2026 End of Session Report

The Washington State Legislature adjourned sine die (a Latin phrase meaning "without a day to reconvene") on Thursday, March 12, 2026 at 8:24pm. The session proved to be one of the most tumultuous in recent years, largely due to issues surrounding the budget.

In December of 2025 Governor Ferguson proposed his 2026 supplemental operating budget, which addressed the state’s looming state operating budget shortfall. Prior to the release of his budget, the estimated shortfall for current and next biennium was estimated to be around $6 billion. While state law (RCW 43.88.055) has a four-year balanced budget requirement, Governor Ferguson proposed a budget addressing shortfalls over a two year period only. This was because it met the following requirements as described in that law: 1) projected employment growth had remained below 1% (as projected by the Economic and Revenue Forecast in Fall 2025), and 2) the proposal relies on use of the budget stabilization account, aka the “Rainy Day Fund.” This helped lower the budget gap in the short term that he and the Legislature needed to address from $6 billion to approximately $2.3 billion. That said, it is anticipated that the state will face another budget gap in the upcoming 2027 legislative session as federal Medicaid funds are expected to be decreased to the tune of approximately $37 billion over the next 10 years as a result of the passage of HR 1 in Congress.

The final supplemental operating budget for 2026 totaled about $80 billion and contained about $1.5 billion in new spending, as well as a number of reductions through measures such as cuts or delays in programs such as child care subsidies and other agency level savings and funding shifts. It also included approximately $880 million from the budget stabilization account, also known as the “Rainy Day Fund.” Lastly it included new revenue from ending or reducing tax breaks for some entities such as data centers, insurers and prescription drug wholesalers, and of course the newly passed Millionaire’s tax (SB 6346) which may see a challenge in the courts as well as at the ballot box.

Below is a report of the 2026 supplemental operating budget, or the final budget, broken down by agency and areas of interest relevant to healthcare and labor as identified by WSNA Government Affairs. Additionally, in this wrap up document, you will find a report of how each of WSNA’s legislative priorities fared this session, as well as updates on a number of other bills we weighed in on throughout the session. If you have questions about any of this information or other areas of the budget, you may contact us at gov@wsna.org.

Healthcare and Labor budget items of interest

Labor budget items of interest

School Nurses of Washington (SNOW) budget items of interest

The following four priorities were decided upon by the WSNA Legislative & Health Policy Council (LHPC) and Government Affairs team. Learn more about how legislative priorities are determined. Learn more about the LHPC.

HB 2155 – Nursing title protection – PASSED 

 The use of artificial intelligence (AI) technology in healthcare is growing exponentially. It is imperative that through the deployment and use of this technology in healthcare that public safety and patient trust are front of mind. This bill amends the “Nurse Practice Act” (RCW 18.79.030) to ensure that anyone using the title “nurse” or is to provide “nursing services” is indeed, a human. By safeguarding the title “nurse” in law, we can help affirm the distinction between licensed professionals and technology. Doing so helps ensure transparency, protects against misrepresentation, and upholds the integrity of the nursing profession as nurses are rated the most trusted profession for more than 20 years. Protecting the title “nurse” is not about resisting innovation but rather helping to ensure that innovation serves people safely, ethically and transparently.

This bill received a final vote on the House floor of 87-8 and 46-2 in the Senate. See a breakdown of those roll calls for each chamber in the section titled “2026 Regular Session” just under the green box.

Effective Date

une 11, 2026

Next Steps

The Code Reviser will update the existing RCW 18.79.030 with the new language following the enactment of this law.

SHB 2360 – Expanding access to albuterol in public and private schools - PASSED

HB 2360 will help school nurses and school districts be able to provide reliable access to albuterol for children experiencing difficulty with breathing at school. Students frequently forget or lose their inhalers, and many children and families lack preventive healthcare access when they need it. Approximately 10% of all school-aged children in the country are impacted by asthma, with a higher prevalence among lower-income students and students of color. Further, undiagnosed students may also experience their first asthmatic attack while at school. Every student should have access to life saving medications. This bill was championed by the School Nurse Organization of Washington (SNOW) and WSNA.

