(The Center Square) – Washington state announced this week that it had requested a waiver from the federal government to allow currently ineligible immigrants to receive health insurance through the state marketplace exchange – a move that could cost Washington taxpayers up to $1 billion per year.
"Washington state submitted a groundbreaking Section 1332 Waiver Application to the federal government for approval on Friday, May 13," Washington Health Benefit Exchange announced in a news release. "The waiver, if approved, will allow all Washington residents regardless of immigration status to enroll in health and dental coverage through the state marketplace Washington Healthplanfinder."
The state exchange continued, "If approved, the coverage will be available starting in 2024 to the newly eligible Washingtonians."
These Washingtonians would not need to be Americans, the governor's office confirmed.
"A Washingtonian is someone who resides in the state of Washington," Mike Faulk, a spokesman for the governor's office, told The Center Square in an email. "We don't think federal immigration status should impact vulnerable communities' access to health care."
Nor is their legal status a sticking point, Washington Health Benefit Exchange spokeswoman Shawna Crume-Bruce confirmed.
"For purposes of obtaining health insurance through the Exchange, individuals must be a resident of the state –they are living in Washington state and this where they intend to reside –which includes those without a fixed address," she said.
The state exchange announced that this waiver, if granted, would apply to at least 105,000 Washington residents and that "newly eligible individuals and families" could also "benefit from Cascade Care Savings, the state's new premium assistance program, that will be starting this fall for plan year 2023."
The waiver could end up costing Washington taxpayers up to $1 billion a year, according to one expert.
The annual price tag "depends on their income levels, and also on whether the [American Rescue Plan] Act's increase in subsidies is renewed," Chris Pope, a senior fellow at the Manhattan Institute, told The Center Square in an email.
He added that "For 2020, [Congressional Budget Office] estimated $53bn in subsidies for 9m enrollees -- so just under $6,000 per enrollee."
If that were the average subsidy per capita for this new pool, 105,000 new enrollees would cost taxpayers 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 $1bn" annually.
As for who would be footing the bill for the expansion in coverage, Pope said it would be "mostly the state," though he allowed that the Evergreen State's health bureaucrats "could be creative in finding a way to shift some of the cost to the Feds" because "waivers are poorly policed."
When the Affordable Care Act was passed, there was some argument over whether or not the subsidies could apply to immigrants whose legal status was tenuous. Pope believes that as long as Washington state ends up picking up most of the tab, this expansion would be likely to be found legal.
The U.S. Departments of Health and Human Services and the Treasury have 45 days for a completeness review of the waiver, followed by a 30-day federal public comment period. Washington Health Benefit Exchange has requested approval of the waiver by Aug. 1.
After publication, Crume-Bruce reached out to The Center Square to respond to Pope's comment, saying Washingtonians "newly eligible under the waiver, if approved, will not be getting federal subsidies and tax credits; hence ARPA renewal is irrelevant." She also disputes the cost estimate, pointing out that the Washington Legislature appropriated $5 million per year in new state funding for the waiver population and other low income residents.