If you live in Washington, or you’re thinking about moving there, you’re probably curious about issues that impact the overall health of the state’s residents. There are numerous factors that might affect how you view the state’s approach to providing health coverage and healthcare, including Washington’s state-based exchange and decision to expand Medicaid. Here’s a partial list for your consideration.
Washington health ratings
In 2015, America’s Health Rankings rated Washington 9th among the 50 states, an improvement from 13th in the 2014 rankings. While the state did not rank No. 1 for any measures, it was among the top 10 for many, including clinical care (i.e., dentists, primary care physicians, low birthweight, and preventable hospitalizations).
The Commonwealth Fund’s Scorecard on State Health System Performance 2015 rated Washington 10th out of the 50 states and District of Columbia, a gain of five spots from 15th in 2014. Some of the health indicators for which it improved were: adults ages 19–64 uninsured; children ages 0–18 uninsured; adults who went without care because of cost in the past year; and adults with a usual source of care
The state’s scorecard includes additional details on how the rankings are calculated.
Additional information is available regarding the state’s specific disease incidence in a summary put together by Trust for America’s Health. The details for Washington are in the 2016 listing of Key Health Data About Washington.
You can also view Washington health data on a county level with this interactive map that ranks the counties in Washington based on their overall health outcomes and health factors.
2017 Washington Healthplanfinder rates, carriers
Washington’s exchange started out with eight carriers in 2014, grew to 10 in 2015 and 11 in 2015. At the end of 2016, Health Alliance Northwest is leaving the exchange and UnitedHealthcare of Washington is leaving both Washington’s exchange and the individual market. That leaves nine carriers with plans available through Washington Healhtplanfinder in 2017. The include the following:
- Community Health Plan of Washington
- Coordinated Care
- Group Health Cooperative
- Kaiser Foundation Health Plan of the Northwest
- LifeWise (a Premera affiliate)
- Molina Healthcare of Washington
- Premera Blue Cross
- Regence Blue Shield
These carriers requested rate increases ranging from 7.4 percent (Coordinated Care) to 20 percent (Premera Blue Cross). Premera currently has the largest segment of Washington’s exchange enrollees: 22 percent.
How has Obamacare helped Washington residents?
Since the Affordable Care Act took effect in 2013, Washington has seen one of the nation’s greatest reductions in percentage of uninsured residents.
In 2012, about 16 percent of non-elderly Washington residents were uninsured. Various studies have projected nearly a 50 percent decrease as a result of Obamacare, anticipating an uninsured rate of just 8.27 percent following ACA implementation. That would put Washington in 9th place in the U.S. for lowest total uninsured rate.
At the end of 2014, Washington had already come close to that mark. According to a Gallup poll, Washington’s uninsured rate had dropped to 10.1 percent following the first Obamacare open enrollment period. Washington’s drop in uninsured rate during 2014 was the fourth biggest improvement among the 50 states.
By late-2015, Washington’s uninsured rate dipped even lower to 7.4 percent, a 9.4 percentage point change in uninsured from 2013 and the sixth biggest improvement among the 50 states.
Washington enrollment in qualified health plans
In late 2013, shortly after open enrollment began, the Kaiser Family Foundation estimated the potential market for the exchange in Washington to be 507,000 residents, and that 272,000 of them would likely be eligible for subsidies to lower their premiums.
When the first ACA’s open enrollment period ended, mid-April 2014, a total of 163,207 people had completed their enrollments in qualified health plans (QHPs) through Washington’s exchange, Washington Healthplanfinder.
Although several thousand more people enrolled after open enrollment began as a result of qualifying events, total enrollment in private plans had dropped to 147,888 people as of the end of July 2014. This attrition rate is to be expected, as people move in and out of the individual market on a regular basis.
Washington’s elected officials and the ACA
In 2010, both of Washington’s U.S. Senators – Maria Cantwell and Patty Murray – were supportive of the health reform law. Both are still in the Senate.
In the House, the six Democratic representatives voted yes and three Republican representatives voted no. The U.S. House currently includes ten Representatives from Washington: The six Democrats are supportive of the ACA, while the four Republicans support either full repeal or significant modification of the law.
Gov. Jay Inslee, a Democrat, is very supportive of the ACA and has enthusiastically worked with his state officials to implement the law in Washington. The state is running the Washington Health Benefit Exchange and also opted to expand Medicaid.
When the ACA was implemented in 2014, Washington accepted federal funding to expand Medicaid eligibility to those earning up to 138 percent of poverty. In early 2014, the Kaiser Family Foundation estimated that about 47 percent of the uninsured population in Washington would be eligible for expanded Medicaid or CHIP.
By the end of July 2014, 1,135,782 people had enrolled in Medicaid through the Washington exchange. But only 552,017 of them were new enrollees. The rest were existing Medicaid beneficiaries who were renewing their coverage through the exchange – all Medicaid enrollments and renewals are now processed through Washington Healthplanfinder.
As of June 2016, Washington’s monthly Medicaid enrollment had grown 59 percent from late 2013, which is the seventh largest increase among the 50 states and District of Columbia.
These numbers will continue to change since Medicaid enrollment continues year-round.
Does Washington have a high-risk pool?
Before the ACA brought guaranteed issue health insurance to the individual market, plans were underwritten in nearly every state. Pre-existing conditions could prevent an applicant from getting a policy at all, or could result in significantly higher premiums or policy exclusions. The Washington State Health Insurance Pool (WSHIP) was created in 1987 to provide people with an alternative if they weren’t able to get private health insurance because of their medical history.
Now that the ACA has been implemented, all health insurance plans are guaranteed issue, largely eliminating the need for risk pools. But WSHIP is one of a few state-run pools that is still operational and will be for the next few years – and indefinitely for some Medicare enrollees.
The pool closed to most new non-Medicare enrollees at the end of 2013, but existing members can stay on the plan until the end of 2017. Under some conditions, WSHIP is continuing to enroll Medicare members as well as some non-Medicaid eligible applicants.
Medicare in the Evergreen State
As of 2013, about 85 percent of Washington Medicare recipients were eligible based on age alone, while 15 percent qualified as the result of a disability.
Medicare Advantage plans offer Washingtonians an alternative to Original Medicare. These plans are an option for consumers who want additional benefits beyond what traditional Medicare offers. 32 percent of Washington Medicare beneficiaries selected a Medicare Advantage plan. Nationally, 31 percent of Medicare enrollees choose Medicare Advantage.
37 percent of Washington Medicare beneficiaries also have a Medicare Part D plan to gain stand-alone prescription drug benefits. This number is much lower than overall percentage of U.S. Medicare beneficiaries who select Part D coverage: 45 percent.
State-based healthcare reform legislation
The Washington legislature has been very active in the area of healthcare, addressing numerous issues that impact public health. Here’s a summary of recent Washington bills related to healthcare reform:
- Washington Senate Bill 6089 was signed into law on July 6, 2015. This bill concerns exchange funding and involved much back and forth among lawmakers. The exchange must actively work to lower its costs, and money allocated for the exchange will come from state general funds ($11 million) and federal funds ($40 million), along with $58 million from the Washington Health Benefit Exchange Account – that account is funded by a 2 percent premium tax on health insurance plans and a per member per month carrier assessment.
Other state-level health reform legislation includes: