Opinion: 2024 legislative session included more spending, some advances in health care, a labor dodge, initiatives

Elizabeth New (Hovde) of the Washington Policy Center offers her summation of the 2024 legislative session.

Elizabeth New (Hovde) offers her summation of the 2024 legislative session

Elizabeth New (Hovde) 
Washington Policy Center

Now that Gov. Jay Inslee has signed a slew of bills approved by the Washington state House and Senate, I feel confident wrapping up the latest legislative session from my perspective. 

Elizabeth New (Hovde), Washington Policy Center
Elizabeth New (Hovde), Washington Policy Center

It won’t be a thorough accounting of legislation that was on my radar, as you wouldn’t read that many words. This partial accounting is long enough. But here are some highlights and lowlights. 

The state’s spending problem

First, it seems important to remember that the state’s operating budget has more than doubled in the past 10 years, while the  population grew only 14 percent.  As our most recent Policy Guide says, “This dramatic increase in spending should be subject to additional discussion and scrutiny by lawmakers.”  I hope there were discussions about wants versus needs and priorities. If they happened, I didn’t hear them. Spending did increase by an additional $2 billion during the second half of the state’s two-year budget cycle, and it sits on top of the $69.8 billion operating budget passed in the Legislature last year. About half of that money was reportedly for new policies.

It’s also worth noting that despite budget surpluses and inflation impacting workers in the state, the Legislature failed to consider broad-based tax relief. Again. 

Action in health care 

When it comes to health care policy, I think lawmakers have good intentions to try and help consumers. The legislative majority is off-target when it comes to the big picture, however. Instead of leading the system toward competition and innovation that could help contain health care costs and increase access, the state is intent on paving a path toward so-called universal health care. 

One of the stated goals of an ongoing Legislature-created Universal Health Care Commission is to get more and more people dependent on taxpayer-provided or subsidized health care to help that effort along. We need more educated payers with stakes in the game, not fewer of them. 

Taxpayer-financed, government-run health care won’t help access or quality of health care, even if the amount of rationing the government plans to practice results in temporary affordability. And it will be temporary: Cost containment is doomed under a government-run, taxpayer-funded system. Demand for resources will always outstrip supply. The pattern of taxpayer-funded care in other countries is the rationing of care that ends up creating two-tiered systems for people who can afford to get care outside of their government system and those who can’t.

Despite being headed in the wrong direction, lawmakers did some favors for the health care system we have now during its 2024 session. They made more progress on licensure issues in the health profession this session. That’s encouraging. Fewer government regulations surrounding occupational licensing can help qualified workers and patients. Among the advances was a bill expanding the ability of physician assistants to practice with autonomy and a bill allowing the state to join a multi-state physician assistants’ compact. I hope to see more regulation easements next session as these compact and licensure changes produce helpful results in the workforce.

Lawmakers also unanimously approved and Inslee signed a bill that continues a temporary lift of certificate-of-need (CON) requirements for psychiatric hospitals and beds. A study from the Treatment Advocacy Center shows Washington state has far fewer beds than a minimum standard. Getting more of them should come with less regulation and opposition from entities not wanting competition. 

Senate Bill 5920, as originally constructed, would have made the CON lift permanent, but the bill was amended. Even in its watered-down form, however, a continued exemption of CON law on psychiatric hospitals and beds improves troubling limitations on psychiatric service offerings.

Legislators need to keep this CON issue front and center. States with such laws have higher health care costs and fewer medical services per capita. Congress repealed its CON law decades ago, recognizing the policy failure. A dozen states have followed suit. While the Legislature passed up a CON-modernization bill this session, I hope that was only because they know what they really need to do is get rid of the anti-competitive, patient-harming practice completely. Extensive research has been done on this issue. 

Another helpful tool that was in danger of ending — hospital-at-home programs — will be allowed to continue with the passage of House Bill 2295. The innovation is producing good results for patients involved in this type of care. 

