Health care reform isn’t reaching everyone

OlympianMarch 11, 2014 

The Washington Healthplanfinder site is the online portal for Washington state's health care insurance marketplace.

The relief of expanded health care coverage is finally being felt by hundreds of thousands of people in Washington state — through Washington’s Healthplanfinder and Medicaid expansion. Even with this progress, there are still too many Washingtonians falling through the cracks, who don’t land neatly in the categories we hear most about.

For example, many low-wage workers who earn just above Medicaid eligibility levels, still struggle to buy and keep coverage through Healthplanfinder, even with assistance in paying for a plan. People with part-time or hourly jobs often have frequent changes to their income, which may also disrupt coverage.

Self-employed workers may have unpredictable income due to contract jobs. The newly employed may also face a transition off of Medicaid and have difficulty maintaining a relationship with their primary care physician.

Another common predicament is the unforeseen costs low-income individuals face when they are understandably attracted to plans with very low premiums. Unfortunately, these plans often have very high out-of-pocket costs. Consequently, patients may forgo necessary care because they cannot pay the deductible or co-insurance — thus making their coverage inadequate. Affordability and continuity of care are critical components of health care coverage for all Washingtonians.

Thankfully our state has a feasible solution to these problems — but the Legislature must act to determine if it’s the right path.

A new initiative championed by Washington state Sen. Maria Cantwell, the Federal Basic Health Option, would allow the state to use federal funds available under the Affordable Care Act to help these low-wage workers afford and keep health care coverage. This initiative was modeled and named after an innovative and successful health insurance program here in Washington, called Basic Health, which was signed into law nearly 20 years ago.

Under the Federal Basic Health Option, the state would use the already-available federal Exchange subsidies to purchase managed care coverage in bulk for low-income residents who are not eligible for Medicaid. By leveraging its purchasing power, the state can increase competition and reduce administrative costs, in turn reducing premiums and increasing insurance for individuals who have been slipping through the cracks.

These are primarily people between 138 percent and 200 percent of the federal poverty level. Depending on the final program structure, an individual earning over $17,000 a year could save nearly $1,200 a year in healthcare-related costs with the Federal Basic Health Option instead of a subsidized Exchange plan, which in reality is unaffordable to them.

These savings of roughly $100 per month would be critical for a person earning less than $1,450 a month who also has to pay for rent, food, utilities, transportation and other necessities. Many of our patients fall into this category — hardworking people, trying to make a go at a small business or piecing several jobs together to support their family.

The Legislature should include funding in the supplemental budget this session to determine if this program is a wise investment for our state, funding both an econometric study of the program’s impacts and the policy design necessary to develop Washington’s Federal Basic Health Option. It’s well worth the effort to explore options to continue keeping health care coverage up and securing it for the future.

At Sea Mar Community Health Centers, a nonprofit health center that has been working diligently to get people enrolled in new coverage, we believe affordable coverage and access to care should be made available to as many people as possible. We’ve spent decades providing high quality care to our community — regardless of their ability to pay.

We’re seeing a significant increase in the number of newly insured patients seeking care at our facilities, but without affordable coverage, many of our patients may not receive the specialty care that they need to live a healthy life.

Let’s call on the Legislature to not leave low-income working people out of the promise of health care reform.

Sean McCliment, MHA, is the clinic manager at Sea Mar Olympia Medical Clinic.

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