House releases budget, overall positive for health care

March 25, 2019

Earlier today, the House released its proposed 2019-21 budget. Overall, this is a positive budget for health care and hospitals. We expect the Senate’s budget to be released either later this week or early next week.

The big picture highlights of the House budget include:

  • There are no cuts to health care or hospitals, including no cuts to Medicaid nor hospital-based clinics.
  • Hospital Safety Net Assessment funding was included in a manner that WSHA supports.
  • There are significant investments in behavioral health, including operating and capital funding to support increasing capacity for long-term civil commitment services.
  • WSHA has been working to improve funding for difficult-to-discharge patients who are stuck in hospitals waiting for an appropriate post-acute setting.
    • WSHA is pleased to see increased funding for community services for patients with developmental disabilities.
    • WSHA is still tracking down budget details on increased funding for dementia patients contained in the budget. The majority of this funding is for patients discharging from the state psychiatric hospitals. It is unclear at this time if this will assist community hospitals.
  • WSHA is disappointed the House does not include funding for partial hospitalization programs.
  • An investment of $115 million in capital funds for behavioral health capacity. Of this amount, $31.9 million is earmarked to three community hospitals to help increase their capacity to serve long-term civil commitment patients. There is also $40 million for competitive grants for facilities seeking to increase behavioral health capacity.
  • While WSHA is still checking, we do not believe the B&O tax referenced below applies to hospitals. The rate increase does not apply to employed physicians but would apply to contracted or independent physicians.

The House’s proposed budget seeks to spend $52.6 billion over the next two years — an increase from the $45.8 billion that was spent in the last budget from 2017-19. A significant driver of this spending is the almost $5 billion cost of the McCleary decision, which impacts the budget this year. Given that revenue for the upcoming biennium falls short of the $52.6 billion price tag, the House seeks to pay its bills by raising new revenue. It assumes new revenue from a new capital gains tax, an increase to the business and occupation tax rate for select activities and moving the real estate excise tax from a flat tax rate to a graduated rate. This new revenue is estimated to generate about $980 million in 2019-21 and $2.2 billion in 2021-23.

Click here to read the budget details

High-priority bills up for hearings this week

SHB 1155: Nurse staffing and nurse fatigue legislation

SHB 1155, mandating uninterrupted meal and rest breaks and restricting overtime and on-call, passed the House and is already moving in the Senate. WSHA is very concerned about the impacts this bill would have on patient care. The bill will be heard Tuesday, March 26 in the Senate Committee on Ways & Means.

Tell lawmakers that you oppose rigid staffing legislation that can harm patient care. (Lauren McDonald)


SSB 5385: Telemedicine payment parity

WSHA supports SSB 5385, which requires health plans to pay the same rate for health care services provided through telemedicine as an in-person service. The bill allows hospitals, hospital systems, telemedicine companies and provider groups of 11 or more providers to negotiate and agree to reimbursement rates for telemedicine services that may be different form the reimbursement rate for in-person services. In addition, the bill removes the current requirement that there must be an associated office visit with the referring provider if services are provided through store and forward technology.

The bill will be heard Tuesday, March 26 in the House Committee on Health Care & Wellness, and it is scheduled for an executive session in the committee the following day. Read more from the March 14 edition of Inside Olympia. (Shirley Prasad)


ESSB 5526: Public option health plans

ESSB 5526 would allow Washingtonians the option to purchase lower-costing health insurance coverage on the Health Benefit Exchange (the individual market). This bill will be heard on Tuesday, March 26 in the House Committee on Health Care & Wellness and is scheduled for an executive session in the committee the following day.

Given the national political momentum surrounding Medicare for All, many Washington State lawmakers view establishing a public option health plan as an alternative way to make health care more affordable. In this Senate bill, the Health Care Authority is directed to negotiate and selectively contract with carriers to offer a public option plan.

Unlike the House bill (E2SHB 1523, which WSHA opposes), ESSB 5526 does not require hospital and provider reimbursement rates in the public option plan to be set at Medicare rates or lower. Rather, the goal of negotiations is to reduce premiums below the average premiums for similar metal tier plans during the current (2019) plan year. Also, hospital and provider participation in a public option health plan network continues to be voluntary rather than mandatory. (Shirley Prasad)


E2SSB 5483: Transitioning developmentally disabled patients out of hospitals

WSHA supports E2SSB 5483, which institutes regulations to track when developmentally disabled patients are hospitalized without medical need and requires the Developmental Disabilities Administration to provide crisis stabilization services before a developmentally disabled patient is discharged. It also requires the Developmental Disabilities Administration to coordinate a patient’s transition to a more appropriate care setting and coordinate reimbursing hospitals that care for these patients. This bill will be heard on Wednesday, March 27 in the House Committee on Human Services & Early Learning. (Zosia Stanley)


ESSB 5295: Concerning labor neutrality and contractor compliance for certain contracted service providers

WSHA opposes ESSB 5295, which would require contractors of the Department Social and Health Services (DSHS) who provide adult care, behavioral health, disability support or youth services to provide “assurances” relating to labor relations to avoid service delivery disruption. If the assurances were not met, and services were disrupted, that would be grounds for DSHS to revoke a contract. The problem is that the enumerated assurances are preempted by the national labor relations act. WSHA opposes ESSB 5295 because of this legal issue, which would trigger expensive, lengthy court battles and create a chilling effect on the development of these badly needed services for vulnerable populations. ESSB 5295 was heard earlier today in the House Committee on Labor & Workplace Standards. (Jaclyn Greenberg)

WSHA Legislative Testimony: March 25-29

WSHA is testifying on the following bills this week:

Monday, March 25: 

  • House Labor & Workplace Standards 
    • ESSB 5295 (see labor neutrality and contractor compliance article above, Jaclyn Greenberg)

Tuesday, March 26: 

  • House Health Care & Wellness 
    • SSB 5385 (see telemedicine payment parity article above, Shirley Prasad)
    • ESSB 5526 (see public option health plans article above, Shirley Prasad)
  • Senate Ways & Means 

Wednesday, March 27: 

  • Human Services & Early Learning 
    • E2SSB 5483 (see developmentally disabled patients article above, Zosia Stanley)


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