(Washington state has been granted a waiver to federal law allowing the state to offer health insurance under the Affordable Care Act to noncitizens who are not lawfully residing in the United States.)
The waiver from the Department of Health and Human Services and the Department of the Treasury allows Washington to suspend a portion of the ACA and extend access to health insurance to some 105,000 Washington residents who are currently ineligible due to their immigration status, according to a statement from Washington Health Benefit Exchange.
“We appreciate the federal government’s recognition of our effort to expand our successful state-based marketplace,” Gov. Jay Inslee said in a statement.
“This waiver is an important step toward providing affordable health insurance coverage for all Washingtonians,” he continued. “Access to health care not only helps strengthen families, it also improves our overall health care system and our state economy.”
Centers for Medicare & Medicaid Services Administrator Chiquita Brooks–LaSure also praised the move.
“Health care should be accessible, affordable and delivered equitably to all. We are pleased to approve Washington’s Section 1332 waiver to expanded coverage and access to qualified health plans,” she said in a statement.
The expanded coverage will bring additional public spending, though experts disagree on the overall impact on taxpayers.
Chris Pope, a senior fellow at the Manhattan Institute, previously told The Center Square that the annual price tag depends on several factors but could reach $1 billion per year.
The cost depends on the income level of enrollees, Pope told The Center Square by email, and whether subsidies financed through the American Rescue Plan Act are renewed and available to noncitizens. Pope added that for 2020, the Congressional Budget Office estimated $53 billion in subsidies for 9 million enrollees, which would be just under $6,000 per enrollee.
If that were the average subsidy per capita for this new pool of an estimated 105,000 new enrollees, the cost to taxpayers would be a little less than $630 million annually.
However, Pope believes the “per capita amount would probably be higher” in Washington state. He estimated the final price tag would be around $1 billion per year.
Washington Health Benefit Exchange spokeswoman Shawna Crume–Bruce disputed Pope’s cost estimate, telling The Center Square that the state Legislature appropriated $5 million per year in new state funding for the waiver population and other low-income residents.
Given an increase in enrollment of up to 105,000 people, that would allow a subsidy of $47.62 each.
Crume–Bruce went on to explain the waiver will also allow newly eligible individuals and families up to 250% of the federal poverty level—the amount of annualized income earned by a household, below which they would be eligible to receive benefits—who are not getting any federal subsidies to take part in Cascade Care Savings, the state’s new premium assistance program.
“The $5 million is divided among them,” Crume–Bruce said.
The goal of the state’s effort to provide health insurance to undocumented immigrants is to lower uncompensated care, she said, which will bring down costs for everyone—with the exception of U.S. taxpayers who will cover the cost of the subsidies.
Elizabeth Hovde of the Washington Policy Center worries about what this change will make to health care in Washington.
“Extending subsidies to undocumented immigrants is another step toward government-run health care, which is a state goal,” she told The Center Square in an email. “But when we make more people dependent on taxpayer-financed health care—in this and other ways—it increases the costs and can weaken the system for others.”
Hovde said illegals should instead continue purchasing their insurance plance through the private market.
In addition to the extra burden on the health-care system, the free services will make Washington state a welfare magnet for undocumented people who anticipate high medical bills,” she warned, even as Seattle, Spokane and other parts of the state continue to deal with a serious epidemic of homelessness and vagrancy.
“In the bigger picture, health care is a need we all have,” Hovde said. “We need more people prioritizing it and devoting money to it in their budgets—not more people dependent on taxpayers.”
The waiver will be in effect for five years, from Jan. 1, 2024, through Dec. 31, 2028.
Washington’s request is known as a State Innovation Waiver, also called a 1332 waiver. These waivers have been available since 2017 and are intended to allow states to “pursue innovative strategies for providing residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA,” according to the CMMS website.
Washington is the 14th state to be granted a 1332 waiver.