Much of our work focuses on designing a universal health care system. The law forming the Universal Health Care Commission (Universal Commission) directs what our design should include.

The law also charges us to find ways to improve the health care system until we move to a universal system — what we call transitional solutions. Additionally, we write yearly legislative reports on our work.

This page details our progress on these three responsibilities.

Universal system design

Our universal system design is made of many parts, called design elements. We recommend ways Washington state might handle every design element.

We examine and research each element one by one (except cost-containment mechanisms, which we consider with every element). Then we sum up our decisions in a design draft.

Design drafts are early proposals on how to make a universal system. We include them in our yearly reports to the Legislature. Eventually, we’ll draw on the design drafts to make a final proposal about a universal system design for Washington state.

Drafts for design elements

We have eight design elements, and we’ve completed design drafts for two.

Completed

• Eligibility — who can be part of a universal system
• Benefits and services — the health care services a universal system would cover

In progress

• Cost-containment mechanisms — ways to keep health care from costing too much
• Provider reimbursement and participation — how health care providers are paid for their work and included in a universal system
• Enrollment — how people join a universal system

Upcoming

• Financing — how to collect, manage, and move money in a universal system
• Infrastructure — underlying base that supports a universal system
• Governance — who runs a universal system

Transitional solutions

Our transitional solutions focus on simplifying the business side of health care and doing more with our current health care programs. We also track the work of groups that monitor or advance the health care system. We use data from these groups and support them where appropriate.

Groups we watch include:

• Health Care Cost Transparency Board
• Prescription Drug Affordability Board
• Rural Health Transformation Program

Legislative reports

We’re responsible for yearly reports to the Legislature. These detail our work, including updates on our universal system design and transitional solutions. We recommend ways for the Legislature to help us move closer to universal health care.

Completed reports

• 2025 legislative report
• 2024 legislative report
• Washington Health Trust analysis report (2024)
• 2023 legislative report
• Baseline report (2022)

Join our work

You can join in the Universal Commission’s work by attending our meetings. For work focused on health care finances, you can also attend our Finance Technical Advisory Committee meetings. Both meetings have public comment periods, where you can share your thoughts on universal design. We hope to see you there!