Health care and economic security of Washingtonians at risk

By Monica R. McLemore, Hiroshi Nakano and John Schapman

Since the inception of the Affordable Care Act, state-based marketplaces, such as Washington Health Benefit Exchange (one of 21 nationwide), have provided access to health insurance coverage for millions of people who would not otherwise afford it or receive it through their employer. These ACA plans help ensure that Washingtonians have better overall health and economic security, which is good for everyone in our state and our economy. And it has made a difference.

Prior to the ACA, the uninsured rate in Washington was 15%. Now more than a decade later, it is less than 5%.

Yet, the stability of our health care system and the economic security of millions of Washingtonians are at great risk with proposed congressional changes to state-based marketplaces. If enacted, it is estimated that up to one-third of people with coverage under ACA plans could lose their health insurance.

Those are not just numbers. Behind those numbers are working parents, small business owners, farmers and entrepreneurs, those who have multiple jobs to make ends meet, as well as early retirees who don’t yet qualify for Medicare, and lower - and middle-class people of all ages and backgrounds.

If Congress is successful in implementing these proposed cuts, Washington will be unhealthier, less financially secure and see additional pressure on an already strained health care system. These risks to our health care system are exacerbated by proposed deep cuts to Medicaid and the impending expiration of federal enhanced premium tax credits, which help make coverage more affordable.

To be clear, access to health insurance is not a partisan issue – it helps people on all sides of the political spectrum. As bipartisan members of the Washington Health Benefit Exchange Board, we are Republicans and Democrats. Our mission is to provide access to health insurance options through our state-based marketplace. Not only is this the right thing to do for our communities, but it makes our state healthier, stronger and more economically competitive.

The “One Big Beautiful” bill now being considered in the Senate could have serious consequences for families in Washington and across the country. If passed, it would take away affordable health coverage from millions of people who rely on ACA plans today. It would make it much harder to sign up for and keep health insurance, just as costs for everyday needs like food and gas continue to rise. The bill would also limit the ability of states like Washington to run their own health insurance marketplaces by adding new federal restrictions. Finally, it would reduce federal tax credits that help make insurance more affordable, effectively raising costs for consumers.

These proposals would undermine progress on health coverage that Washington and other states have made in the past decade via state-based marketplaces. These proposals do not help the people who need it, or the health systems, such as rural hospitals and clinics, who face unprecedented financial strain. These proposals will not help our already strained state budget, as they will reduce federal assistance coming to our state and increase state costs of covering the uninsured. These proposals will threaten the stability of our Exchange and the availability of private insurance plans to serve customers in all parts of our state.

Congress should reject these proposals and support what’s already working – helping more people access affordable, private health insurance. As we’ve demonstrated in Washington, the state-based marketplaces are an effective and valuable way to do just that.

Monica R. McLemore, Ph.D, MPH, RN, FADLN is board chair of Washington Health Benefit Exchange and a professor at the University of Washington School of Nursing and a visiting professor at Rory Meyers School of Nursing at New York University.

Hiroshi Nakano, MBA is a member of the Washington Health Benefit Exchange Board of Directors.

John Schapman is a member of the Washington Health Benefit Exchange Board of Directors and executive Director, Thriving Together NCW in Wenatchee.