Everyone has a right to high-quality, affordable health care. For over 40 years, people and organizations across Washington have worked to make this right a reality. Many people may not know that Washington, famous for its stunning and diverse ecosystems and multi-billion-dollar tech companies, is also a leader in health care reform and innovation. And access is expanding in 2025 as Cascade Care Select public option plans will become available in all 39 Washington counties. Consumers can buy plans starting November 1, when open enrollment launches this year — and every year.

Washington’s elected leaders now have the opportunity to further expand essential health care — empowering Washingtonians and providing essential care for all.

Washington state is a leader in health care reform.

Washington created the Basic Health program in the 1980s to cover poor people regardless of immigration status, the first of its kind in the United States. Washington also passed the country’s first public long-term care program (currently under attack with I-2124). More recently, we implemented the country’s first public option plan with the passage of Cascade Care in 2019.

Economic Opportunity Institute was at the center of the creation and passage of Cascade Care, along with many strong community and legislative partners. We coalesced around the need to improve health care affordability and access for consumers buying plans on the Health Benefit Exchange (Exchange). The program was also developed to help address income-based disparities and to minimize “churn” when people transition on and off Medicaid or lack coverage between jobs.

Cascade Care, which originally passed the Washington State Legislature in 2019 and was improved upon in 2021, has three components:

• Standard plans: Now called Cascade Care, these are high-value plans that offer consumers more predictable costs through standardized benefits and services; they also cover more health care services before the deductible, which helps make preventive care more accessible.
• Public Option plans: Now called Cascade Care Select, these plans are standard plans with added quality and value requirements, which helps take the guesswork for consumers who must choose from 100+ confusing plan options. Cascade Care Select plans also help lower costs for consumers with a first-of-its-kind provider reimbursement rate cap. Hospitals are required to participate, which helps protect provider networks for patients.
• Cascade Care Savings: a statewide premium assistance program designed to support the Exchange’s lowest income consumers, available to consumers earning up to 250% of the federal poverty level ($32,200 annually for a single person) who enroll in silver or gold Cascade Care plans. Cascade Care was designed to improve affordability, particularly for people who are just above the Medicaid cut-off of 138% of the federal poverty level but still relatively low-income.

Since its implementation, Cascade Care has steadily improved. For example, in 2023, Washington became the first state in the nation to obtain a 1332 waiver allowing undocumented immigrants to buy plans on the Exchange, thereby enabling additional access to Cascade Care Savings subsidies. In 2024, the vast majority of new program enrollees qualified for these subsidies.

Statewide access to Cascade Care plans has also improved since implementation. Cascade Care standard plans are now available in every county in Washington.

As Cascade Care plans have been expanded, they’ve become the most popular plans by far, and consumers are choosing Cascade Care plans at record numbers. Most (nearly 73%) of Exchange customers are now enrolled in Cascade plans. Over 100,000 people have received subsidies, including immigrants ineligible for federal premium tax credits.

But now, Cascade Care funding is at risk.

The legislature only set aside enough funds for these critical subsidies through the end of 2025, leaving thousands of families at risk of losing their health insurance if they are not maintained.

The legislature dedicated $55 million in the state budget per year for Cascade Care Savings subsidies beginning in the 2023 launch year. However, these funds will sunset at the end of 2025 unless the legislature takes action to maintain or expand funding in the 2025 legislative session. Two state agencies, the Health Benefit Exchange and the Health Care Authority, have partnered to request the legislature to expand these subsidies to $75 million per year starting in 2026.

As health care costs increase, and the cost burden continually gets shifted onto workers and families, we must invest in critical programs like Cascade Care.

Washington will be up against a tough budget outlook this coming legislative session, and legislators will face pressure to cut spending. But, for our state’s health and economic security, we must ensure that essential health care programs like Cascade Care are not on the chopping block.

EOI will work hard with our policy partners this January and beyond to help protect these critical subsidies. Stay tuned for more ways you can take action to improve health care affordability and access for all in Washington.