With costs growing, health care is set to be a major theme in Olympia this year.

Sam Hatzenbeler, health policy associate for the Economic Opportunity Institute, said state lawmakers have made progress, but care is still becoming increasingly unaffordable.

Hatzenbeler pointed out some Washingtonians have to make tough decisions.

"They're forced to choose between getting needed medical care and buying food, putting food on the table, paying rent, paying their car bill," Hatzenbeler outlined. "People shouldn't be forced to choose between these necessary pieces of being a human."

Across the U.S., the average worker's premium contribution has increased almost 300% over the past two decades. And Americans spend more than $1,500 each year on prescription drugs.

To tackle drug prices, state lawmakers hope to establish the Prescription Drug Affordability Board. Lawmakers approved a similar board in 2020, but Gov. Jay Inslee vetoed it because of its price tag. The Senate version of the bill had a public hearing this week.

Another measure, Senate Bill 5688, would give the attorney general oversight to ensure market consolidations don't result in increased cost.

Hatzenbeler noted the attorney general also would ensure care is not restricted.

"For example, some Catholic mergers and acquisitions have resulted in reduced access to reproductive care, gender-affirming care, end-of-life care, things like that," Hatzenbeler explained. "We want to make sure that consolidations don't result in this diminishing of care."

The bill includes a health equity assessment as well. It had a public hearing this week.

Hatzenbeler added another important provision to her organization is in the budget, and would increase funding for health care to immigrants. She reported 105,000 immigrants in the state lack health care.

Hatzenbeler emphasized low-income people, people of color and front-line workers in particular have shouldered a disproportionate impact from the pandemic.

"We have an opportunity this session to correct some of those long-standing inequities," Hatzenbeler asserted. "And make sure that health care is not only more affordable and higher quality for those people who are disproportionately impacted, but for all of us."

California is poised to become the first state in the nation to give health care to all income-eligible residents, regardless of their immigration status.

The Legislature is set to pass the final budget bills this week, which will be signed by Gov. Gavin Newsom shortly thereafter.

Cynthia Buiza, executive director of the California Immigrant Policy Center, said it is the fulfillment of an almost decadelong push by the Health4All campaign.

"This is very timely, but also long overdue," Buiza asserted. "Because for many, many years, many of our immigrant workers who have contributed tremendously to what makes California, California, have gone on without this very important safety net."

The budget deal represents a huge step toward universal health coverage and is expected to benefit about 700,000 people, starting in 2024. Opponents cite the cost: The budget includes $625 million to cover the first six months of 2024, and then allocates $2.1 billion per year.

Beatriz Hernandez, Central Valley organizer for the California Immigrant Policy Center, said it will make a huge difference in people's quality of life.

"This means that they will finally be able to get the health care that they need to care for the chronic illnesses that they've been suffering for many years," Hernandez pointed out. "And also be able to get the checkups that they need."

The deal marks the final push to expand Medi-Cal to all low-income Californians. In 2015, the state expanded Medi-Cal to include undocumented children. In 2020 the program grew to include young adults, up to 26 years old. And this year the program began to accept undocumented adults, age 50 and older.

The ruling on abortion by the U.S. Supreme Court has returned the issue to the states, fulfilling long-held goals of Republican lawmakers in Texas to ban and criminalize abortion.

With the 49-year-old Row v. Wade case overturned, a trigger law takes effect next month, banning abortions from the moment of fertilization - there is no exception for rape or incest.

Texas lawmakers were ahead of the high court, passing legislation last fall to prohibit abortions after six weeks. Aimee Arrambide, executive director of the Texas chapter of the abortion rights group Avow, said she expects half the states to follow Texas' lead.

"We've been ringing the alarm that what is happening in Texas, doesn't stay in Texas," said Arrambide. "And that the public health crisis Texans have been facing for nearly 10 months will be the reality in half the country. Our opponents are not going to stop until abortion is completely inaccessible in the country."

In his concurring opinion with the 6-3 vote, Supreme Court Justice Clarence Thomas said high court rulings that established a right to contraception, as well as gay rights should also be reconsidered.

Following the ruling, Texas GOP Gov. Greg Abbott said abolishing Roe v. Wade, "reinstated the right of states to protect innocent, unborn children."

New Mexico is now the closest state for many Texans seeking an abortion, but getting there may not be possible for low-income people who don't have the time, money or child care to travel out of state. Progress Texas Advocacy Director Diana Gomez said education is the next step.

"There are a lot of folks who don't know about the existence of abortion funds," said Gomez, "of infrastructures that are already in place to help people get abortions, and so we want to let people know about clinics in surrounding states."

In addition to Texas, 25 other states are expected to make abortion illegal, affecting the lives of 36 million people. University of Texas at Austin Associate Professor Kari White said entire regions of the country may soon be in the business of extreme criminalization.

"In a state like Texas," said White, "it's also going to criminalize a whole range of behaviors and practices for people who are trying to help someone get an abortion."

Prior to the court's ruling, a poll by Reuters showed about 71% of Americans - including majorities of Democrats and Republicans - believed pregnancy termination should be a patient-doctor decision.

Medical negligence cases in Washington and elsewhere have taken on a new shape during the pandemic, as hospital resources have been strained and the potential usefulness of certain treatments has ebbed and flowed.

Drugs like ivermectin, for instance, were touted online as a potential COVID-19 treatment but ultimately lacked scientific evidence to back up those claims.

Elizabeth Calora is a Tacoma lawyer who specializes in medical negligence cases. She said there are some legal requirements for determining if a health professional acted carelessly which have been affected by COVID.

"We need to figure out what a reasonably prudent provider should have been doing in that context," said Calora, "and it usually means talking to experts in the field and then determining if what the provider did in the moment or over the course of several visits violated that standard of care."

Calora said after that, the person has to prove that the breach is what caused the damages.

The Washington state Legislature modified evaluations of negligence cases in 2021 so that resources and staffing must be taken into account. For instance, hospitals have often lacked beds at the height of different COVID waves, a factor outside of doctors' or facilities' control.

Calora said the standard of care evolves over time. What was once an acceptable medical practice in the 1970s, for example, might not be anymore.

"But usually it happens in a much slower timeframe than what we experienced at the start of the pandemic," said Calora. "With COVID, you had physicians all over the world basically - it makes me think of throwing spaghetti on the wall to see what sticks. Everyone was trying everything they could."

Calora said the unforeseen nature of the pandemic has made it hard to bring medical negligence cases forward. However, she added that shouldn't discourage people from speaking with an attorney if they feel they or a loved one has been wronged.

"Even though things were bad," said Calora, "it doesn't give people license to practice beneath the standard of care."