Uninsured rate for King County, 2008-2015. Source: U.S. Census Bereau.

Washington State has been hugely successful at using the tools offered by the Affordable Care Act to help its low-income uninsured residents get the health coverage they need and can now afford. By covering all children with the Apple Health for Kids Act, 96% of children received coverage.[i] In fact, King County now has the lowest rate of uninsured individuals ever recorded due to successful outreach and enrollment efforts (chart below).[ii] But our health system is threatened with each tweet from Trump, and universal access to health care still does not exist for all who live and work in our communities. Many immigrants with low incomes are not eligible for Medicaid or subsidies that make insurance more affordable. Many others who have disabilities or chronic health conditions, are unemployed, or are low-wage workers cannot afford insurance even with subsidies.

We can do better for our neighbors, and the best way to do that is to start locally. We need to develop a plan, similar to Healthy San Francisco, that assures immigrants and others in our community that they can get care when they need it.[iii] To make this a reality, we will work with local government, health clinics, hospitals and other stakeholders to create a program that guarantees access to needed care for low-income individuals who cannot get free or subsidized coverage through Medicaid, Medicare, or subsidized insurance.

Healthy Seattle: A Regional Plan is Possible

  • Cover low-income immigrants and others so they can access care that they need by serve low-income immigrants who are not eligible for full-scope Apple Health coverage or subsidies to buy insurance on the exchange.
  • Create a medical home model in Seattle, where patients choose a primary care provider and clinic or hospital where they get most of the outpatient care they need. Collaborate with health clinics and other community providers that already serve many of the individuals who could get care through a program like this
  • Focus on primary and preventive care while making it easier for patients to get care from specialists and hospitals, when they need it. Fill existing gaps in care by providing access to a broad range of outpatient services, including some that are often unavailable from safety-net providers, like dental care and diagnostic tests.
  • Coordinate registration and screening with community-based agencies that already help individuals apply for Apple Health and Exchange-based coverage.
  • Require that cooperating providers provide culturally appropriate care and equal access for patients with disabilities or whose primary language is not English.
  • Additionally, for small businesses: Advocate for our state HBE to merge the SHOP and individual exchange markets into one risk pools; Simplify small business process by requiring the exchange to do premium aggregation; Require state reinsurance programs to cover small business insurance products.

Creating a program like this will require local government, health care providers, social service agencies, and community leaders to work together and commit to the time and resources needed to make it succeed. But, we know that we can do this affordably as many communities across our country have already created cost-effective low-income health care programs like this with proven results. By working together with our community partners, we can ensure that the promise of affordable health care for all is kept for every [King] County resident regardless of their ability to pay.

Source: policy concepts and research compiled by the Northwest Health Law Advocates.

[i] Children’s Alliance, No Kidding Blog, https://www.childrensalliance.org/no-kidding-blog/new-report-highlights-critical-moment-childrens-health

[ii] King County, Executive Dow Constantine, News Release: “How King County became one of the best Affordable Care Act success stories in the country.” Sept 22, 2017. http://www.kingcounty.gov/elected/executive/constantine/news/release/2016/September/22-uninsured-rate-record.aspx

[iii] Mercury News, April 2, 2017. http://www.mercurynews.com/2017/04/02/san-franciscos-universal-health-care-plan-eyed-as-model-for-california/


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