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Behind the numbers: The ACA and the uninsured

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1. Should we be concerned as a community about the number of people without health insurance in Chelan and Douglas Counties. Why?

2. Will the expanded Medicaid and new subsidized private plans now available to state residents through the ACA have an impact on those numbers?

— Rufus Woods, publisher

By Patrick Jones

Chelan-Douglas Trends

The Affordable Care Act (ACA) is one of the most controversial pieces of federal legislation in a generation.

In contrast to other states, however, Washington State has embraced it. Despite the early glitches in the roll out of the state exchange, Washingtonians have signed up for health insurance at rates not seen in most parts of the U.S.

As of late February, over 323,000 previously uninsured state residents have signed up for some form of health insurance. This represents about 7.3 percent of Washington’s adult population 18-64. Data from the Health Benefit Exchange for the same time period now indicate that 8,632 residents in Chelan and Douglas Counties have signed up, with another 3,478 in Okanogan County. The share of the “take-up” of insurance of all adults 18-64 stands at 10.2 percent for the two counties and about 11 percent for the three counties. By a factor of 3:1, most of the new enrollees are in the Medicaid program.

This embrace of the ACA will go a long way to reduce a glaring disparity in health insurance coverage between the Chelan and Douglas counties and Washington State. As Chelan Douglas Trends indicator 6.11 reveals, the two counties register an uninsured rate for adults that is more than 50 percent higher than Washington’s. Children are not counted in this measure and are likely to have a much lower rate, due to the state’s long-standing commitment to extend Medicaid to that age group. Data come from the U.S. Census and are put together in a three-year rolling average, due to the small population of Chelan and Douglas counties. Consequently, the most recent observation available covers the years 2010 through 2012. For that period, the average share of the two county adult population 18-64 without health insurance of any form was estimated to be 31.2 percent. Over the same time period, Washington State registered a rate of 19.7 percent.

There are no further data that tell us which adult residents of the two counties are most affected. But it is highly likely that Chelan and Douglas counties’ experience is like that of most of the U.S.: those without health insurance are clustered in lower-paying job and at incomes approaching federal poverty levels.

Interestingly, there is little difference in the estimates for the counties. For the 2010-2012 period, the rate of adult uninsured in Chelan County was approximately 30 percent while that of Douglas was about 33 percent.

Will the sign up success at the Health Benefit Exchange start to bend the trend line of the indicator downward? Undoubtedly. In fact, the two counties are on track to halve the rate.


By Malcolm Butler

Medical director, Columbia Valley Community Health

Should we be concerned as a community about the number of people without health insurance in Chelan and Douglas Counties. Why?

Absolutely we should be concerned.

From a financial perspective: People without health insurance, for whatever reason, still get sick, and will still receive care. Someone must pay for that care. Thus the larger the percentage of uninsured, the larger the subsidy that everyone else must pay to reside in this community.

From a compassion perspective: We know that people without insurance have worse access to care, worse health outcomes and shorter lives than people with insurance. Thus we should hope that all of our neighbors and friends have excellent access to care as that (in general) leads to a higher quality of life.

Will the expanded Medicaid and new subsidized private plans now available to state residents through the ACA have an impact on those numbers?

Yes — it already has. We have had over 8,600 people enroll in Medicaid in Chelan and Douglas counties alone.

There is no longer any excuse for a citizen not to be covered. In fact, anyone who is eligible, but elects not to become covered, might be accused of being a freeloader. In the past, insurance often wasn’t available to individuals at any price — now it is.

If insurance is available, and you don’t sign up for it, even though you are healthy, then you are gambling that you will never be in an accident, never get pneumonia, never break a bone, and never develop cancer. You are gambling that the “good people” of Chelan and Douglas counties will care for you. You are gambling that the clinics and hospitals will provide for you in your hour of need, even though you attempted to avoid paying in to the healthcare system while you were healthy.

Therefore, outside of those who are ineligible, every good citizen who doesn’t want to be a free-loader on the healthcare system needs to sign up for health insurance. That should drive down the number of uninsured people to a very low number.


By Patrick Bucknum

CEO of Columbia Valley Community Health

Rural communities see a higher uninsured rate primarily due to the lack of coverage for undocumented immigrants. This will not change with the implementation of the ACA, and may become more exacerbated in comparison to urban communities. This places a responsibility on rural healthcare systems to provide affordable primary care services to undocumented immigrants. If the uninsured lack access to affordable primary care services then they will seek care in the hospital, which is not a sustainable solution for non-emergent healthcare needs. Taxpayers cannot afford to pay for an ER visit every time an uninsured patient needs to see a doctor. We have to offer affordable access to preventative care that keeps the uninsured out of the hospital.

Chelan and Douglas counties have outpaced the rest of the state in our success in enrolling the uninsured that are newly eligible for Medicaid.

These patients are enrolled in the AHAC (Apple Health Affordable Care) programs. These new Medicaid patients are over 30 percent of the Medicaid enrollment in our counties, versus 11 percent statewide. This means we have done a much better job in our community at assisting the working poor who have citizenship to find affordable coverage in the ACA.

It is time for our community to look behind the label of “Obamacare” and understand what has changed for our community, and for our families. There are very few families that do not have at least one family member that is benefiting from the ACA. Whether it be a child in college that is able to stay on their parent’s insurance, or their ability to get coverage despite a pre-existing condition, or their ability to enroll in the Exchange or on Medicaid.

Reach Rufus Woods at 509-665-1162 or .