Health Care Reform in Washington: Past, Present and Future

In 2019, Washington Governor Jay Inslee, a Democratic presidential candidate, announced that he was pursuing a state "public option" for health care coverage. The idea was received nationally with some initial progressive fanfare. However, what Inslee proposed was not a true public option, but rather designating a private insurance carrier to offer a statewide policy. Compared to the evolution in progressive thinking on health care since the 2010 passage of the Affordable Care Act, with many Democrats embracing a "Medicare-for-All" single-payer system, Inslee’s proposal could be viewed as retrograde, as it would further enmesh health care consumers with private insurance. This is consistent with the play-it-safe tendencies of the Democratic party's leaders relative to its base. Washington was once a national leader on health care reform. In 1987 it enacted a first-in-the-nation Basic Health Plan for low-income families. In 1993 Washington became the only state to succeed in enacting comprehensive insurance market reforms at the time President Bill Clinton's similar effort faltered in Congress. This article examines where Washington has been relative to health care, and where it might be going. It concludes by recommending two approaches that could address the state's rapidly-rising health insurance costs and set an example for other states.