Health care reform

The Affordable Care Act (ACA)

The ACA became law in 2010 to increase the quality and affordability of health insurance. It has brought major improvements to our health care system, giving millions of Americans access to high-quality, low- or no-cost health care coverage.

In Washington, health care reform has allowed more than half a million adults who were previously uninsured to enroll in Apple Health (Medicaid). In addition, the Washington Health Benefit Exchange was created to offer affordable health and dental insurance coverage that meets ACA requirements. Tax credits or financial help is available to pay for copays and premiums.

We have experienced an unprecedented 10-point drop in the uninsured rate in Washington—one of the highest drops in the rate of uninsured in the country. In fact, Governor Jay Inslee set a goal of reducing Washington’s uninsured rate to 6 percent by the end of 2017. We reached that target two years early.

The Affordable Care Act (ACA) ensures that:

• Parents can keep kids on their insurance until they are age 26.
• There is no lifetime cap (or limit) to how much insurance will pay.
• There is no annual cap (or limit) to how much insurance will pay.
• You cannot be denied coverage if you have a preexisting condition.
• You cannot be dropped from your insurance if you get sick.
• Insurance must cover certain essential health benefits, such as hospitalization, doctor visits, prescription drugs, pediatric services, maternity and newborn care, lab services, and mental health and substance use disorder services.

The ACA requires that almost everyone have health insurance. In Washington, most individuals who need to get health insurance can use Washington Healthplanfinder through the Washington Health Benefit Exchange. To learn more about eligibility, benefits and services, or how to apply, visit the Apple Health (Medicaid) coverage section of our website.

Transformation beyond the ACA

The ACA brought major strides in coverage for Washington State. The Health Care Authority (HCA)—alongside our partners, health care providers, health care plans, community-based organizations, and others—continue to transform our state’s health care system in many ways.

This includes paying for value, integrating physical and behavioral health, and strengthening connections between health care and social supports. Some of our transformation-related activities include:

• Medicaid Transformation Project (MTP)
• VBP Roadmap
• Rural transformation
• Primary Care Transformation

The State Innovation Models (SIM) grant was a foundation for these efforts. SIM funded four years of health system transformation in our state and ended January 31, 2019.