Insurance coverage

State Moves to Expand Health Insurance Coverage for All Residents Regardless of Immigration Status

Elise Takahama / The Seattle Times

Washington has taken a major step toward extending health and dental insurance coverage to nearly all residents, especially those who are undocumented.

The Washington Health Benefit Exchange, the state’s health insurance marketplace, submitted a waiver request Friday that, if approved, allows states to circumvent or modify certain requirements of the Affordable Care Act. If the federal government greenlights the waiver in the coming months, thousands more Washingtonians will be eligible for new health and dental benefits starting in 2024, the exchange said in a statement this week.

“Since the introduction of the Affordable Care Act, we have paved the way toward providing health insurance coverage to all Washingtonians,” Governor Jay Inslee said in the statement. “This waiver comes at an important time in our healthcare journey and its approval would strengthen our ability to provide equitable access to historically marginalized and uninsured populations.”

If the waiver is approved, the state could become one of the first in the country to offer full benefits, regardless of immigration status.

About 2 million Washingtonians currently receive health care through the exchange, said Michael Marchand, the market’s chief marketing officer. Under the ACA, undocumented immigrants (except pregnant women and children) are not eligible to purchase health coverage through, an online tool administered and operated by the exchange.

The waiver would expand access to more than 105,000 people — about 23% of the state’s total uninsured population — depending on the application.

“We hear far too many stories of people putting off care because they don’t have insurance until it becomes a huge financial and health burden for them,” Marchand said. “And then they end up using the emergency room as a primary care physician, which ultimately is actually more expensive for all of us.”

The federal government has approved waivers from several other U.S. states, including Oregon, Colorado, Alaska, Montana, Georgia, Pennsylvania and Maine, though none of the requests are related to state status. immigration, according to a 2020 report from the Kaiser Family Foundation.

In 2016, California asked to expand access to health coverage for undocumented immigrants, but state lawmakers withdrew the request the following year because they feared the Trump administration would use information of the plan to evict the residents, Kaiser Health News reported.

Plans to submit the waiver had been in place since last year, when the state legislature ordered the exchange to explore different coverage options for those who do not qualify for state health insurance. or federal. In the past, the Centers for Medicare & Medicaid Services has also encouraged states to take advantage of the “flexibility” of Section 1332.

In Washington’s request, the state asks to waive a particular section of the ACA that prohibits undocumented immigrants from purchasing health insurance through Healthplanfinder.

The application is now in the hands of the US Department of Health and Human Services and the Treasury Department, which will determine whether the coverage offered under the waiver is “comprehensive, affordable, results in coverage gains and does not increase the federal deficit,” the statement read.

The waiver would also take advantage of publicly funded affordability programs that help reduce premium costs for customers, in addition to increasing access to Cascade Care Savings, the new premium assistance program for the state which is expected to open this fall.

“There are many in our state who have never had the good fortune to purchase health insurance,” exchange CEO Pam MacEwan said in the statement. “This waiver gives these individuals a chance to obtain meaningful health coverage for themselves and their loved ones.”

The federal government has up to 45 days to consider the request, before holding a month-long public comment period. He then has up to 180 days to respond to the request, although the state sought approval in early August.

“Over time, we’ve seen more and more requests to focus on specific populations to reduce the overall number of uninsured people in Washington state,” Marchand said.

Although the state has been busy for the past two years making sure people who lost their jobs during the pandemic don’t fall through coverage gaps, Marchand said it was exciting to submit the application. of derogation and possibly to open doors to a “population that, in the past, has been forgotten. »