The 2017 state legislative session began on Jan. 9, and is slated for an extended 105-day session. In recent years the legislature has returned for one or more special sessions to finish business, and by all indications, it is anticipated that they’ll do so again this year. A key driver is the requirement that they find a solution to fully meet K–12 education funding obligations.
Some expected bills will be introduced, but there will be surprises too. Here are issues we’re watching that impact our industry.
- Budget: 2017 is a budget year and the state must enact a two-year biennial budget (2017–2019) before the end of the state’s fiscal year on June 30. By 2018, the legislature must meet a constitutional obligation to fully fund K–12 as required in McCleary—the state Supreme Court-mandated increase in funding. This is the final chance for the state to address its constitutional obligation to fully fund K–12. Many believe that current funding for K–12 still falls short by up to $2 billion, but democrats and republicans disagree on the exact amount of the gap, making it difficult to find a solution. Another challenge facing budget writers is health care costs and, in particular, the rising costs of prescription drugs. The state has been particularly hard hit with hepatitis C drug costs, given the disproportionately large numbers of infected people in the state’s corrections system and on Medicaid. These budget constraints mean budget writers will look closely at all budget expenditures.
- Prescription drug cost transparency: Health plans have been struggling to manage the rising cost of specialty and generic prescription drugs. This is the second year that we will be part of a coalition that will introduce legislation increasing prescription drug price transparency.
- Prescription drug continuity: Legislation is expected that would prohibit carriers with prescription drug benefits from limiting or excluding coverage for current or new enrollees if three conditions are met:
- A specific drug was previously approved for coverage.
- The prescribing provider continues to prescribe the drug for the medical condition.
- The member continues to be enrolled in the plan that covers the drug.
Except during open enrollment, carriers with prescription drug benefits are prohibited from increasing the out-of-pocket cost for a drug if it previously had been approved for coverage.
- Balance billing: The Washington State Office of the Insurance Commissioner (OIC) has introduced a bill that would prohibit enrollees from incurring out-of-pocket expenses for emergency services delivered by out-of-network providers that exceed the amount that would be billed by in-network providers. The bill spells out how out-of-network providers must be reimbursed. It also allows for arbitration for out-of-network providers and carriers if they are unable to agree on the allowed amount of the providers’ charges.
- Washington State Health Insurance Pool (WSHIP): Legislation is expected that would remove or postpone the current 2017 sunset.