The bill received a final vote on the House floor of 60-34 and 48-0 in the Senate. See a breakdown of those roll calls for each chamber in the section titled “2026 Regular Session” just under the green box.

Effective Date

By January 1, 2027 the superintendent of public instruction and the secretary of the department of health shall update the uniform policy and procedure for when school nurses and designated personnel access and administer the stock supply of albuterol as authorized by this bill.

Next Steps

WSNA and SNOW will work with DOH in order to establish the standing order for albuterol and from there SNOW will educate their members on specifics around implementation.

Protect and preserve access to healthcare – LIMITED SPENDING REDUCTIONS, NO LARGE CUTS

Washington began the 2026 legislative session with a projected budget deficit of ~$2.3 billion over the next 2 years and ~$6 billion over the next four years. Simply cutting our way out of this deficit would have devastated hundreds of thousands of Washingtonians. As we have seen in the past, healthcare is often one of the first things on the chopping block when we find ourselves in this situation. On top of that, our working class and traditionally under-resourced Washingtonians are going to be hit incredibly hard by the impending federal cuts to SNAP and Medicaid as a result of passage of HR 1 at the federal level. Our goal with this priority was to protect access to healthcare and coverage, as well as jobs. WSNA worked closely with several other organizations to oppose cuts that would impact patients and our nurses. Our hope is that Washington state can, over time, develop a more balanced tax structure that prevents lawmakers from having to cut the very lifelines that help keep people alive, healthy, and thriving.

The final budget (ESSB 5998) passed by the legislature totaled about $80 billion, an increase from the previous enacted biennial budget which was about $77.8 billion. While there were not any significant direct cuts made to healthcare, we did see some cost reduced spending growth and scaled back expansions. Lawmakers also made a number of revenue adjustments, transfers, and increases as part of their final budget including, but not limited to:

• $880 million transfer from the Budget Stabilization Account, aka the Rainy Day Fund
• $394.6 million due to revised capital gains tax distribution
• Assumes $2.2 billion revenue tied to the millionaires’ tax in the 2027-29 biennium

We are anticipating the need to revisit this topic again in 2027 as we see the implementation of HR 1 passed by Congress continue to roll out.

ESHB 2471 – Protecting workers’ rights – PASSED

Due to leadership shakeups at the federal level last year, the National Labor Relations Board (NLRB) has lost quorum, the minimum number of members needed to make binding decisions. This has effectively crippled many of the NLRB’s normal functions and is holding back unions’ ability to properly fight for their members’ rights. This new law will allow a state-based structure (the current Public Employee Relations Commission, or PERC) to secure basic collective bargaining rights for private sector workers if federal courts undermine bargaining rights, effectively “triggering” this state-based structure to step in place.

This bill received a final vote on the House floor of 58-35 and 31-18 in the Senate. See a breakdown of those roll calls for each chamber in the section titled “2026 Regular Session” just under the green box.

Effective Date

June 11, 2026 – bills without an emergency clause go into effect 90 days after session adjourns.

Next Steps

WSNA will continue to work closely with WSLC in monitoring this issue at the federal level in preparation should this law need to be used.

In addition to our own legislative priorities, WSNA also tracks and weighs in on other bills that are introduced throughout the legislative session that may impact our members directly or the quality of patient care and access. Below are some of those bills that WSNA weighed in on either in support, opposition, or simply monitored. These bills are not presented in any particular order, nor is it the complete list of all bills we tracked this past session.

• PASSED (Final budget bill) HB 2289 /SB 5998 - Making 2025-2027 fiscal biennium supplemental operating appropriations.

  The final budget included funds for nurse educators originally appropriated in 2019 as part of a larger initiative to fund educators for high-demand professions. WSNA is pleased that those funds were formally set aside once again in the final budget, assuring those dollars will be there to adequately pay nurse educators in our community and technical college system. This proviso had been undone in the 2025 budget and reinstated this year after strong advocacy from WSNA, AFT-WA and our fellow healthcare union partners.
  

• PASSED  HB 2548 - Strengthening health care market standards.

