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A RESOLUTION advancing the Board of Health's commitment to actively supporting immigrant and refugee health access and requesting exploration of King County sponsorship towards that commitment.

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                     WHEREAS, health insurance facilitates access to care and is associated with lower death rates, better health outcomes, and improved productivity according to the American Hospital Association citing extensive research, and

                     WHEREAS, Article 25 of the Universal Declaration of Human Rights states that everyone has the right to medical care, and

                     WHEREAS, King County has reaffirmed its commitment to equity and social justice by recognizing limited access to safe and affordable healthcare for immigrants as a systemic problem affecting primarily people of color, in part when it recognized racism as a public health crisis, and

                     WHEREAS, many categories of immigrants have been excluded from federally funded health coverage; in 2023, approximately forty-two thousand noncitizens in King County were uninsured, and

                     WHEREAS, in 2019, public health - Seattle & King County released a study at the request of the King County council demonstrating significant disparities among uninsured noncitizens and exploring options for county-based health coverage, and

                     WHEREAS, the state of Washington has since acted to fill some coverage gaps for immigrants, but access and affordability challenges persist.  In 2023, the U.S. Centers for Medicare and Medicaid Services approved Washington's 1332 waiver allowing individuals without a federally recognized immigration status to purchase qualified health and dental plans without federal subsidies through Washington's online marketplace for qualified health and dental plans.  To account for the inability of people who are without a federally recognized immigration status to access federal premium tax credits and cost-sharing assistance, the legislature provided Cascade Care Savings state premium assistance subsidies up to two hundred fifty dollars per month for Washingtonians ineligible for federal subsidies with incomes up to two hundred fifty percent of the federal poverty level.  However, fewer than one in nine of those who shopped for 2024 coverage were able to enroll in coverage and fewer than one in six in 2025 were able to enroll because the premiums were still unaffordable, according to the Washington state Health Benefit Exchange, and

                     WHEREAS, Washington's Apple Health Expansion for adults with income up to one hundred thirty-eight percent of the federal poverty level who are not eligible for Medicaid or federal premium tax credits  due to immigration status launched in July 2024, but the Legislature appropriated only enough funding to serve fewer than twelve thousand Washingtonians.  The vast majority of space for that funding filled in less than two business days and, as of September 2025, over twenty-two thousand Washingtonians have been denied coverage due to limited funds, according to the Washington state Health Care Authority, and

                     WHEREAS, the Washington state Health Benefit Exchange partners with more than sixteen organizations across the state to help make coverage affordable by offsetting heath care costs for members of their communities, including:  eleven tribes; government entities sponsoring Compact of Free Association Islanders and people living with HIV; three nonprofit, private sponsors, which are Project Access NW Pierce County Project Access, and Evergreen Health Insurance Program; and public health - Seattle & King County, and

                     WHEREAS, H.R. 1 - 119th Congress (2025-2026), signed into law this July, included a provision stripping federal premium tax credits and cost-sharing assistance from lawfully present immigrants for coverage starting January 2026.  The Washington state Health Benefit Exchange estimates approximately ten thousand Washingtonians will lose access to affordable health coverage due to this change, and

                     WHEREAS in October 2026, HR 1 - 119th Congress (2025-2026) is expected to create additional coverage losses when the Washington state Health Care Authority estimates as many as thirty thousand lawfully present immigrants including refugees, asylees, trafficking survivors, and others will lose federal funds for Medicaid and the Children's Health Insurance Program, as well as in January of 2027 when approximately fifteen thousand lawfully present immigrants including refugees, asylees, trafficking survivors and others will lose access to federal subsidies for health insurance through Healthplanfinder, and

                     WHEREAS, the federal administration has funded and unleashed a campaign persecuting immigrants, militarizing immigration enforcement, and eroding core democratic values of equity and due process, with demonstrated harm to the health and well-being of immigrants and communities across King County and Washington state, and

                     WHEREAS, the Board of Health affirmed in Resolution 18-01, which passed in January 2018, that the government must serve all residents regardless of immigrant status, country of origin, race, age, or other identities, and

                     WHEREAS, King County seeks to welcome immigrants and refugees as full members of the community with a right to access culturally appropriate and affordable healthcare;

                     NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF HEALTH OF KING COUNTY:

                     A.  The Board of Health supports the fundamental human right to access healthcare.

                     B.  The Board of Health seeks to expand coverage and lower health care access barriers for low-income immigrants in King County who are unable to afford private insurance and unable to access Medicaid and federal subsidies.

                     C.  The Board of Health asks the King County council to seek out and pursue cross-jurisdictional funding strategies to maximize the impact of available funding, including exploring a county sponsorship program to leverage state subsidies and mitigate impending coverage losses.

                     D.  The Board of Health further encourages all jurisdictions within King County to share "know-your-rights" information with immigrant communities, including supporting residents in developing safety plans when accessing health care services within King County, and engage in state policy decisions for uninsured and soon-to-be uninsured Washingtonians.