Worker penalties continue

As for worker rights, a lot of issues have overlapped with health care in the past several years. New payroll taxes are penalizing work and lowering people’s wages to fund social programs many won’t qualify for or even need. Also, a health-related job requirement resulted in thousands of worker terminations. The state has disappointingly not corrected its wrongs there. 

The long-term-care payroll tax, like the payroll tax for paid family and medical leave, creates winners and losers, regardless of anyone’s need or plenty. Taking money from even low-income workers and redistributing wages to people with higher incomes is misguided. 

The Legislature missed an opportunity to repeal the long-term-care law that created the payroll tax that funds the unpopular WA Cares program. The program promises the moon and won’t deliver. Now voters will have an opportunity to make the program optional in November, since lawmakers did not consider passing Initiative 2124 on their own. (They did pass three other initiatives that relate to police pursuits, parental rights to information and banning an income tax in the state.)

Critics of the initiative that restores choice to Washingtonians likely are correct that if the initiative passes, it will tank the program. If the initiative passes, it certainly ought to: WA Cares will be even harder and more costly to manage. Insurance providers with far more experience in long-term-care funding should be the ones offering such products to Washingtonians who want to plan and invest that way.

Both programs have solvency concerns. The general fund and a doubling of the tax rate is keeping the leave program afloat. In WA Cares’ case, solvency concerns existed before the tax even began and we’re still a few years out from the first payouts for those who do qualify for the inadequate $36,500 lifetime benefit. We already have a safety net for people in need of long-term care, and it is being abused. Lawmakers should get busy and reform Medicaid to protect that safety net for the vulnerable. 

Labor wants others to pay for its agenda

Another issue for workers is that unions have outsized influence and control on individual workers, impacting their pocketbooks and sending political messages with which many workers disagree. 

Bills this session would have further impacted the pocketbooks of not just union workers, but all Washingtonians. I wrote a legislative memo against them, and, luckily, I don’t have to mourn that they passed.

House Bill 1893 went the furthest. It would have created a strike fund of sorts for people choosing not to work. People who go on strike would be eligible for unemployment insurance benefits, which are meant for people who lose jobs through no fault of their own. Creating an unfair playing field for businesses in the employee-employer work relationship won’t help Washingtonians. It could increase strike activity, which is bad for businesses, consumers and even striking workers in the long run. Labor leaders promise the effort to have the state fund paying strikers will be back. Read more about that here.

A policy aim of mine this session and one I hope lawmakers will take up next session was urging the state to get out of the union dues collection role. That would help workers realize and consider their Janus rights. Public employees should pay union dues just as they do other personal bills, and the state should limit itself to protecting a public employee’s right to join or not to join a union. It makes no sense why unions aren’t responsible for their own dues collection. Netflix doesn’t ask the government to collect money from its consumers who are government workers. 

As it is, many taxpayer-funded workers lose their Janus rights and are stuck giving their wages to unions with which they disagree before they know they have them. Unions and the state do not offer adequate information to public employees about Janus rights, even on a Washington State Department of Labor and Industries web page supposedly devoted to workers’ rights. 

Balancing information for public and private workers is even prohibited in many ways. A bill that passed this session further curtails the ability of even private employers to give their side of union-forming considerations that will impact the workers they supply with livelihoods. The bill was misleadingly sold as an effort to stop employers from holding employees captive to meetings involving religion or politics. Hogwash. Including speech about union formation as politics is crafty.

That’s a wrap

That’s my summation of the 2024 session, after analyzing proposals that could help or hurt Washingtonians. Government plays a large role in whether Washington state is a place people want to live and work. I want to live and work in a state that spends well, promotes self-sufficiency, allows for innovation and choice, and preserves safety nets for people in need.

Elizabeth New (Hovde) is a policy analyst and the director of the Centers for Health Care and Worker Rights at the Washington Policy Center. She is a Clark County resident.

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