This bill creates a new Washington health trust and an associated 17-member board of trustees to finance and administer a single, comprehensive essential health benefits package for all Washington residents. It establishes the trust as a nonprofit financing entity within a state department, requires the board to set benefits (including long-term care beginning January 1, 2029), negotiate provider payments (including prospective global budgets for community health providers and fee‑for‑service within budget limits), adopt a drug formulary and payment parity rules for telemedicine and mental health, and seek federal waivers or demonstrations to integrate federal programs into the trust. The bill also creates multiple state accounts (reserve, benefits, displaced worker training, capital improvements, enforcement) and limits administrative expenses to no more than 7 percent of the trust’s annual budget. Key implementation and reporting deadlines include board establishment by May 15, 2026; a finance start date and federal-approval steps by October 1, 2026; trust financing to begin November 1, 2026 subject to funding; and trust coverage to be offered to residents and eligible nonresidents by November 1, 2027. The bill creates new revenue and collection mechanisms and amends state law to authorize them. It imposes new employer assessment rates beginning January 1, 2029 (standard 10.5 percent of quarterly payroll less employer health expenditures, with lower rates for smaller businesses), allows a two percent employee payroll deduction, and requires sole proprietors to pay a two percent self‑employment contribution beginning January 1, 2028. It also raises Washington’s long‑term capital gains tax effective January 1, 2026 and adds filing and payment rules: individuals with federal net long‑term capital gains or sole‑proprietor net self‑employment earnings over $200,000 must file state returns, and the measure creates administrative rules, recordkeeping, audit, refund, and appeal procedures. The bill makes tax evasion of this new tax a class C felony and defines knowingly failing to pay or report as a gross misdemeanor; it also provides normal civil collection remedies, penalties, and an enforcement account to receive interest and penalties. This is a comprehensive set of new statutes and tax provisions: it creates new chapters and sections in the Revised Code of Washington (including a new Title 50C RCW and changes in Title 43 and Title 82), establishes new procedural requirements for collection, reporting, and appeals, and creates new crimes/penalties for tax evasion and noncompliance. Important operational details are not present in the extracted text: several cross‑referenced sections (for example, full text of sections 104, 109, 201, 202, 203, 110, 122 and others), some definitions (complete definition of “revocable expenditure”), precise capital gains bracket mechanics between $250,000 and $300,000, and the named department that will house the trust are missing from the provided excerpts.

If enacted, Washington would create a nonprofit Washington health trust that aims to give every resident comprehensive, low‑or no‑cost coverage for a defined set of essential health benefits, add long‑term care coverage beginning January 1, 2029, and require participating providers to accept trust payment as payment in full while allowing providers to be paid by salary or under negotiated global budgets for community providers. Providers and community health organizations would negotiate reimbursement with the trust, the Health Care Authority would run a Health Options Program for the uninsured, and the trust’s board must be in place by May 15, 2026 with the board required to begin financing benefits as of late 2026 and offering coverage statewide by November 1, 2027; administrative spending for the trust is capped at 7 percent and the trust must build a reserve equal to 10 percent of its annual budget. The money to pay for this comes from a mix of new and reallocated revenues and mandates: a state capital gains tax increase starts January 1, 2026 with proceeds directed to the trust’s benefits account, employers must begin quarterly required health care expenditures (standard assessment 10.5%, lower rates for smaller businesses) and collect a 2% employee payroll deduction, sole proprietors pay a 2% self‑employment contribution (starting January 1, 2028), and the Employment Security Department and Department of Revenue are given collection and enforcement roles with penalties for nonpayment; major operational changes and reliance on federal waivers to fold Medicare, Medicaid, and federal programs into the trust mean significant administrative work for the Health Care Authority and the governor’s office. Key implementation details and some funding mechanics are incomplete or contingent in the text (for example, how certain employer spending components count, full integration of federal funds, and several cross‑referenced sections), so the timing, exact costs to employers and high‑income taxpayers, and final benefit administration remain uncertain.