SB 6173
In CommitteeSenate
Apple health employer assess
Creating an apple health employer assessment.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill creates a new assessment on large employers who have employees enrolled in Apple Health (Medicaid), requiring them to pay a fee based on how many of their employees are covered and how long they were employed. The money raised will go into a dedicated state account to help low-income residents afford health coverage.
- Imposes a new Apple Health employer assessment on large employers (100+ employees in Washington) that have at least one employee enrolled in Medicaid (Apple Health) during the prior year.
- The assessment is calculated as: number of 'member months' (each month a qualifying employee worked for the employer) multiplied by the Medicaid fair share capitation rate, which reflects the average per-person cost of Medicaid coverage for the expansion population.
- Assessments are collected quarterly by the Employment Security Department, starting in the calendar year after the state implements federal community engagement requirements for Medicaid.
- Money collected goes into the State Health Care Affordability Account, which can only be spent on programs that help low-income residents afford health coverage (e.g., premium and cost-sharing assistance).
- Exempts employers with fewer than 100 employees in Washington, the federal government, state agencies, and local governments; and assigns responsibility to franchisors (not franchisees) for assessment payments.
Who is affected
- State of Washington and local governments — Large employers (100+ employees in Washington) who have at least one employee enrolled in Apple Health (Medicaid) during the prior year must pay an annual assessment based on the number of those employees' months of employment.
- Franchise businesses — Federal government, state agencies, and local governments (counties, cities, etc.) are explicitly excluded from the assessment.
- Workers enrolled in Apple Health — Franchisors (not franchisees) are considered the employer for assessment purposes if they meet the definition.
Pro/Con Analysis
Potential Benefits (5)
The bill creates a dedicated revenue stream ($200–300M/year) to fund premium and cost-sharing assistance for low-income residents, directly improving access to health coverage and reducing financial barriers to care for vulnerable populations.
HealthcarePeopleRef: Sec. 1(5), Sec. 2(1), Sec. 2(2)(d)By exempting federal, state, and local governments—and assigning liability to franchisors rather than franchisees—the bill avoids placing assessment burdens on public-sector employers and small, locally owned franchise operations, preserving public-sector budgets and community-based business viability.
Public SafetyPeopleRef: Sec. 1(6)(f)(ii), Sec. 1(6)(f)(i)(C), (D)The capitation rate is calculated using the most recent managed care organization rates and certified by a contracted actuary, introducing a degree of actuarial transparency and fairness in how assessments are calculated—though not fully risk-adjusted, it is more objective than flat per-employee fees.
HealthcareLean peopleRef: Sec. 1(6)(e)Annual assessment calculations and notifications by DSHS and ESD create predictable billing cycles, reducing uncertainty for employers and allowing time to plan for payments—though this also implies administrative costs borne by state agencies.
Local GovernmentLean peopleRef: Sec. 1(3), (4)The assessment is designed to internalize a portion of the public cost of Medicaid expansion by requiring large employers who rely on public coverage for part of their workforce to contribute—aligning with the 'beneficiary pays' principle and reducing reliance on general fund revenue.
FinancialPeopleRef: Sec. 1(1), Sec. 2(1)
Potential Concerns (5)
Large employers (100+ employees) with at least one employee on Apple Health will face a new quarterly assessment based on employee Medicaid enrollment, potentially increasing labor costs and creating administrative burden for compliance and reporting.
Business & EmploymentLean industryRef: Sec. 1(1), (f)(i)(A)Franchise businesses are structured so that only the franchisor—not the franchisee (often small, local operators)—is liable for the assessment, shielding large franchisors from meaningful accountability while placing compliance responsibility on entities that may lack bargaining power or legal standing to adjust wages or benefits in response.
Business & EmploymentIndustryRef: Sec. 1(6)(f)(ii)Local governments are exempt from the assessment, but local employers (e.g., hospitals, retail chains, universities) with 100+ employees may reduce hiring or freeze wages to avoid triggering assessment liability, indirectly affecting municipal tax bases and public service delivery.
Local GovernmentLean industryRef: Sec. 1(2), (4)The assessment is tied to the *Medicaid fair share capitation rate*, which reflects the *average cost* of Medicaid for the expansion population—but this rate may not account for variations in health status or utilization, potentially over-assessing employers whose employees are healthier and use fewer services, distorting risk-based pricing.
HealthcarePeopleRef: Sec. 1(6)(f)(i)(A), Sec. 1(6)(e)The 100-employee threshold excludes many small-to-midsize employers, creating a cliff effect: businesses with 99 employees face no cost, while those with 100+ face a new liability—this may incentivize artificial workforce restructuring (e.g., splitting departments, outsourcing, or limiting hiring just below 100) to avoid assessment, harming job stability.
Business & EmploymentPeopleRef: Sec. 1(6)(f)(i)(A)
Who Is Most Affected
Workers enrolled in Apple Health who are employed by large employers (100+) may see indirect benefits if their employers use the assessment as leverage to reduce wages or hours to avoid triggering liability—but this risk is mitigated by the 80-hours-per-month threshold for 'qualifying' employment and the fact that most large employers already offer some form of health coverage.
Large employers (100+ employees) with Medicaid-enrolled staff will face a new cost, but those that already offer employer-sponsored insurance may see reduced Medicaid enrollment among their staff—potentially lowering future assessments. The assessment is not punitive (capped at full Medicaid cost), and the revenue funds coverage for others—making the net effect modestly negative overall.
Franchisees (small, local operators) are shielded from liability, while franchisors (often large national or regional chains) bear the assessment. This preserves small business viability but may reduce franchisors' incentives to support employee benefits or wages, indirectly affecting franchisee stability.
Low-income residents who qualify for premium and cost-sharing assistance will benefit significantly from the new funding stream, improving access to care and reducing out-of-pocket health costs—especially those near or below 100% FPL who face the greatest financial barriers.
The state and local governments avoid assessment liability, preserving public budgets—but local governments may face downstream pressure if large employers reduce hiring or wages in response to the assessment, affecting local tax revenues and demand for public services.