The Washington State Basic Health Plan (BHP) began in 1987 as a pilot project to provide health insurance for low-income and lower middle-class workers who do not receive health coverage through their employer. The BHP is intended to provide a no-frills package of health care benefits to Washington residents with incomes at or below 200% of the Federal Poverty Level.1 State funds are used to help pay a portion of monthly premiums on a sliding scale basis, depending on family income.
The BHP was made a permanent statewide program in 1993 when the legislature mandated the implementation of universal health coverage. While the universal coverage mandate was repealed two years later, the legislature retained the BHP and set a statutory enrollment target of 200,000 adults. Enrollment grew rapidly from 57,264 in January 1996 to 128,858 in November 1996.2 This increase in BHP enrollment during the mid-1990’s offset decreases in employer coverage. The result was a stabilization of the proportion of uninsured at slightly more than 13% of people ages 19-64.
By the end of 1996, demand for Basic Health Plan coverage had already exceeded budgetary allocations. A cap was placed on enrollment, and a waiting list was created. By June 1997, over 100,000 people were on the waiting list. In 1998 the legislature imposed steep cost-sharing increases on BHP participants, and within six months, the waiting list disappeared.
The legislature had effectively succeeded in pricing the BHP out of the reach of the very people it was designed to serve: low-income and lower-income working families. In 1999, the legislature somewhat decreased premiums for participants but not enough to remove significant cost barriers for BHP participants