A Q&A with Washington’s New Governor
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On Jan. 15, Bob Ferguson was sworn in as Washington state’s 24th governor, taking over from fellow Democrat Gov. Jay Inslee. In his inaugural address, Gov. Ferguson positioned himself as someone intent on reforming government, not defending it. “Our mission must be to speed up government, improve customer service, and center the people in every decision we make,” he said.
As for specific health challenges and priorities facing Washington state, Gov. Ferguson called out the ongoing behavioral health crisis and threats to reproductive freedom. The latter he called a “core freedom” with vows to protect it for all Washingtonians. Gov. Ferguson said his administration “will work with President Trump where we can. We will stand up to him when we must.”
During his time as Washington state attorney general, Gov. Ferguson defended the Affordable Care Act from the legal attack from the Trump administration and Republican attorneys general, preserving health care for 825,000 Washingtonians. He then wrote and passed legislation guaranteeing access to free and reduced-cost hospital care for 4 million Washingtonians.
After his speech, Gov. Ferguson signed an executive order directing the Washington State Department of Health to convene a roundtable of medical professionals, reproductive health experts, and policymakers to recommend strategies for protecting reproductive freedom, including strengthening health data privacy laws.
When it comes to rising health care costs, Gov. Ferguson is keenly familiar with the economic pressures facing Washingtonians and the physician community that cares for them. The state Legislature had tasked his attorney general’s office and the Office of the Insurance Commissioner with analyzing policy options and making recommendations that could impact affordability. The directive came after a report showing consumers and businesses in Washington state have faced double- digit increases in health insurance rates over the last decade-nearly double the rate of inflation. The trend continues in 2025, with an average 10.7% increase for health plans purchased on Washington’s health insurance marketplace.
Gov. Ferguson invited the WSMA and other health care organizations to participate on a health committee as part of his transition team. As a follow- up, WSMA Reports asked Gov. Ferguson how he intends to build on his work as attorney general and what the physician community can expect when it comes to other health care priorities. We asked these questions prior to President Trump taking office and the slew of directives affecting health care policy and information access that have since followed. -RITA COLORITO
WSMA Reports: The WSMA represents physicians and physician assistants working in all specialties and practice settings across the state. What is your connection to the physician community?
Gov. Ferguson: Because health care touches each and every Washingtonian, my family and I have had our own personal experiences with the physician community, which helps inform and guide my policies on access and affordability of health care. I am grateful for the care that nurses, physicians, and other health care professionals have provided my family. I understand that not every Washingtonian has had access to good health care as I have over my time in public service. This is why I repeatedly fought to preserve access to health insurance under the ACA and will continue to do so if the Trump administration seeks to remove subsidies or change our public insurance system in ways that will hurt Washingtonians.
As attorney general, my team and I took a hard look at consolidation of health care entities to try and retain access to independent physician practices as much as possible. We are concerned about noncompete agreements and other effects of ownership changes on doctors, not only from the point of view of their professional and business challenges, but also on the morale toll that the corporatization of health care has taken on so many who have gone into the profession to take care of the rest of us.
The WSMA was grateful to have the opportunity to participate in the health committee of your transition team. Looking at the big picture, what’s front of mind for you in terms of health policy priorities for our state?
Thank you for participating in the health committee of our transition team. We needed our valuable health care experts to guide my administration on the immediate health priorities facing the state. We heard loud and clear that youth behavioral health needs to be bolstered so that our young people can thrive in supportive environments. There is coordination to be done between agencies to ensure we get new behavioral health providers licensed and registered with Medicaid in a timely manner. My team has already begun meeting with Department of Health and Health Care Authority on these issues. We’re also exploring how to expand Medicaid coverage to effective youth interventions, both in school, community, and medical settings.
Given what we’re facing with the new federal administration, maintaining the coverage gains Washington has made over the last decade is also vitally important. While we know that our state is facing a difficult budget crisis, preserving funding for coverage to current benefits is one of our top priorities as we review options for spending efficiencies and cuts.
Lastly, almost every Washingtonian is feeling an affordability crunch and health care costs are a major factor in what families across the state are faced with day-to-day. We are aware of several pieces of legislation that the Legislature is considering in order to address health care cost containment and transparency of health care ownership and expenditures. All of these proposals are important to evaluate to help alleviate the health care cost pressures our communities are facing.
Are there policy options you will be proposing to promote health care affordability?
One of my top priorities is bringing down the cost of living for Washingtonians. As attorney general, I fought for affordable health care to help Washingtonians, and as governor, I will continue working to improve access to excellent, affordable care. As you know, there is lots of work to be done. My team is already exploring what we can work on with the Legislature and in the interim to address the underlying costs for actually delivering care, how to make care delivery as effective as possible while maintaining a level of efficiency, and how we streamline our goals for oversight and management of health care expenditures across our state agencies so the health care community knows the exact direction we’re headed in.
