By Patty Hayes, Director, Public Health—Seattle & King County
As various proposals to replace the Affordable Care Act continue to circulate, here is the yardstick Public Health—Seattle & King County will use to measure any proposals and the potential impacts.
Any reform or replacement for the Affordable Care Act should help people lead healthier lives. We believe that’s the underlying purpose for health care reform (while acknowledging that there are economic and other reasons to reform, as well). We’re tracking four key areas that help us measure each proposal.
For context, the Affordable Care Act (ACA) undoubtedly has improved both access to health care and quality of life for people in King County. Innovative outreach and enrollment efforts led by Public Health have helped reduce the number of uninsured in our county by more than 50 percent since 2013. The rate of uninsured working-age adults is now 7.7 percent, the lowest level ever recorded. For children, the rate is now as close to zero as it can get, under 2 percent.
Measuring up in four areas:
- Maintain or increase health care coverage
Any changes to federal health care law should not negatively impact coverage for the more than 200,000 people in King County who currently have insurance through the ACA. Over time, the number of people impacted by reforms could grow substantially. Any new reforms should:
Make private insurance through the Health Exchange more affordable – not unaffordable. Proposals advanced in the US House (the American Health Care Act, or AHCA) would greatly increase the cost of health insurance for many of the 65,000 people in King County who purchase insurance through our state’s Health Exchange (Washington Healthplanfinder). In particular, lower income adults would have to pay more, even though they don’t have the capacity to do so. Instead, we need steps that keep these Exchange plans within reach for lower income working adults.
Sustain the Medicaid expansion, a source of insurance for more than 150,000 people in King County. Our greatest concern is for the newly eligible adults covered by what is referred to as the Medicaid expansion. The proposed AHCA (as amended in March, 2017) would cut reimbursements for care, freeze new enrollments, and lock out anyone who leaves from re-enrolling. Any reforms must build on the Medicaid program — not undermine it.
Prevent the private insurance market from entering a death spiral. Reforms must consider incentives for all people to get and keep coverage – whether young or healthy or older and sicker.
2. Include health care benefits that keep people healthy
Federal healthcare reform should:
Preserve coverage for Behavioral Health. Currently more than 12,000 people covered through the Medicaid expansion are getting treatment for mental illness or substance use disorder. If people were to lose this coverage or if the Medicaid program must reduce spending, our communities would see increases in people facing mental health or substance abuse crises.
Broaden access to women’s health services. Any federal proposals that reduce funding for family planning, including defunding Planned Parenthood, would remove a key provider of women’s health services for low-income women in King County.
Require coverage of “Essential Health Benefits.” Federal proposals have included reducing the benefits that all private insurance plans are required to cover as a way to make plans cheaper. Evidence suggests this will not substantially lower the cost of insurance. The benefits most likely to be cut from plans include behavioral health and women’s health services, such as contraception. If states are given discretion to cut benefits, it will be incumbent on the Washington State Legislature to maintain the current benefits.
3. Health care system is on a solid footing
The Affordable Care Act stabilized many health care providers and they risk losing revenue if it is repealed. In order to serve growing ranks of uninsured (and under-insured) patients, federal programs should support:
Community & Behavioral Health Centers. Local providers built new clinics and expanded services under the ACA to offer care for newly insured people, but this expansion depends upon reliable and sustainable reimbursements from Medicaid. New funding proposed for these centers is not adequate to compensate for the loss of Medicaid reimbursement.
Hospitals. Hospitals, particularly our flagship trauma center at Harborview Hospital, would see a spike in underinsured patients who cannot pay their bills if healthcare reform reduces access to health insurance. Rising demand for charity care would not be met by funding allocated in the proposed AHCA to account for this trend. Harborview has stated it would see approximately $275 million in annual losses under the AHCA proposed in March.
Emergency Rooms. Without insurance, we know people delay care until an issue becomes urgent, crowding local emergency rooms and impacting everyone in our county, including the privately insured, and driving up the cost of care.
4. Support essential Public Health services
The federal government must continue funding the services currently included in the Prevention & Public Health Fund (PPHF) – which the proposed AHCA would eliminate. The PPHF provides $14 million annually to Washington State. Any replacement must enable King County to continue:
Controlling disease outbreaks. The PPHF supports vaccines for those who might otherwise fall through the cracks. These funds have been critical in confronting an historic mumps outbreak in King County. The fund also supports the investigation of highly resistant bacteria and emerging infections like MERS.
Preventing diseases. Federal support from this fund also enables important health promotion and prevention work that keeps people from getting sick in the first place. For example, the fund supports our efforts to prevent our children from being exposed to lead poisoning.
Promoting overall health. The PPFH creates a foundation that enables King County to enforce smoke-free laws and work with apartment complexes so that, regardless of income, residents have the choice to live in smoke-free housing.
Tracking the consequences & supporting the most vulnerable
Public Health – Seattle & King County will be monitoring key indicators of our health-care safety net and overall health system, such as:
- Insurance coverage; people not seeking care due to cost
- Uncompensated hospital care; affordability of health plans
- Teen birth rates; prenatal care
- Unmet need for behavioral health
Originally published April 30, 2017
Thank you for the excellent article. It is illuminating and motivating to know the impact of the current ACA, and that our Public Health Department is measuring specific important effects of proposals to modify the current law. I hope many people read this very clear overview of what is at stake.
Thank you for laying this out.
I’m curious, do you talk with your colleagues who work under anti-Medicare state legislatures? Have they written appraisals of the risks to the health of their public?
Do you track the percentage of people who avoid treatment because their deductibles are too high? Those that do this are using their health care as a catistrofic plan. They see the doctor for no cost prevention treatments such as annual physicals or Mamagrams but don’t follow through on additional testing due to high deductibles.