Article written by Jack Petrie, Feb 2 2026

Washington senate bill 5233, first introduced in the 2025 regular legislative session by the 69th legislature, and then reintroduced in the 2026 session. Attempts to create a universal healthcare system for all of Washington State through the “consolidation of public health plans in Washington under a unified financing system in order to universalize eligibility to all Washington residents, ensure comprehensive medical coverage including primary care, dental, vision, and prescription drug benefits, and achieve cost savings through administrative efficiency, bulk pricing, and cost controls” (WA SB 5233). It amends various titles in the Revised Code of Washington (RCW), and creates a new insurance framework for the state to build off of.

The legislation heavily emphasizes universal eligibility eliminating means testing, and aims to address health care access disparities, particularly for marginalized communities.

The legislation does this through the creation of the “Washington Health Trust” a large scale public health financing system dedicated to providing universal medical coverage to all residents of Washington State. The Washington Health Trust would be governed by a seventeen member board of trustees composed of individuals with health care expertise, ensuring diverse perspectives in health care financing and delivery.

So Lets go line by line:

Section 101 of the legislation details the reasoning behind the creation of the Washington Health Trust. Citing economic well being, current economic turmoil, “sky rocketing” unemployment rates, and exposed inequalities of the current employer-based healthcare system. 

The legislation intends to utilize existing healthcare passageways to an extent with Health Trust partners being made up of medical establishments that have a standard of care consistent with RCW 7.70.040.

Section 102, of this legislation proceeds with definitions of particular items in the legislation which will be defined here when necessary.

Section 103, establishes the mission of the Health Trust, in addition to specific election and replacement procedure for the board of trustees. 

Section 108, will establish “a single comprehensive essential benefits package covering essential health benefits that are effective and necessary for the good health of residents and that emphasize preventive, primary, and integrated health care.” this results in a state rather than federally sanctioned single payer healthcare model.

Section 111, is an important one, outlining the eligibility requirements to be enrolled in the Health Trust. Residents under the age of 19, or who are both Medicare & Medicaid are exempt from any work requirements outlined in the legislation. It additionally outlines that retirees pending full integration of the Trust may use it as an extension of their Medicare part C plan.

Section 112, defines how the Trusts plan will provide coverage with the plan allowing  “No cost sharing, including deductibles, coinsurance, copayments, or similar charges, may be imposed on an enrolled  individual for any benefits provided under this chapter”, except in the case of long term care. With the goal of having the Health Trust initially operative by November 1st 2027, with full operability in 2029.

How does this get paid for?:

Employer Contribution: Employers pay a 4.5% to 10.5% tax on wages, while sole proprietors contribute 2% of earnings.

Employee Contribution: A 2% payroll deduction applies to employee wages, with potential exemptions for those earning below certain thresholds.

Capital Gains Tax: A 5% to 9% tax on long-term capital gains for individuals with profits exceeding $200,000, with an additional 2% for gains over $300,000.

Exemptions: Profits from home sales, retirement accounts, and reinvested capital gains in a primary residence are exempt.

How does this compare to now?:

This overall will likely result in an overall less expensive system with The Washington Health Care Authority’s Work Group Report estimating in 2021 that a system like the WHT would potentially save $800 million to $2.5 billion in an implementation year, and up to $5.6 billion on an annual basis in total health care spending once its transition is complete.

With total health care spending in Washington expanding, total “health care expenditures (THCE) in Washington State grew by 5.3% ($2.8B), reaching $55.1 billion in 2022” according to a 2022 report by the Washington Office of the Insurance Commissioner. 

The dramatic reduction in spending allowed by the consolidation of insurance into a state sponsored scheme allows for the expansion of equitable healthcare while reducing these growing cost.

Lets talk PROS, and CONS:

Pros

Universal Coverage: The program aims to cover all Washington residents, eliminating uninsured populations and reducing financial barriers to care.

Cost Savings & Efficiency: Proponents argue that the WHT could reduce total healthcare spending by replacing private insurance administration with a single, state-run entity, potentially saving between $800 million and $5.6 billion annually.

Lower Costs for Employers/Workers: Proponents suggest that the new tax structure may be more competitive than current private insurance premiums for many, with studies indicating only the top 1% of earners might pay significantly more.

Decoupling Health from Employment: Workers would no longer be tied to specific jobs to maintain health benefits, allowing for better job mobility.

Comprehensive Benefits: The plan covers a wide range of services, including primary care, dental, vision, and prescription drugs.

Cons

Significant Tax Increases: The proposal requires substantial new funding mechanisms, including a 4.5% to 10.5% employer tax on payroll, a 2% tax on sole proprietor earnings, and a new capital gains tax.

Implementation Challenges: Critics argue that the actual cost is unknown, the plan is complex to implement, and it would require federal waivers to incorporate existing Medicare and Medicaid funds.

Provider Pay Concerns: A shift to negotiated, lower reimbursement rates (similar to Medicare) could lead to lower income for doctors and nurses, potentially leading to staffing shortages and migration to other states.

Potential for Lower Quality/Longer Waits: Critics argue that single-payer systems can become overstressed, leading to rationing of care, long wait times for procedures, and reduced access to specialists.

Impact on Hospital Finances: Hospitals, already facing financial losses, could see further strain if reimbursement rates are lowered, risking reduced services.

Political/Federal Hurdles: Implementation faces significant political challenges and potential opposition from a federal administration, making it difficult to move forward.

To Conclude:

The Washington Health Trust is a notable attempt to create universal healthcare at the state level. Should it ever get out of committee and pass through into law, it would likely result in a cheaper system of healthcare overall. Letting Washington state be a more equitable location for healthcare and act as an example of modern healthcare policy and state support that other US States could look to for guidance