  WSNA has worked extensively around the issue of corporatization in health care for several years. First, in supporting the Keep Our Care Act (KOCA) for a number of legislative sessions, and now here on passage of HB 2548. As part of a larger coalition consisting largely of consumer advocate groups as well as other healthcare unions, WSNA worked closely with Representative Taylor and Senator Dhingra on this bill. This bill is a first step in the direction of holding corporations and private equity groups accountable as it relates to healthcare. It expands the scope of transactions in healthcare that qualify as a “material change transaction” and therefor under review by the Attorney General’s office. See bill summary and report.
  

• PASSED  HB 2110 - Concerning personnel for ambulance service interfacility specialty care transports. See bill summary and report.

  WSNA worked to amend this bill given concerns we had about the lack of accountability for hospitals to make sure nurses put in the back of the ambulance have knowledge on how to operationalize the equipment in the vehicle. We also expressed concerns about the lack of clarification of the term “appropriate competencies.” We lobbied for a “just in time” training outlining specific things the nurse should be trained on how to do. This request was not met but rather offered a compromise in language. WSNA countered with a slightly stronger amendment to that language requiring that hospitals “….shall coordinate with the ambulance service to confirm the RN is familiar with the equipment and medical supplies in the ambulance before the nurse participates in an interfacility specialty care transport.” This law is intended for rural hospitals only and WSNA will be keeping a close eye on the implementation of this law in the coming months. 
  

• PASSED  HB 2442 - Providing local governments tax resources and fund flexibility. See bill summary and report.
  
• PASSED  HB 2113 - Concerning the supervision of diagnostic radiologic technologists, therapeutic radiologic technologists, and magnetic resonance imaging technologists. See bill summary and report.
  
• PASSED  HB 2152 - Permitting the medical use of cannabis by qualifying patients in specified health care facilities. See bill summary and report.
  
• PASSED  HB 2303 - Prohibiting employers from microchipping employees. See bill summary and report.
  
• PASSED  HB 2345 - Concerning contributions in the state paid family and medical leave program. See bill summary and report.
  
• PASSED  HB 2577 - Concerning hospital inspections. See bill summary and report.
  
• PASSED  SB 5917 / HB 2182 - Improving access to abortion medications. See bill summary and report.
  
• PASSED  SB 5923 - Concerning critical access hospital designations in Skagit county. See bill summary and report.
  
• PASSED  SB 6025 - Updating the definition of fetal death. See bill summary and report.
  
• PASSED  SB 6134 - Concerning notice to striking workers applying for unemployment insurance benefits of potential overpayment assessment upon receipt of retroactive wages. See bill summary and report.
  
• PASSED  SB 6346 - Establishing a tax on millionaires. See bill summary and report. See bill summary and report.
  
• PASSED  HB 2105 / SB 5852 - Concerning immigrant worker protections. See bill summary and report.
  
• PASSED  HB 2225 / SB 5984 - Concerning regulation of artificial intelligence companion chatbots. See bill summary and report.
  
• PASSED  HB 2264 - Concerning unemployment insurance benefits for workers separated from employment because of employer-initiated layoffs or workforce reductions. See bill summary and report.
  
• PASSED  HB 2339 - Concerning the regulation of nursing. See bill summary and report. See bill summary and report.
  
• PASSED  SB 5845 - Modernizing and clarifying timely payment requirements for health carriers. See bill summary and report.
  
• PASSED  SB 5981 / HB 2145 - Protecting patient access to discounted medications and health care services through Washington's health care safety net by preventing manufacturer limitations on the 340B drug pricing program. See bill summary and report.
  

• DEAD SB 5906 - Establishing data and personal safety protections within areas of public accommodation for all Washington residents.

  WSNA worked closely with legislators and sponsors of the bill to amend it to be more worker friendly. Senator Dhingra sponsored a floor amendment to bring the section related to healthcare facilities up to par with other sections stating that if an enforcement action was taken against an employee, that their union bargaining representative would be notified. On the House side Representative Thai sponsored a floor amendment requiring health care facilities’ immigration enforcement policies to be individualized for each facility.  Unfortunately, this bill did not get a final vote on the House floor.
  

• DEAD  HB 2498 - Concerning nursing education program standards.

