In Washington, nearly 1 million residents are uninsured, few part-time and low-income workers get health insurance from their employers, and hospitals and clinics provide more than $1 billion worth of unpaid-for medical care.
That’s where we’re starting from.
A report released Thursday by Washington’s Office of the Insurance Commissioner examines the current state of health-insurance coverage and makes some bold predictions about how the system is likely to improve as a result of the Affordable Care Act (ACA).
The state projects that the fraction of uninsured residents will decrease from more than 14 percent today to 6 percent by 2016. As more people get coverage, the amount spent on charity and uncompensated care is projected to decrease by 25 to 40 percent.
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“It’ll be a challenge. It’ll be a lot of work,” said Insurance Commissioner Mike Kreidler. But he’s optimistic.
The ACA created insurance marketplace exchanges where people can purchase plans that, depending on an applicant’s income level, have discounted premiums and reduced out-of-pocket costs. In addition, as part of the health-care overhaul, Washington expanded the definition of who is eligible for free health care through Medicaid.
Since the state launched its insurance exchange in October, more than 230,000 people have newly enrolled in Medicaid and an additional 86,000 have purchased health insurance through the site. What officials don’t know is how many of the people buying coverage were previously uninsured.
“We’ve really done a good job of attracting people who did not have Medicaid before,” said Sen. Randi Becker, Republican chair of the state Senate’s Health Care Committee. “But what the Affordable Care Act is trying to do is to attract all individuals into having health insurance.
“It’s hard to tell whether all of this will work,” Becker said.
Kreidler expects that as word spreads about the new insurance options — and as penalties for failing to buy coverage kick in — more people will enroll.
“People will say, ‘Do I want to get penalized, or do I want to get something for my money?’ ” Kreidler said.
To avoid the penalty, most Americans will need to get insurance coverage as an individual, through their employer or from a government program such as Medicaid or Medicare. The deadline for enrollment in individual plans is March 31.
The report found that income level was a strong determinant as to whether someone was insured.
More than 40 percent of middle-age adults living close to or below the federal poverty line are uninsured. On the flip side, only 5 percent of those adults who annually earn $46,000 or more are uninsured.
Most state residents below retirement age get their insurance through work. But the report found that workers earning below the state’s median income are much less likely to be insured that way. Fewer than half of full-time workers making between $26,000 and $42,000 a year have insurance through their job. Fewer than 15 percent of part-time workers in that wage bracket have employer-provided coverage.
What does coverage matter? Lack of insurance frequently results in poorer health.
“If you ask people were there times in the past year when you were sick and didn’t seek medical care, people with no health insurance were much more likely to answer that question ‘yes,’ ” said David Fleming, director of Public Health — Seattle & King County.
The report finds that nearly half of uninsured adults have an “unmet medical need,” compared with 10 percent of people who have private insurance.
Young adults are the least-insured age demographic, according to the report, with 26 percent lacking health insurance. Men are less likely than women to have coverage. And 30 percent of Hispanic and Latino residents are uninsured, the highest rate compared with other racial and ethnic groups.
The report, the fourth study on the state’s uninsured since 2006, highlighted the need for more affordable insurance options.
Insurance premiums for families buying their own coverage have increased more than 70 percent during the past decade, while premiums for employees paying their share of employer-provided coverage have doubled.
The report said that by 2016, more than 800,000 residents will qualify for free or discounted health insurance through the state’s exchange, called Washington Healthplanfinder. But the ACA doesn’t provide Medicaid or subsidies for undocumented immigrants, who make up a significant fraction of the state’s uninsured.
Even as the insurance rolls grow, there are still plenty of challenges. Once people are insured, they only benefit if they see a doctor for preventive care and other treatment. There are concerns about whether there will be enough primary-care physicians to tend the newly insured.
“Enrollment is a first step, and we’re having good success here,” Fleming said. “But it is only the first step.”
Lisa Stiffler, a freelance writer in Seattle, can be reached at firstname.lastname@example.org.This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation.