This bill creates a new statewide Washington health trust as a single, nonprofit financing entity housed in state government to reimburse a comprehensive essential health benefits package for all Washington residents. It establishes a 17‑member board of trustees, advisory committees, and board authorities to set the benefits package, negotiate provider payment methods (including prospective global budgets for certain community health providers), adopt a prescription drug formulary, develop enrollment and claims systems, and oversee quality/confidentiality rules. The trust allows supplemental private coverage, requires participating providers to accept trust payments as payment in full for covered services within their scope and standard of care, and includes specific long‑term care coverage and nondiscrimination requirements; tribal health funding and sovereignty references are preserved. The act creates new funding and collection mechanisms. It increases the state excise tax on capital gains effective January 1, 2026 and directs the new revenues to the trust, with specified rate increases and several statutory exclusions and allocation rules described for particular asset types and family‑owned businesses. It also establishes employer assessments, employee payroll deductions, and self‑employment contributions for sole proprietors (with key dates: sole proprietor self‑employment contributions begin January 1, 2028; employer assessments and quarterly payments begin January 1, 2029), with defined assessment rates by business size, rules for employer withholding and reporting, and administrative collection and enforcement handled by state departments. The bill imposes filing, payment, recordkeeping, and penalty rules for the new taxes and assessments, including criminal penalties for knowing tax evasion and gross misdemeanor penalties for certain failures to comply. The bill creates several state treasury accounts and fiscal controls: benefits, reserve, displaced worker training, capital improvements, and an enforcement account, authorizes transfers and limits on use, caps administrative expenses to operate the trust (not to exceed 7 percent of the trust’s annual budget), requires annual actuarial analyses and regular reporting, and directs the Health Care Authority and governor to pursue federal waivers or demonstrations to integrate federal programs (Medicaid, Medicare, federal employee and military health programs) into the trust. The act sets deadlines for board establishment and program rollout (board by May 15, 2026; financing rules to support benefits by November 1, 2026; offering coverage by November 1, 2027) and staggers effective dates for different sections. Legally, the measure creates comprehensive new law by adding chapters and a new title to the Revised Code of Washington, establishes new taxes and assessments, creates administrative procedures for a statewide health financing system, and adds criminal and civil penalties for tax and enforcement violations. Important implementation details are not included in the provided facts: several referenced sections (for example, the full texts of sections 104, 109, 110, 115, 201–203, and other operational provisions), the complete capital gains rate schedule for all income ranges, the full definition of "revocable expenditure," and some contingent effective dates and precise copayment or premium amounts are missing from the extracted material.

If enacted, Washington would stand up a statewide nonprofit Washington health trust to provide one comprehensive package of essential health benefits to all state residents, run by a 17‑member board and administered with deadlines to be operational between 2026 and 2027. Funding would come from new and redirected revenues: an increase in the state capital gains excise tax effective January 1, 2026; phased employer assessments and payroll‑based contributions beginning January 1, 2029 (with smaller rates for micro and mini businesses); a two percent self‑employment contribution for sole proprietors beginning January 1, 2028; and premiums or other payments during a transition period. The board is required to negotiate provider payment models (including global budgets for community health providers), set a formulary and drug pricing rules, cap administrative expenses at 7 percent of the trust budget, and ensure providers who accept trust payment treat it as payment in full for covered services. The people most affected will be employers (new quarterly assessment and reporting obligations, phased rules about what employer spending counts, and potential payroll deductions or hardship waivers), sole proprietors (new self‑employment contribution), higher‑income individuals with significant capital gains (subject to higher capital‑gains rates whose revenues are dedicated to the trust), health care providers (new contracting and payment arrangements and limits on extra billing), and several state agencies (Employment Security Department, Health Care Authority, Department of Revenue, and others who must collect, administer, audit, and seek federal waivers). Important implementation details that will materially affect costs and risks—final premium and copayment levels, exact reimbursement rates, the mechanics and timing of integrating federal programs like Medicare and Medicaid, and many operational rules—are not included in the extracted text, leaving substantial uncertainty about the program’s ultimate fiscal impact and transition effects.