How new Washington laws aim to lower out-of-pocket health care costs
Insulin, abortions, hearing aids and cancer screenings are among the medical expenses that may soon cost less for Washington residents with health insurance.
In a session when addressing rising costs and making the state more affordable was top of mind, the Legislature this year passed a number of bills to lower out-of-pocket costs for routine screenings or equipment. Supporters say the new measures could save individuals hundreds of dollars each year, but opponents say they will make premiums more expensive for everyone.
Sen. Karen Keiser, D-Des Moines, pointed out that health care is a major cost that isn’t optional for many people. For people with diabetes, for example, insulin is a necessity. “Even with insurance, these out-of-pocket costs are a problem,” she said. “It’s too damn expensive.”
Keiser sponsored the bill that caps the cost for a 30-day supply of insulin at $35.
Rep. Marcus Riccelli, D-Spokane, who chairs the House Health Care and Wellness Committee, said the bills will have significant upsides for consumers, though he said there’s still more to do, especially on prescription drug prices. “When you add these things up, it’s helpful, but you still need to look at the total cost of care,” he said.
While the abortion legislation proved divisive, other bills drew strong bipartisan support.
Still, some lawmakers are unconvinced the slate of new laws will be helpful overall.
Rep. Joe Schmick, R-Colfax, said he wants to reduce health care costs but that lowering out-of-pocket costs and adding benefits simply leaves others to pick up the tab when paying their insurance premiums. “It’s a cost shift,” said Schmick, who is the top Republican on the House Health Care and Wellness Committee. “You’re making somebody else pay.”
He sees other downsides as well, including the potential for fewer options for consumers and less competition between carriers. “We are dictating what they’re going to cover,” he said.
In a March 16 Senate Health and Long Term Care committee hearing, Jennifer Ziegler, a lobbyist for the Association of Washington Healthcare Plans, urged the Legislature to think about how all of the cost-sharing and benefit bills together could affect premiums.
Ziegler said insurers estimated the bills in play at that time could’ve added up to $7.25 per member per month, although all of those bills did not subsequently pass.
Here’s a rundown of some of the bills lawmakers did approve.
Senate Bill 5729 caps the price of a 30-day supply of insulin at $35, effective July 23.
In 2020, the Legislature capped out-of-pocket expenses for insulin at $100 for a 30-day supply. Two years later, following the federal government’s lead, the Legislature capped the cost at $35 through 2023. Keiser’s bill removed the expiration date for the cap.
The senator acknowledged there’s still more work to be done to lower the costs of insulin and other prescription drugs. “We haven’t solved the problem,” she said.
The bill passed unanimously in the Senate and 95-2 in the House.
Senate Bill 5242 will eliminate cost-sharing for abortion in health plans that provide coverage for the procedure.
Under state law, health plans that cover maternity care or services must cover abortions. Starting next year, those plans cannot require copays for abortion services.
This bill was one of a number passed this year as Democrats sought to protect access to abortion and reproductive care.
“No one’s reproductive health decisions should be impacted by their ability to pay,” Riccelli said.
It passed the state Senate 29-19 and the state House 57-39.
House Bill 1222 requires health carriers offering large group health plans and plans offered to public employees to include certain hearing-related coverage.
Starting next year, coverage must include things such as a hearing aid, initial assessment, fitting adjustment, training and ear molds. Under the law, hearing instruments do not include over-the-counter devices. The coverage must be no less than $3,000 per ear every three years, and it is generally not included in a deductible.
The bill passed the state Senate unanimously and the state House 88-8.
Senate Bill 5396 eliminates copays for breast examinations.
It includes examinations that are used to screen for breast cancer based on an individual’s personal or family history or additional factors that increase the risk of breast cancer. It also includes those necessary to evaluate an abnormality that showed up in a previous exam.
The bill passed unanimously in the Senate, and 90-6 in the House.
House Bill 1626 requires the Health Care Authority to cover noninvasive preventative colorectal cancer screening tests under medical assistance programs. Those tests include at-home stool sample tests.
It also requires the programs to cover colonoscopies performed as a result of a positive test result.
The bill passed the House unanimously and the state Senate 39-9.