Single-Payer Health Care: Paid for One Job at a Time

January 22, 2013

Throughout his campaign and even in the days leading up to his inauguration, Governor Inslee has repeatedly said he is, “focused like a laser beam on jobs.” 

It seems some lawmakers from his own party didn’t get that memo.  Bills have been introduced in the House and Senate to create a job-killing single payer health care system funded by a new payroll tax on employers and a new “premium” paid by all residents.

SB 5224 and HB 1085 would create a “single health financing entity,” the Washington Health Security Trust, to “provide coverage for a set of health services for all residents.”  This new state agency would be tasked with providing coverage for health services for all Washington residents. 

A single benefits package would be established that “are effective and necessary for the good health of residents.”  The bills list a slew of mandated coverages, and leave the door open to just about any mandate with the inclusion of the ambiguous “any other benefits defined as essential health benefits” under the federal Affordable Care Act.  The federal ACA last month proposed what will constitute an “essential health benefit” but nothing has been adopted. 

The bills also specify that long-term care be covered within three years of the bill’s effective date and that dental care benefits be covered by January 1, 2015. 

Someone has to pay for all of the benefits doled out by this “single health financing entity.”  All Washington state employers would pay a “health security assessment” to the state Department of Revenue (DOR) to fund the new agency.  The “assessment” (aka tax) would be an unspecified percentage of aggregate gross payroll.

In addition, all Washington residents would pay a “health security premium.”  Employers would collect the premium of their employees through a payroll deduction.  Those who are self-employed or don’t work would be responsible for paying their monthly premium to DOR themselves. 

The amount of the tax and forcibly collected premium paid by employers and individuals is not specified in the bills.   Those will be determined by the unelected “board of trustees” appointed by the governor.

At first glance, SB 5224 and HB 1025 appear to be very similar to the failed Initiative 245 in 2000.  An initial scan of I-245 and the bills introduced today show that entire sections of the failed initiative are incorporated, verbatim, into the bills.  Over a decade ago, WPC outlined why single-payer health care is bad for Washington’s employers and workers.  Voters agreed by refusing to support the initiative with the signatures necessary to even qualify for the ballot.

The analysis by WPC 13 years ago hasn’t changed.  A single-payer health care system is bad for Washington.  Apparently the bill’s sponsors don’t believe the federal Affordable Care Act, which promises health care coverage for all individuals, will do enough.

While Governor Inslee’s focus may be job creation, his colleagues clearly have different priorities.  Forcing employers to pay a new tax, on top of the high taxes they already pay, and forcing residents to pay a mandated “premium” will further stifle the economic recovery of this state.



A 2007 UW study of WHST estimated that the "forced" payroll tax would be 10-12% of payroll over $500K/year, and 1-1.2% for payroll under that amount. This is a far better deal than the 13-16% of payroll that large employers are currently paying.

The "forced" individual adult fee would be $125/$200 per month. Before I got on Medicare, I was paying $500/month. I'd say that anyone who resents being forced to pay a $200 fee instead of a $500 premium should probably not be allowed out in public without adult supervision. And there are no charges at all for kids.

All other industrialized countries provide health care to ALL their residents for half per capita what we pay. That's what you can do when you spend health care money on actual health care instead of on administrative nonsense.

Insurance employees have the option of doing actual useful work, given the impending shortages of health care professionals and caregivers. Not to mention which, companies and government agencies would have a much reduced health care payment burden and would therefore be able to hire more employees.