Wait list for the Basic Health Plan now exceeds enrollment

There are now more Washingtonians waiting to receive health coverage through the state’s Basic Health Plan (BHP) than are actually enrolled in the program. As of today, the number of people on the wait list for the program reached 79,013, while the number of enrollees stands at 78,830.

The Basic Health Plan provides affordable health insurance coverage for low-income adults in Washington State. According to the Bureau of Labor Statistics, nearly 130,000 jobs have been lost in Washington since the start of the current recession, which began in December of 2007. The BHP provides a crucial backstop for Washingtonians that have lost employer-sponsored health coverage.

Though demand for BHP coverage continues to rise, monthly premiums and annual deductibles charged to enrollees are scheduled to increase sharply in January as a result of budget cuts enacted earlier this year.

In Franklin and Yakima Counties, 28 Percent of the Population Lacked Health Insurance in 2008

According to new data from the U.S. Census Bureau, 13.1 percent of Washington’s population went without health coverage last year. Among the state's 19 largest counties – those with populations over 65,000 – there was significant variation, with more than one of every four Washingtonians in Franklin County and Yakima County lacking health insurance.

Counties with larger populations generally experienced lower uninsured rates compared to the state average. Yet even in King County, one of every 10 residents (10.6 percent of the population) was uninsured in 2008. In addition to King County, Island County (9.5 percent), Thurston County (10.9 percent), and Spokane County (11.8 percent) all experienced uninsured rates significantly lower than the statewide average. In Benton, Clark, Kitsap, Lewis, Pierce, Snohomish, and Whatcom counties the uninsured rate was about the same as the state average.



Of Washington’s most populous counties, Franklin County and Yakima County had the highest uninsured rates in 2008, which stood at 27.7 percent and 27.5 percent, respectively. Residents in the counties of Grays Harbor (16.0 percent), Clallam (16.6 percent), Cowlitz (16.7 percent), Skagit (16.7 percent), Chelan (19.7 percent), and Grant (20.5) were also significantly more likely to lack coverage compared to those in rest of the state.

While today’s data sheds much-needed light on the disparities in health coverage throughout Washington, next year’s data are likely to be far worse. In 2008, the unemployment rate averaged 5.3 percent in Washington. However, the economy deteriorated dramatically in 2009. As of August, the unemployment rate in Washington stood at 9.2 percent, and nearly 66,000 jobs have been lost in the state since January. A BPC analysis of the census health coverage data in 2007-08 shows the employer-based coverage weakened significantly during that period – a trend that will certainly continue throughout 2009.

For information on the uninsured rate among children in Washington State counties, click here to view an analysis from Washington Kids Count and the Children's Alliance.

Editor’s note: The Census Bureau originally planned to release single-year estimates of all indicators included in the 2008 American Community Survey (ACS) today. Due to a coding error, however, ACS poverty estimates will not be released until September 29, 2009. That morning, the Budget & Policy Center along with Washington Kids Count will release an analysis of the latest poverty data from the ACS.

Public Insurance Keeps Uninsured Numbers from Rising, New Census Data Shows

New Census data shows that while the overall share of Washingtonians who lacked health insurance went down between 2000-01 and 2007-08, employer-provided coverage weakened significantly over that time. Public coverage, that is Medicaid, increased during that time, offsetting the decreases in employer-based insurance.

National data shows that in 2000-01, 13.1 percent of Washingtonians lacked health insurance. This number dropped to 11.8 percent by 2007-08. Over that time, the table below shows that employer-sponsored health insurance fell from 67 percent of the population in 2000-01 to 64.6 percent in 2007-08. At the same time, the share of the population covered by Medicaid jumped from 12.1 percent to 13.6 percent.

Before the Census data was released, the Budget & Policy Center, Washington Kids Count, and others expected there would be a decrease in the share of Washingtonians with health insurance between 2000-01 and 2007-08. The news that the share of the population with health insurance actually went up, highlights the importance of publicly provided health care coverage.

During the last legislative session in Washington, lawmakers decided to cut funding for the state’s Basic Health Plan. This will result in a loss of coverage for Washingtonians who do not receive insurance through their employer. At the same time, the unemployment rate in the state has been rising, which means many people who did have employer-sponsored insurance will no longer have coverage. Because of these trends, we anticipate that a drop in the share of Washingtonians with health insurance will become evident in the near future.

