Bill would let Health Benefit Exchange set annual market-factor criteria to shore up county coverage
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Summary
ESSB 62 10 would authorize the Washington Health Benefit Exchange to develop annual market‑factor certification criteria (meaningful differences, provider networks, premiums, formularies) and to convene stakeholders in counties at risk of being left with one carrier; sponsors say it’s a tool to stabilize rural access without immediate budget costs.
Sen. Slatter presented ESSB 62 10, telling the committee the bill responds to falling plan choice in parts of the state, particularly San Juan County, where two carriers have left the marketplace and only one carrier remains in some product tiers. "Coverage is disappearing in parts of our state," she said, and the bill gives the Exchange authority to consider access and affordability during plan certification to ensure options such as bronze plans remain available.
Kim Weidner (committee staff) and Ingrid Ulrey, CEO of the Washington Health Benefit Exchange, explained the mechanics: each year the Exchange would review market conditions and may adopt objectively defined, measurable market-factor criteria by January 31 (proposed) and final criteria by March 1; carriers may request waivers; and certain criteria may be confidential. Ulrey said enrollment is down by about 20,000 compared with last year and that the Exchange needs new tools to stabilize the marketplace.
Supporters — including consumer advocates, tribal health representatives, brokers, and patient groups — urged passage to protect rural access and consumer shopping simplicity. Opponents, including carriers, coordinated care plans, and the Association of Washington Healthcare Plans, warned the timeline is unrealistic for carriers to implement plan design changes for 2028, that annual changes could destabilize markets, and that more clarity is needed on the definition and application of "meaningfully different." Hospitals asked for removal of language that would tie a hospital contracting threshold to the Exchange's county response.
The committee heard robust Q&A on how "meaningful difference" would be defined, waiver processes, and potential enforcement pathways. Public testimony closed at the end of a multi‑hour panel and the bill moved toward later committee consideration.