Northwest Health Law Advocates

Founded in 1999, Northwest Health Law Advocates (NoHLA) is a non-profit consumer health advocacy organization. Our mission is to achieve a health care system that enables all individuals to receive quality, affordable health care on an equitable and timely basis, and ensures they have basic rights and protections. NoHLA’s vision is a health care system that allows all Washington residents to receive quality, affordable health care.

For 25 years, NOHLA has been working to improve access to health care for all Washington residents and to advance health as a human right.

Refining and Improving Health Reform

NoHLA is at the forefront of efforts to ensure Washington state’s new health system attracts enrollees and that it works for all residents, including those who are low-income. Our work includes:

Ensuring effective state implementation of the ACA and addressing continuing barriers to access. NoHLA has played a key role in advocating for ensuring that people can easily enroll in Washington’s Medicaid expansion and Exchange, leading to better coordination and access and enabling many more people to become – and stay – insured.

Advocating to guarantee full contraceptive coverage in insurance plans. NoHLA issued a groundbreaking “secret shopper” report finding that insurers gave women inaccurate information on contraceptives now covered at no cost. In response, many insurers took corrective action, improving access to coverage.

Spurring improvements in equitable, affordable access for all. NoHLA has been instrumental in the push for the state to adopt policy options such as easier access to Medicaid, coverage for immigrants left out, lower premiums and cost-sharing for health insurance on the Washington Exchange, and reproductive health equity. NoHLA provides input into the policy choices that will create equitable coverage for all. We provided extensive comments as the Medicaid regulations were restructured to adapt to the ACA. We worked toward the creation of a family planning program for immigrants not eligible for Medicaid that was enacted and began in October 2019. More recently during the COVID-19 pandemic, we have engaged with state agencies on simplifying and liberalizing programs so people can gain coverage more easily and can access services via telehealth.

Protect and defend our progress. In the face of threats at the federal level to eviscerate health programs – not only those created under the Affordable Care Act (ACA) but Medicaid itself and reproductive health programs – NoHLA has engaged in defensive work, which includes broadly informing the public and policymakers of the value and impact of these programs for Washington residents, and the importance of building upon them.

Supporting Legislation to Protect Patients from Surprise Medical Bills

NoHLA is a key consumer advocate in long-term efforts to “take consumers out of the middle” – a situation where insurers and health providers cannot reach agreement on payment and the provider ends up sending a bill for the balance of the charges to the patient. A person needing emergency care has no idea that they were seen by an out-of-network health provider, laboratory, etc., and has no ability to change to an in-network provider. They are later surprised by a separate, costly bill that far exceeds their insurance plan’s cost-sharing. A person getting care at an in-network health care facility can be similarly surprised.

After many years of NoHLA advocacy, in April 2019, the Washington legislature enacted a law that prevents “surprise billing” and protects many Washington residents caught in this situation. The legislation limits what consumers are billed to in-network cost-sharing. Insurers and providers must work out payment between themselves. More recently, NoHLA has worked to address a remaining loophole in the balance billing law, bills for ground ambulance services. As a result, in 2024, the Washington legislature eliminated balance billing and limited the amount ground ambulance services can charge. 

Health Care for Immigrants

The ACA did not preserve immigrant coverage that many Washington residents had through the now-expired state Basic Health Program, and federal policies threaten accessing even what does exist. After considerable effort by NoHLA and other advocacy organizations, a new Medicaid-like program exists for undocumented immigrants who are financially eligible. Open enrollment for the program was held in June 2024, enabling nearly 12,000 undocumented immigrants access to health coverage for the first time.

Our priorities over the next generation of advocacy include:

• Representing the interest of consumers as state agencies implement new laws.

• Eliminating disparities in health care access, ensuring that race, immigration status and language are never barriers.

• Informing our community and fighting back against threats to equitable health care access.

• Working toward universal, equitable, affordable health care access for all Washington residents.