New health insurance market opens in Washington state in October

SEATTLE— Another aspect of President Barack Obama’s health care law will go from concept to reality this fall as Washington state residents who don’t have health insurance will become eligible for Medicaid or gain access to a new insurance exchange.

Some questions and answers on where the health care law stands in Washington state:

How many people are uninsured in Washington and how many of them are projected to get insurance under the Washington Health Benefit Exchange?

About 1 million Washington residents are uninsured, or about one in seven people who live in the state. Officials do not know the total number who will benefit from an expansion in Medicaid coverage or will buy health insurance through the state’s new exchange, which opens in October. State officials estimate that by 2017, insurance coverage obtained through Medicaid and the exchange is expected to reduce Washington’s uninsured rate to less than 5 percent.

How many people are served by Medicaid in Washington state and how many more will be served by a proposed expansion?

About 1.2 million Washington residents are currently served by Medicaid. Another 75,000 are eligible for the free health insurance for low-income people but do not participate, said state Health Care Authority spokesman Jim Stevenson. About 250,000 will be newly eligible on Jan. 1, 2014, under new rules that set the bar at 138 percent of the federal poverty level. If everyone who is eligible signs up for Medicaid, state officials expect to add about 325,000 over the new few years.

How is the exchange being set up in Washington?

A new public-private partnership called the Washington Health Benefit Exchange is setting up an online marketplace called the health plan finder. It will allow people to compare plan and enroll as individuals, families or small businesses. It was created by the Legislature in 2011. Rules were refined by another bill in 2012. It is governed by a board of volunteers with experience in health care, economics or actuarial science.

How is it being paid for?

Federal dollars are paying for setting up the exchange. Washington has received grants totaling more than $150 million so far. About 50 people currently work at the exchange, and that number is expected to reach 100. Nearly $10 million has been set aside for marketing and outreach, including paid advertising starting in late summer.

Beginning in 2015, the exchange will be required to be self-sustaining, with estimated expenses totaling about $50 million in 2015. How that will happen will be a topic of discussion during this year’s Legislature. A monthly fee of nearly $13.69 per participant per month, which would add up to the costs of running the exchange, is being discussed along with other approaches.

How will people access the exchange?

Although its main interface will be online, people will also be able to access the exchange by fax, mail, telephone and in person.

The Affordable Care Act requires that the exchange build relationships with local groups to help them with outreach and to also assist people who need help signing up for insurance, said Michael Marchand, spokesman for Washington health plan finder. These groups, called navigators, will likely be local nonprofits that help people in a certain community. The Health Benefit Exchange will be asking groups to apply for navigator grants soon. They’ll be trained and certified to help people navigate the exchange but they will be prohibited from giving advice about which plan to join. Insurance agents and brokers also will have access to the exchange and people who want more advice can turn to them, but they will have to pay these private companies a fee for their advice.

How will the online site work?

People will be able to search by cost, of course, but the interface will be much more sophisticated and potentially more confusing for people who would prefer not to have so many choices. They will be able to narrow their search to see what plans their own doctor will accept. They could search by name brand or type of plan and by what services are covered such as mental health and physical therapy.

Online they’ll find links to places where they can get extra help, on the telephone or in person and eventually the site will include a live chat feature for immediate help. People who enter their information into the system may also get a few nice surprises, such as a determination that they are eligible for Medicaid or for help paying their premiums.

Will the exchange be ready to start enrolling people by the Oct. 1 deadline?

Absolutely, says Marchand. But the program will continue evolve in the future, as will its online presence.