Bill would let state exchange add market-factor plan criteria to protect access and affordability; witnesses split

Senate Bill 6210, presented Jan. 22, would permit the Washington Health Benefit Exchange to establish a new market-factor certification criterion for qualified health plans to address county-level access and affordability problems.

Greg Attenasio briefed the committee on the proposal, which would allow the exchange to adopt one or more market-factor criteria each year after consulting the Office of the Insurance Commissioner and the governor, holding notice-and-comment and at least one public hearing, and publishing final criteria before the plan year to which they apply. For plan-year 2028 the bill specifies a more formal development timeline; carriers may request waivers from criteria under defined conditions.

Supporters — including Ingrid Ullery (CEO, Washington Health Benefit Exchange), Senator Karen Kaiser (board member), AARP, patient-advocacy groups and navigators — told the committee the authority is needed to address counties with no on-exchange plans (so-called 'bear' counties), to preserve consumer choice and to require a meaningful range of premium options in some markets. Proponents said the tool is used in other states and can be implemented with guardrails, including waiver and governor/OIC review.

Opponents — including the Association of Washington Healthcare Plans, Premera, Coordinated Care and Regence/Blue Shield — warned the bill would expand exchange authority without clear limits, risk carrier exit, and could shift costs if carriers are required to serve counties with concentrated provider markets. Insurance regulators (Office of the Insurance Commissioner) testified pro with requested clarifying amendments around timing and disclosure of rate information.

The hearing produced detailed exchanges on San Juan County as a case study, timing of rate filings, and whether rate information should be shared with the exchange before it is filed with OIC. The committee closed the hearing after receiving broad testimony for and against the bill.

Next steps: Committee will consider amendment language and fiscal/administrability questions before further action.