  WSNA testified and lobbied with “concerns” about this bill, but not about the intent of the bill. Rather, WSNA’s concerns were about how the importance of state licensing standards are critical to assure patient safety and proper training for nurses as opposed to national accreditation standards alone. Forty-seven other states require licensing standards in addition to national accreditation standards. We also testified that the rulemaking process underway with the Washington State Board of Nursing (WABON) around nursing education program standards was the more appropriate way to make improvements, as opposed to doing so through state statute, given the level of technical expertise needed. 
  

• DEAD  SB 5968 / HB 2198 - Improving regulatory efficiency by integrating executive order 25-03, concerning permitting and licensing processes, into chapter 43.42A RCW. Governor request legislation. 
  
• DEAD  SB 5993 - Prohibiting interest charges for new and unpaid medical debt.
  
• DEAD  SB 6115 – Concerning comprehensive cancer education programs.
  
• DEAD  SSB 6284 - Providing consumer protections for artificial intelligence systems.
  
• DEAD  HB 2073 - Funding health insurance premium assistance.
  
• DEAD  HB 2683 - Promoting transparency and efficiency in health carrier relations with health care providers and facilities.
  
• DEAD  HB 1812 - Concerning patient-centered equitable access to anesthesia services and reimbursement. 
  
• DEAD  HB 2242 / SB 5967- Preserving access to preventive services by clarifying state authority and definitions. 
  
• DEAD  HB 2250 - Concerning residency requirements for charity care. 
  
• DEAD  SB 5947 - Establishing the Washington health care board. 
  
• DEAD  SJR 8206 - Amending the Constitution to establish a right to affordable health care. 
  
• DEAD  SB 5823 - Concerning patient advocates.
  
• DEAD  SB 6292 - Establishing a joint legislative executive committee on health care financing. 
  
• DEAD  HB 2382 - Concerning excise taxes on cigarettes, vapor products, and tobacco products. 
  
• DEAD  HB 2122 - Requiring hospitals to offer immunizations for influenza in certain cases. 
  
• DEAD  HB 2144 - Requiring notices to employees when electronic monitoring is used to assist employers conducting performance evaluations.   
  
• DEAD  HB 2157 - Regulating high-risk artificial intelligence system development, deployment, and use. 
  
• DEAD  HB 2106 - Requiring carriers to provide substantive notice to health care providers and health care facilities about significant contract modifications. 
  
• DEAD  HB 2329 - Concerning midwife supervision of medical assistants and lactation consultants. 
  
• DEAD  HB 2148 - Creating the pay it forward program. 
  
• DEAD  SB 5826 - Concerning access at public postsecondary educational institutions to medication abortion.
  
• DEAD  SB 5990 - Expanding the qualifications of those who may serve as a local health officer in rural counties. 
  
• DEAD  HB 1496 - Strengthening patients' rights regarding their health care information.
  
• DEAD  HB 2196 - Expanding access to PANDA PANS treatment.
  
• DEAD  SB 6071 - Standardizing overpayment recovery requirements.
  
• DEAD  HB 2372 / SB 6067 - Concerning workers' compensation benefits.
  
• DEAD  HB 2439 - Enhancing public health by modifying cigarette, vapor product, and tobacco product policy.
  
• DEAD  HB 1828 - Authorizing certain health professions to act as physician substitutes for plasma source donation centers.
  
• DEAD  SB 6031 - Enhancing public safety and enforcement of crimes that impact insurance.
  
• DEAD  SB 5652 - Reducing environmental and health disparities and improving the health of Washington state residents in large port districts. 
  
• DEAD  HB 2261 - Ensuring transparency in credentials and communications between patients and health care professionals.
  
• DEAD  SB 6107/HB 2425 - Concerning nursing delegation.
  
• DEAD  HB 2098 - Adjusting higher education funding.
  
• DEAD  SB 5985 - Concerning endometriosis. 
  
• DEAD  HB 2100 - Enacting an excise tax on large operating companies on the amount of payroll expenses above the minimum wage threshold of the additional medicare tax to fund services to benefit Washingtonians and establishing the Well Washington fund account.
  
• DEAD  SB 5956 - Addressing artificial intelligence, student discipline, and surveillance in public schools.