Mar. 16, 2026
2026 Session Recap: Key Policy Wins for Physicians, Patients
The 60-day, 2026 legislative session adjourned as scheduled on March 12. It was a successful session for the WSMA and physician community, with passage of key policy bills to ensure access to vaccines, reform prior authorization, and require insurance carriers to pay claims in a timely fashion. We also successfully defeated all bills we opposed this year.
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 WSMA successfully advocated for priority funding items to maintain the state's Apple Health Expansion immigrant coverage program, promote insurance affordability though subsidies for plans on the Washington Health Benefit Exchange, and fully fund Foundational Public Health Services. We also advocated against a proposed cut to Medicaid coverage for physical, occupational, and speech therapy services, which was restored in the final budget.
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, we will continue to advocate for Medicaid rate increases for professional service delivery and business and occupation tax reform for independent practices. While we were disappointed to not see more progress on those issues this year, given the state of the state's budget, we were also grateful that the final spending plan did not include cuts to Medicaid rates or tax increases on physician 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 WSMA 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.
The WSMA worked in collaboration with physician groups to develop one of the few amendments that was accepted. Our 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.
WSMA Policy Priority Wins
The millionaires tax grabbed most of the headlines from Olympia this year, but it was far from the only issue on the table. 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. The WSMA tracked and engaged on more than 600 of those bills, seeing wins on our following priority issues:
-
Prior authorization reform | Senate Bill 5395
- Continues recent efforts to modernize insurance carrier prior authorization processes, including prohibiting carriers from solely using AI to deny prior authorization and clarifying an existing prohibition on retroactive denials of prior authorization. This bill was developed by the WSMA in partnership with the Washington State Hospital Association and Proliance Surgeons.
-
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.
Other bills supported by the WSMA that were passed by the Legislature this year include Senate Bill 6025 from the Washington Chapter of the American College of Obstetricians and Gynecologists to update the state's definition of fetal death, House Bill 1155 to prohibit noncompetition agreements, Senate Bill 6182 to fund direct patient abortion clinical care services, House Bill 2225 to regulate AI chatbots, and House Bill 2320 to prohibit the manufacture of 3D-printed firearms.
As is always the case, scope of practice proposals consumed a substantial portion of our lobbying capacity this session. 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. Guided by our policy to analyze whether scope proposals entail adequate education and training to ensure patient safety, the WSMA successfully opposed these bills. At the direction of key legislators, we will be working with the pharmacists over the interim to try to find common ground on an appropriate update to their scope of practice.
Another topic of extensive discussion in recent months is the practice of international medical graduates. Upon negotiation with legislators and advocates for the IMG community, the WSMA was able to work to compromise on Senate Bill 5185, which creates a pilot program under which IMGs who are currently working in structured settings in the state can work toward licensure as primary care physicians upon attainment of extensive, stipulated education and training.
The WSMA was successful in amending or defeating all bills we opposed this session. Those that died include House Bill 2613 imposing restrictions on drug compounding, Senate Bill 5921 legalizing psilocybin, and Senate Bill 5990 permitting advance practice providers to work as local health officers.
Legislative advocacy is a team sport. Through the course of session we partnered on these bills and others with the physician organizations that advocate in Olympia, as well as patient groups, the public health community, hospitals, community health centers, and other stakeholders. We’re grateful for these partnerships and the ongoing advocacy efforts of our physician members.
At the top of the WSMA's legislative agenda this year were two ongoing priorities: mitigating recent B&O tax increases on independent practices and across-the-board rate increases for Medicaid professional services. Both come with steep price tags and uphill climbs given the state's budget shortfall. But both are also essential for promoting the viability of independent practice, as well as health care affordability and access to care.
As we move into the legislative interim, we'll carry these issues and other priorities into conversations with legislative candidates in the 2026 midterm elections. We’ll also be discussing next steps around medical title transparency, as the bill the WSMA developed with physician specialty partners was considered but not passed in the 2026 session.
WAMPAC is the nonpartisan campaign arm of the WSMA which works to identify and support candidates for political office whose priorities align with the house of medicine. If you want to support the WSMA's advocacy efforts, consider joining the WAMPAC Diamond Club. Or keep an eye on WSMA communications as we'll be visiting communities across the state in the coming months, creating opportunities for physicians to connect with area candidates.
In the meantime, thank you for your support of WSMA's advocacy efforts. This year saw the launch of our Medical Student and Resident Advocacy Program, with more than 70 participants from across the state. We also held a sold-out WSMA Legislative Summit at the Capitol, and numerous physicians took time this session to meet with legislators and testify on bills. We're grateful to all of you who take time out of your busy schedules to advocate for your profession and your patients.