Advocacy

2026 Legislative Session Overview

Prepared for WA-ACEP by Malorie Wilson, WA-ACEP Lobbyist

WA-ACEP Advocacy Update | March 2026

2026 Legislative Session Recap

Overall, it was a successful session for the physician community as a whole, with passage of key policy bills, such as ensuring access to vaccines and requiring insurance carriers to pay claims in a timely fashion.

Legislators worked against the backdrop of a state budget dynamic that continues to be challenging. Updates to the state budget were approved on the final day of session with a combination of cuts and new spending, the latter driven by rising state tort claims and increased utilization of state programs such as Medicaid.

In the budget space, the physician community successfully advocated for priority funding items to maintain the state’s Apple Health Expansion immigrant coverage program, promote insurance affordability through subsidies for plans on the Washington Health Benefit Exchange, and fully fund Foundational Public Health Services.

Budget negotiations in the coming years will likely continue to be challenging, particularly as cuts to federal health care funding from H.R. 1 are implemented. In spite of this, WA-ACEP will continue to advocate alongside the physician community for Medicaid rate increases for professional service delivery and business and occupation tax reform for independent practices.

The Millionaires Tax

While the final state budget did not rely on tax increases on physician organizations, much of session was dominated by tax talk, specifically on Senate Bill 6346, which establishes a state income tax on individuals and spouses with annual income over $1 million.

Through the course of session, the physician community advocated for dedicated revenue from the millionaires tax to support Medicaid rate increases and broad B&O tax mitigation for physician groups and health care professionals – both intended to help promote health care access and affordability, as well as the viability of independent physician practice.

Negotiations over the bill culminated in a debate in the House of Representatives that ran more than 24 hours, with majority-party Democrats rejecting numerous amendments before taking a final vote on the bill.

Physician groups worked to develop one of the few amendments that were accepted. The amendment eliminates the 0.5% B&O tax surcharge on large medical groups that gross over $250 million annually one year earlier than directed under current law, saving physician groups an estimated $22 million and aligning with a similar policy in the bill for hospitals. Other noteworthy tax mitigation in the bill includes elimination of sales tax on certain services beginning in 2029, such as temporary staffing services, continuing education, custom IT projects, hygiene products, and diapers.

While Gov. Bob Ferguson has signaled that he will sign the millionaires tax into law, that won’t be the last hurdle before it’s implemented. Opponents of the law have signaled they will attempt to gather sufficient signatures to force ratification by voters in November. The bill will also face legal action challenging its constitutionality. If it withstands scrutiny, the tax will be assessed beginning in 2029.

Policy Priority Wins

Between bills that were introduced in the 2026 session and those from 2025 that didn’t pass and were automatically reintroduced, there were more than 3,500 bills eligible for consideration this session. Here are some policy priority wins from the 2026 session:

Timely insurance payments | Senate Bill 5845 – Generally requires insurance carriers to pay “clean claims” within 30 days and reduces the time period in which reimbursement for claims can be retroactively clawed back by a carrier to 12 months.

Vaccine and preventive service access | House Bill 2242 – Modifies state policy to preserve access to preventive services, including vaccines, on a covered basis through health insurance plans and the state’s Childhood Vaccine Program.

Medicaid Access Program date extension | House Bill 2385 – Maintains the Medicaid Access Program in statute until 2030 to allow the state to revisit seeking federal approval of the program in the future when feasible.

Scope of Practice – Along with the reintroduction of bills to grant prescriptive authority to psychologists and expand it for naturopaths, a new proposal was considered to permit pharmacists to independently diagnose and prescribe. The physician community successfully opposed these bills.

2026 WA-ACEP Legislative Priority Update: Time-Sensitive Emergencies Data Repository

The 60-day, 2026 legislative session adjourned as scheduled on March 12th. Building on years of advocacy, a top priority of WA-ACEP in the 2026 legislative session was improving cardiac and stroke outcomes in Washington state by creating a time-sensitive emergencies data repository, to include data related to cardiac, stroke, and trauma events, which would inform quality improvement measures in the timeliness of care and patient outcomes.

With the state’s current budget deficit, HB 2232, which directed the Washington state Department of Health to create a time sensitive emergencies data repository did not pass out of the House Health Care & Wellness Committee due to its anticipated cost to the state. As a result, WA-ACEP advocated for a portion of revenue generated by a proposed increased cigarette tax to fund this data system. Many emergency physicians testified, contacted members of the Committee, and submitted written testimony.

Unfortunately, in the final days of session, there were not enough votes in support of increasing the cigarette tax in the House Finance Committee, so the bill did not pass. Funding and creating a time-sensitive emergencies data repository remains a top priority for WA-ACEP as it will promote equitable access to timely care for all residents of our state experiencing life-threatening medical conditions.