Of all the claims and counter claims about the Affordable Care Act (Obamacare) at least one fact is indisputable - there is tremendous pent up demand for health insurance and, if given a reasonable opportunity and the right price, people will sign up for coverage. This has certainly also been our experience here in Whatcom County this fall.
As of the end of November, in two months' time, 6,513 local residents who were previously uninsured had signed up for insurance coverage. That's about 3 percent of the total county population. Looked at another way, 34 percent of all the local uninsured people signed up in just two months. Of all the larger counties in Washington State, the proportion enrolling has been the highest here. In contrast to our 34 percent enrolled, the statewide average at the end of November was 24 percent, still pretty good.
As I write this on a Friday in late December every chair in our waiting room here at Whatcom Alliance for Health Advancement is occupied by people wanting help signing up for coverage. If anything, December has been even busier than the previous two months. What really impresses me and my fellow staff here is the amazing diversity of the people coming in - young and old, every ethnic and language group imaginable including some I did not even know existed here. There are well-dressed people and not-so-well-dressed folks. It is interesting to see how many people have brought along friends and family to help them navigate the complex language of health insurance speak - a language spoken fluently only in America and only by a few of us.
Why have we had such success here in Whatcom in signing people up? After all, we started with one of the lower uninsured rates in our state. I believe it is mainly because success begets more success. Prior to Obamacare we have had concentrated enrollment efforts here dating back 10 years. There are trained people and trusted organizations in our community which can help individuals cut the Gordian knot of health coverage. Interfaith Community Health Centers, the Whatcom Alliance for Health Advancement and SeaMar are all among the leaders statewide in the number of people they have enrolled.
Before this enrollment process began, there was a misconception that people would simply go on-line and seamlessly sign up for coverage. While that day may come in 10 years, it is surely not today's reality for large numbers of people. The vision that buying health insurance could be like buying a book online has proven wildly exaggerated. It turns out that buying health insurance is a bit more complicated than buying a copy of "Moby Dick." And then too there is this emotional component of trusting your health and a large purchase to cyberspace. And there is more: It turns out that many people's lives are too complicated to capture easily in computer algorithms - they have blended families, many tax statuses in a single family, needs for different coverage. And still more, the Insurance Exchange website has been down at least 10 percent of the time and demand has far exceeded anticipated levels, putting even more strain on a fragile system. And so people have turned to other people - us and our partner organizations to navigate these changing and roiling seas. That's why we have done well here in Whatcom. We were ready. But let's not lose sight of the big picture here. By the end of December at least 7,000 of our neighbors will have managed to get it done, to enroll, and that's a really big deal for them and for all of us. Here in our corner of the universe we will manage to at least cut the uninsured rate in half by the end of 2014.
So who is enrolling so far? Through the end of November about 88 percent of all enrollments have been into Medicaid - the state/federal program for the lowest income individuals. The remaining 12 percent have completed purchase of a private insurance product (also called a qualified health plan or QHP), subsidized through tax credits. In December that proportion is changing dramatically as about 20 percent of new enrollment is in qualified health plans. In addition, large numbers of partially completed applications lacking payment are converting to paid status as the individuals and families look to start coverage on Jan. 1. It looks to me as though, when the dust settles, about 25 percent of all enrollments will be into qualified health plans. Over the summer I recall predicting that 40 percent to 50 percent of enrollment would be qualified health plans. Another number to keep an eye on is the average age of those signing up for the private subsidized plans. There is a reason all the insurance company ads show 20-year-olds running to the finish line or skiing down mountain sides. These are the people who keep the average premium low and the profit high. The key here is to do better at enrolling the young and healthy than the insurance company actuaries predicted. We do not yet know the answer to this long-term question though it appears that sign-ups of 55- to 64-year-olds are higher than expected.
As 2014 approaches it is clear that our tattered charity care system provided by doctors and hospitals to the uninsured will shrink as it is replaced by insurance coverage. And even more importantly, for many of our neighbors the reason to delay needed care due to lack of coverage will be far less compelling. As the chaos of the fall settles into realization of actual change achieved, I can only think of Winston Churchill's famous comment about the messiness of democracy: "Democracy is the worst form of government. Except for all the others that have been tried from time to time."
ABOUT THE AUTHOR
Larry Thompson is the executive director of Whatcom Alliance for Health Advancement, a nonprofit health care organization.