay an additional $13,000 in deductibles.

Every month Jed’s family is faced with a harsh reality: maintain his son’s health and place the family’s other needs on the back burner. They prioritize all of their income toward his son’s medical care. The recent growth in his business means that next year they will lose federal subsidies for insurance and will likely have to pay 18 percent of their income on insurance alone.


Stories like Jed’s are far too common. Individuals and families live in fear of being injured or falling ill because they can’t afford to see the doctor or pay their deductible. They scrimp and save to purchase insurance, but can’t actually use the coverage when necessary because of steep out-of-pocket costs. Statistics show that many people are starting to drop insurance coverage altogether.

Cascade Care will lower the cost and eliminate the guesswork of shopping for affordable and high-quality insurance coverage by creating a new standard plan which will reduce deductibles and provide more services before those deductibles kick in. It shifts the health care delivery system to focus on healthy outcomes and evidence-based best practices.

Cascade Care leverages federal subsidies and requires the Health Care Authority to develop a study to fund additional premium subsidies for lower- and middle-class families. By 2021, all insurance carriers on the Exchange must offer standard plans, and by 2025, only standard plans will be available on the Exchange. Oregon, California, and a number of other states already offer similar plans.

Despite the clear need for these reforms and the support of many health care providers and policy experts, some providers and industry groups testified in opposition to the cost containment measures of Cascade Care.

House Bill 1523 addresses soaring health care costs for Washingtonians while creating a viable pathway to universal coverage. The House Health Care & Wellness committee has scheduled a vote on the Cascade Care bill next week on February 6.

You can share your views with the committee members through this link.

  • Leave a Reply
    • Patricia Sims

      How will this bill be funded? That wasn’t entirely clear to me. Will a clear cost analysis and the potential tax burden be submitted as well?

      Feb 3 2019 at 9:56 AM

    • Patricia Sims

      Will a complete cost analysis be submitted along with the routes for possible funding? If doctors are reimbursed at Medicare like rating (which is lower than traditional insurance) will there be enough physicians to take on patients enrolled under Cascade? Is there a possibility that hospitals and doctors will drop patients that are enrolled in this plan due to the reduced compensation?

      Feb 3 2019 at 10:01 AM

    • Ashley Sutton

      The bill requires the Health Care Authority to both study the costs and develop a plan to fund additional subsidies. Next year, the legislature will have to make additional decisions about how much funding to allocate based on that study. Even if the Legislature appropriates no additional funding, Cascade Care will lower premiums and deductibles for individuals and families by capping costs. The plan design limits the amount carriers and providers can charge patients and will add more services before reaching deductibles. It shifts the system to focus on outcome driven care, while creating predictable cost sharing. Governor Inslee has allocated $500,000 in startup funding for the 2019-2020 budget, but Cascade Care poses no immediate costs to tax-payers.

      Medicare rates (70% percent higher than Medicaid) will boost access to primary care and reduce uncompensated care which benefits the entire medical system.

      Feb 8 2019 at 11:51 AM

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