HB 2408 — Preserving access to individual market health care coverage throughout Washington state.

H-4482.1SUBSTITUTEH-3490.1HOUSE HOUSE BILL 2408State of Washington65th Legislature2018 Regular SessionBy House Health Care & Wellness (originally sponsored by Representatives Cody, Jinkins, Goodman, Johnson, Slatter, Tharinger, Stanford, Macri, Ormsby, Doglio, and Appleton)READAppletonPrefiled FIRST01/05/18. TIME 02/02/18.AN ACT Relating to preserving access to individual market health care coverage throughout Washington state;

Read first time 01/08/18.

Referred to Committee on Health Care & Wellness.AN ACT Relating to preserving access to individual market health care coverage throughout Washington state;

adding a new section to chapter 41.0548.43 RCW;

and(e) If the private market fails to provide coverage in a county, the state must intervene.(2) The legislature therefore intends to:(a) Leverage the provider networks used by private insurers offering coverage to school employees to ensure private insurance coverage is available in all countiescounties; where those insurers offer coverage to school employees;

and(b) Until such coverage is available, make coverage in the Washington state health insurance pool more affordable to persons residing in counties where no private insurance is available.NEW SECTION.  Sec. 2.  A new section is added to chapter 41.0548.43 RCW to read as follows:Forfollows:(1) planAs yearsprovided beginningin Januarythis 1,section, 2020, a health carrier offering a school employees' benefits board-approved health plan to school employees under this chapter 41.05 RCW shall offer at least one silver and one gold qualified health plan on the Washington health benefit exchange in any county wherethat thewould carriernot offersotherwise ahave schoolany employees'individual benefitsmarket board-approved health planplans, toother schoolthan employees.Sec. 3.  RCWcatastrophic 48.41.200health andplans, 2007offered c 259 s 28 are each amended to readcounty asresidents follows:(1)on Thethe poolWashington shallhealth determinebenefit theexchange.(2) standardA riskhealth ratecarrier bysubject calculatingto thesubsection average(1) individualof standardthis ratesection chargedshall forannually coveragesubmit comparable to poolthe coveragecommissioner by the fivefilings largestnecessary members,to measuredoffer ina termsqualified ofhealth individualplan marketin enrollment,every offeringcounty suchof coverages in the state.

The commissioner shall provisionally approve a health plan submitted under this section if it meets all of the requirements applicable to any other nongrandfathered individual market health plan.

A plan submitted under this subsection shall be in addition to any other individual market filings submitted by the health carrier.(3)(a) If, by the filing deadline for individual market plans, the commissioner has received no filings for individual market health plans to be offered on the health benefit exchange in a particular county other than the filings for a health plan submitted under subsection (2) of this section or a catastrophic health plan, the commissioner shall extend the filing deadline by fourteen days and notify all health carriers that have submitted filings for individual market plans in other counties that no on-exchange filings have been received for the county.(b) If, by the end of the extension period, no health carriers have submitted filings for individual market plans in the county to be offered on the health benefit exchange, other than a plan submitted under subsection (2) of this section or a catastrophic health plan, the commissioner shall notify each health carrier that has submitted filings for an individual market plan under subsection (2) of this section and approve the plan for sale in the county.(4) A health carrier whose individual market health plan is approved under subsection (3)(b) of this section shall submit the plan to the health benefit exchange for certification as a qualified health plan.

If the health benefit exchange certifies the plan as a qualified health plan, the health carrier shall offer the health plan on the health benefit exchange throughout the plan year for which it was approved.Sec. 3.  RCW 48.41.200 and 2007 c 259 s 28 are each amended to read as follows:(1) The pool shall determine the standard risk rate by calculating the average individual standard rate charged for coverage comparable to pool coverage by the five largest members, measured in terms of individual market enrollment, offering such coverages in the state.

and(ii) For a pool care management plan, one hundred ten percent of the rate calculated under subsection (1) of this section.(3)(a) Subject to (b) and (c) of this subsection:(i) The rate for any person, other than a person eligible for a rate reduction under subsection (4) of this section, whose current gross family income is less than two hundred fifty-one percent of the federal poverty level shall be reduced by thirty percent from what it would otherwise be;(ii) The rate for any person, other than a person eligible for a rate reduction under subsection (4) of this section, whose current gross family income is more than two hundred fifty but less than three hundred one percent of the federal poverty level shall be reduced by fifteen percent from what it would otherwise be;(iii) The rate for any person who has been enrolled in the pool for more than thirty-six months shall be reduced by five percent from what it would otherwise be.(b) In no event shall the rate for any person be less than one hundred ten percent of the rate calculated under subsection (1) of this section.(c) Rate reductions under (a)(i) and (ii) of this subsection shall be available only to the extent that funds are specifically appropriated for this purpose in the omnibus appropriations act.(4) The rate for any person eligible for pool coverage under RCW 48.41.100(1)(a)(i) shallwho be reduced as follows:(a) The rate for a person whose current modified adjusted gross income is lesseligible than or equal to two hundred percent of the federal poverty level must be reduced by eighty percent from what it otherwise would be;(b) The rate for aan personadvance whosepremium currenttax modifiedcredit adjustedunder gross26 incomeU.S.C. is more than two hundred percent, but less than or equal to three hundred percent of the federal poverty level must be reduced by sixty percent from what it otherwise would be;(c) The rate for a person whose current modified adjusted gross income is more than three hundred percent, but less than or equal to four hundred percent of the federal poverty level must be reduced by fifty percent from what it otherwise would be;

and(d)Sec. The rate for a person whose current modified adjusted gross income is more than four hundred percent of the federal poverty level must be reduced by thirty percent from what it otherwise would be.Sec. 4.  RCW 48.41.090 and 2013 2nd sp.s.

36B shall be reduced by the average amount of the advance premium tax credit a person with the same modified adjusted gross income would receive in counties within the same geographic rating area.

If no qualified health plans are available in the same geographic area, than the amount of the reduction must be the average amount of the advance premium tax credit a person with the same modified adjusted gross income would receive statewide.Sec. 4.  RCW 48.41.090 and 2013 2nd sp.s.