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 2014, America’s Health Rankings rated Washington 13th among the 50 states. The state earns high marks for having a low rate of uninsured, a high presence of primary care physicians, an active population, infrequent incidence of preventable hospitalizations and a low prevalence of low birthweight. Despite being among the healthiest in the nation, at least according to this ranking, the state struggles with a large disparity in health status by educational attainment, as well as a high rate of drug deaths and pertussis.
The Commonwealth Fund’s Scorecard on State Health System Performance 2014 rated Washington 15th out of the 50 states and District of Columbia, a gain of three spots from 18th in 2009. Washington‘s Scorecard includes 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 2014 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.
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.
How did Obamacare help Washington 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 mid-2015, Washington’s uninsured rate dipped even lower to 6.4 percent, a 10.4 percentage point change in uninsured from 2013 and the fifth 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. 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. This attrition rate is to be expected, as people move in and out of the individual market on a regular basis.
Following the second open enrollment period, 170,000 had enrolled in QHPs – 16,000 of them during a special enrollment period made available from February 17 to April 17. However, by mid-year, as happened in 2014 and as happens elsewhere in the country, enrollment dropped. On June 30, 2015, effectuated enrollment for Washington’s exchange was 164,280. Of those remaining, 77.8 percent were enrolled in health plans with advanced premium tax credits and 42,7 percent were receiving cost-sharing subsidies.
Twelve carriers will offer 2016 health plans through Washington Health Benefit Exchange. Until just days before open enrollment, there were to be 13; however, Moda Health announced its exit from the Washington market on October 28. The 12 remaining carriers are as follows:
- Columbia United Providers (Clark County only)
- Community Health Plan of Washington
- Coordinated Care
- Group Health Cooperative
- Health Alliance Northwest
- Kaiser Foundation Health Plan of the Northwest
- Molina Healthcare of Washington
- Premera Blue Cross
- Regence Blue Shiled
- UnitedHealthcare of Washington
Not all carriers will offer plans in all areas of the state; however, the options available to Washingtonians have increased significantly since 2014. The average rate increase among Washington’s exchange plans for the individual market will be 4.2 percent for 2016.
federal funding to expand Medicaid eligibility 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.
As of 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.
Washington Healthplan finder announced that between October 1, 2014, and September 30, 2015, the exchange enrolled more than 1.4 million Washington Apple Health (Medicaid) eligible individuals. By August 2015, Washington’s monthly Medicaid enrollment had grown 55 percent from late 2013, which is the sixth 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.
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.
Medicare in the Evergreen State
Historically, about 83 percent of Washington Medicare recipients qualify based on age alone, while 17 percent qualify for Medicare as a result of a disability.
In Washington, Medicare spends about $8,496 per enrollee each year and ranks 20th in terms of overall spending with $8 billion annually.
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. Thirty-percent of Washington Medicare beneficiaries selected a Medicare Advantage plan. Nationally, 32 percent of Medicare enrollees choose Medicare Advantage.
Thirty-six 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: 43 percent.