Opinion: 2023 Legislature on health care – What passed? What didn’t?

Elizabeth Hovde of the Washington Policy Center offers a recap of 2023 health care legislation

Elizabeth Hovde
Washington Policy Center

Some longtime Washington Policy Center solutions made it across the finish line this legislative session. Victories for Washingtonians came in the form of failed legislative attempts, too.

Among the spoils

— Senate Bill 5499 paves the path for Washington state to join 37 other states, Guam and the U.S. Virgin Islands in the Nurse Licensure Compact (NLC).

This allows qualified, licensed, background-checked nurses to move freely about the country with their careers intact and without state licensing barriers. Eliminating licensing delays can get nurses to work quickly when they relocate to Washington state or simply come help us out in nursing shortages or pandemic times.

Paula Meyer, executive director of the state’s Nursing Care Quality Assurance Commission, told me in March that she has supported the compact for more than 25 years. Legislatures haven’t, unfortunately.

For years, key lawmakers have listened to opposition to the compact from the Washington State Nurses Association. Now, and after COVID-19, lawmakers finally agree with the NCQAC, Washington Policy Center and a slew of states and health associations that patient-centered care and access should take center stage in this fight.

An implementation process now needs to be completed before multistate license holders can practice here. Read more about that from the National Council o f State Boards of Nursing. And read more about the value of belonging to the NLC in my policy paper, “Joining 37 other states in the Nurse Licensure Compact is one of the ways to help Washington patients, nurses and hospitals.”

— Also helping the health care workforce in Washington state were scope-of-practice expansions that emphasize adequate training. Several bills passed this session, including House Bills 1039 and 1073 and Senate Bill 5389. They could help patient concerns and advance workers’ careers.

Another scope of practice bill, House Bill 1041, died. It should be strongly considered again next session, as should a bill that eases credentialing of certified health care professionals providing long-term-care services (HB 1568).

— More good news came wrapped in SB 5582, which will work to reduce barriers and expand educational opportunities to increase the supply of nurses here through multiple ways. Expanding the nurse pipeline is imperative. In a graying population, the nurse workforce is aging and retiring at the same time there are more people in need of care.

— Senate Bill 5103 was an encouraging bill that passed and will require the state to pay more of its way for Medicaid patients that are difficult to discharge from hospitals. The state cannot continue to take responsibility for patients that it then doesn’t reimburse medical facilities for adequately. The costs are often pushed off onto private payers.

Several misguided policies rightly died in the session

— It was good to see the death of House Bill 1094. Senate Democrats said the legislative proposal “seeks to break the cycle of generational poverty by making a one-time deposit of $4,000 into an account for each baby in Washington born into poverty.” In 2020, 37 percent of births were financed by Medicaid. In a committee hearing, I heard the percentage of children eligible for Medicaid in their first year now is even higher.

Even if the transfer of $4,000 taxpayer dollars set aside for people born into poverty was enough to bring and keep a person out of poverty (it isn’t), it’s not healthy or wise to suggest to Washingtonians that if once poor, you’re always going to be poor. It’s also not accurate to think that if a person is born into economic security, he or she stays there forever. We need safety nets for people in need, not money going to people not in need.

— Bills related to the state’s continual push to enact taxpayer-financed health care, Senate Joint Memorial 8006 and Senate Bill 5335, failed. That would be as exciting to me as the bill allowing us to join the Nurse Licensure Compact, if it weren’t for the strong possibility the bills will be back.

The state’s taxpayer-financed health care push will carry on. In fact, the state’s Universal Health Care Commission has already agreed to analyze SB 5335, hoping to draw from proposals in the failed legislation. I hope the commission and legislators spend as much time looking into free-market health care successes around the country as they do considering having all of us dependent on fellow taxpayers for health care financing.

Even if taxpayers wanted new, substantially higher taxes instead of insurance premiums, the pattern of universal, government-run health care is the rationing of medical care. Some patients are denied care to save money. Patient-centered health care is not the priority, as limits on medical services are imposed by governments. It’s better to keep medical decision-making between doctors and patients.

— This one was ridiculous — and telling. Senate Bill 5767 was introduced late and after the Washington state Supreme Court’s majority got it wrong declaring a capital gains tax an excise tax, instead of an income tax, skirting the state Constitution and ignoring voters in Washington state.

SB 5767 would impose an “excise tax” on hospitals for what some lawmakers deem “excess compensation” paid to hospital administrators. The sponsors of the bill believe hospitals pay administrators too much, and they want to stop that.

SB 5767 was a statement-making bill that could become a serious contender. And it could have an impact not just on individuals’ pay opportunities but on the health care system as a whole. I wonder if sponsors have thought through the possible implications such a tax would have on the quality of care and business acumen at Washington’s hospitals if hospitals need to pay administrators less than administrators are paid in other states or face a tax.

Yikes is right.

A few random bills that passed are harmful

— SB 5242 eliminated cost-sharing for abortion. The bill that has been signed into law means that health insurers cannot require anyone seeking an abortion to pay a copayment. (I wonder how cancer patients, parents of accident-prone kids or numerous other people needing health care services feel about that. Copays are numerous for many and add up.)

Regulations drive up health care costs. Unfortunately, this misguided one rode the wave of pro-abortion fever in Washington state after the U.S. Supreme Court’s landmark Dobbs decision in 2022. The court returned decisions regarding abortion regulations back to the states.

— Senate Bill 5599 is among the worst of the bills passed by the 2023 Legislature. It’s related to the health of children in our state and beyond our borders. I hope the governor will not sign it. He hasn’t yet.

The bill’s passage allows minors to be in youth shelters or “host homes” without proper parental notification if they are seeking gender transitions or abortions.

Cutting parents out of children’s life-impacting health care decisions is harmful and contradicts other Washington state laws. It won’t end well for many children who get trapped in this law in a state that is claiming it is helping them make decisions we tell them they are too young to make in other circumstances. Insisting the state cares and knows more about a child’s individual needs than his or her parents do — and that it is a better guide through them — is insulting and beyond invasive.

That’s a wrap

This recap of 2023 health care legislation is by no means exhaustive. And with numerous challenges in our health care system, I expect my bill-watchlist next session will be just as long.

Throughout the year, I plan to highlight some solutions that lawmakers and society members don’t even know to look at. There are innovations all around the nation that provide people with affordable access to health care. The choices don’t have to be between the hybrid system we have right now and socialized health care.

Elizabeth Hovde is a policy analyst and the director of the Centers for Health Care and Worker Rights at the Washington Policy Center. She is a Clark County resident.