Our state has become very consolidated, in terms of where care is offered, and some would argue this has driven up cost and limited choice. Do you think we can get back to helping practices operate independent from a hospital health system or private equity?
What I want to see in our health care ecosystem is the availability for physicians to have a choice in how they want to practice. We know some physicians like to be a part of a health system and they should have an opportunity to do so. However, we need to help support the option for other physicians to operate independent practices or join independent physician groups without the fear of closure or affiliation.
We must adopt good policies that prohibit mergers and acquisitions that create unlawful monopolies and those that cut off care to essential services. Additionally, we must look at ways to ease the administrative burden physicians and providers face as independent practitioners. Managing multiple health plan contracts and their associated policies and procedures has become untenable. We hear that, and are committed to finding regulatory or legislative solutions to ease this burden and make the choice between health system and independent practice more available statewide.
I’m also aware of the impact prior authorization requests have on administrative burden and the level of justification that can be required to get a referral for your patients or prescribe the appropriate medication treatment to meet your patients’ health needs. Medical necessity guidelines, turnaround times, and policies need to be better streamlined across our health plans. I am committed to working with the Health Care Authority and the insurance commissioner to determine how we can do that with or without legislative intervention.
The state is facing a difficult budget dynamic, with hard choices ahead on spending and revenue. Even as we want to avoid cuts to critical health care programs that would adversely impact access to care for patients, many WSMA members are wary of the possibility of a business and occupation (B&O) tax increase or the establishment of a statewide payroll tax that may threaten their ability to keep their practice doors open. How will you approach closing the budget gap?
Washingtonians expect that we will increase revenue as a last resort. I will not contemplate additional revenue options until we have exhausted efforts to improve efficiency.
I am prioritizing budget savings and efficiencies. As a first step, I propose reducing state agency spending by at least $4 billion. These reductions will be challenging, but, ultimately, I believe they will improve our capacity to serve the people. I hired agency directors who share this vision, and I know our dedicated state employees will rise to meet the challenge.
One of your first actions as governor was to sign an executive order related to protecting reproductive freedom. What are your thoughts on how our state can further protect patients and the physicians who are providing abortions and other reproductive health care services?
Protecting reproductive freedom remains one of my top priorities. In light of the Dobbs decision and what has been outlined in Project 2025, we know we need to work immediately to identify any additional policies and funding strategies that are necessary to protect access to services.
As one of my very first official acts as governor, I signed an executive order directing the Department of Health to convene a roundtable of medical professionals, reproductive health experts, and policymakers to recommend strategies for protecting reproductive freedom. Not only will we be focusing on access to abortion and miscarriage services but also on access to gender-affirming care and pregnancy prevention. We also want to focus on the safety and security of reproductive and gender-affirming care. This means ensuring the physical security of our patients and clinics but also developing policy options to ensure our data systems are as secure as possible to protect patient health information.
Washington state was ground zero for the COVID-19 pandemic. The Trump administration has nominated Robert F. Kennedy Jr., a vocal skeptic of vaccine safety and efficacy, to head the Department of Health and Human Services. What are your concerns regarding public health? How do you intend to safeguard public health vis a vis vaccine requirements and availability?
Combating misinformation about the effectiveness and side effects of vaccines is where we need to focus in the coming years. This means ensuring state and local public health officials aren’t restricted from educating the public in any way about the importance of vaccines in preventing and containing the spread of communicable diseases. Part of what we’re analyzing during our state budget exercise is how to maintain foundational public health funding to ensure community education programs are not eliminated. It’s no guarantee but we recognize the importance of having accurate, evidence-based information available for the public to easily access.
You’ve been a leader in helping address the fentanyl and opioid crisis, and you campaigned on combating the opioid epidemic. What policies will you propose (or seek to change) and what public health initiatives are needed to manage and reverse the epidemic in Washington state? And are you concerned with the possibility of the opioid settlement funds getting diverted to uses other than what they were intended for, given the state budget gap?
As attorney general, my legal team and I recovered more than $1 billion from opioid lawsuits. I refused to settle with opioid manufacturers and distributors without legally enforceable agreements in place ensuring that the recoveries must be used to address the opioid and fentanyl epidemic.
Addressing the fentanyl crisis will take all stakeholders to be bold and innovative in preventing and treating patients. We welcome the expertise of WSMA members to provide us with emerging clinical solutions to help communities across the state address this urgent crisis.
This article was featured in the March/April 2025 issue of WSMA Reports, WSMA’s print magazine.