Building an Economy that Works for Everyone

Improving Health Care Access and Affordability

Cascade Care

With the passage of Cascade Care legislation in 2019 and Cascade Care 2.0 in 2021, state residents gained alternatives to health plans with high out-of-pocket costs and limited coverage – including a public option called Cascade Select that increases access to high-value care at a lower cost. Tens of thousands of Washingtonians are now benefiting from Cascade Care Savings, which provides state-funded premium assistance.

Cigarette Tax for Health Care

In the late 1980s, Washington State took a major step forward to improve health care coverage by creating the Basic Health Plan (BHP), which provided basic health insurance to low-income working families. But after a decade of chronic underfunding, in 2001, only 125,000 people were enrolled in the plan, leaving hundreds of thousands of workers with inadequate health coverage – or none at all.

EOI responded by spearheading policy research and design for Initiative 773, and building a coalition of health care activists and organizations, including the Community Health Plan of Washington, Group Health Cooperative and the American Lung Association, to promote the initiative.

Passed by Washington voters with a 2 to 1 majority, I-773 increased taxes on cigarettes, directing the proceeds into the BHP to provide additional coverage for low-income adults and children. The increased tax brought another benefit: the state’s youth smoking rate declined by nearly 50 percent.

During the 2003 recession, Washington legislators reallocated state funds. The BHP suffered deep budget cuts But without I-773, the BHP would not have survived that budget crisis at all. Hundreds of thousands of Washingtonians – including 105,500 individuals enrolled in the BHP in 2008 – would have no health coverage. Further, the BHP provided Washington state with the experience and policy platform for implementation of the Affordable Care Act, beginning in 2012.