Editor’s note: On September 22, 2009 the Census Bureau will release state-by-state estimates of poverty, median income, and health insurance coverage for 2008 from the American Community Survey (ACS). The ACS has a very large sample size, allowing for single-year estimates at the state and county levels. On the 22nd, the Budget & Policy Center and Washington Kids Count will jointly release an analysis of poverty, median income, and health coverage in Washington using the latest ACS data.

The Children's Alliance along with Washington Kids Count posted an analysis of the latest census data looking specifically health coverage among children in Washington. Consistent with the general population, they find that Washington's S-CHIP program (Apple Health for Kids) has kept number of children without health insurance from climbing in 2007-08.

New Census Health Insurance Data Likely to Show Declines in Health Coverage throughout Washington State

Tomorrow, the U.S. Census Bureau will release national and state health insurance data for 2007-2008. The data will provide a preliminary glimpse of the impact that the current recession has had on families in Washington and throughout the nation. The data will not however, capture the full impact of the current economic crisis which deepened dramatically in 2009.

The new Census data is expected to show significant increases in the share of the population that is uninsured since the early 2000’s to 2007-2008. The loss of employer-sponsored health insurance is likely to be the dominant driver behind this trend. During the current recession, the economy sunk rapidly in 2009 and many more people lost their jobs and their health insurance. So while tomorrow’s release will signal trouble, next year’s 2008-2009 health coverage data will undoubtedly be far worse.

For example, as the graph below shows here in Washington the unemployment rate jumped from an average of 5.3 percent in 2008 to 9.1 percent by July 2009. Since the start of 2009, over 64,000 jobs have been lost in the state. As a result, next year’s 2008-2009 data will show a large drop in the number of Washingtonians enrolled in employer-sponsored health coverage.

Stay tuned to schmudget tomorrow when the Budget & Policy Center in conjunction with Washington Kids Count will post an analysis of health coverage trends in Washington using the new Census data. Our analysis will highlight changes in the share of the population without health insurance over time and will detail changes in employer-sponsored coverage and public coverage in Washington State.

Editor’s note: Tomorrow’s release will also include updated data on poverty and median income. To obtain state-level estimates of these measures, however, the Census Bureau recommends using data from a different survey, the American Community Survey (ACS). The latest ACS data for 2008 will be released on September 22, 2009. That morning, the Budget & Policy Center and Washington Kids Count will post analysis of the ACS data on poverty, median income, and health coverage in Washington State.

UPDATE: Basic Health Waiting List Continues to Grow

Last month we posted on the increasing numbers of people on the waiting list for the state Basic Health Plan. As the revised graph below shows, this trend continues. In June there were 31,275 people on the list. Today, there are 38,662.

Will Basic Health Become Unaffordable?

The budget signed by the Governor last month included a 43 percent cut in Basic Health, a program that provides health insurance to lower income Washingtonians. The Health Care Authority (HCA) was given the unenviable task of figuring out how to make the cuts happen.

The HCA considered a number of approaches that would have directly and dramatically reduced the number of people enrolled in the plan. Finally, they settled on sharp increases in premiums and deductibles.*

This option may have some advantages over the alternatives, but it does not mean that people won't end up uninsured. The cost increases are likely to make enrollment unaffordable for many.

The table below compares the current and proposed premiums for a single enrollee aged 40-55 (premiums are on a sliding scale based on income and age). The highest increases are for those earning between $20,036 and $21,660. Their premium would raise by $780, requiring them to spend 11 percent of their annual income on premiums.* Premiums for individuals under $13,538 would double. In addition to the increases shown in the table, the annual deductible will rise by $100.


If Basic Health is made unaffordable, it will no longer serve its purpose as a source of health insurance for people who lack other options, including the 30,000 people currently on the waiting list. That purpose cannot be maintained under a 43 percent budget cut; it will require bold action by state policymakers.


*The Health Care Authority has also identified 5,000 people on the progam who also receive benefits through Medicaid and another 3,000 who the agency believes may qualify for the federal program. They will be transitioned off Basic Health and onto Medicaid.

Basic Health Waiting List Growing by 386 People Per Day

The recently enacted state budget made deep cuts to the Basic Health Plan (BHP), which is the state program that provides affordable managed care health insurance to lower income Washingtonians who do not qualify for Medicaid. Because of the cuts, the number of people receiving health insurance through the plan will be reduced by 36,000.

But disenrolling participants is only one part of the picture. The budget cuts are coming at a time when the need for the BHP is growing dramatically. As shown below, between the end of the legislative session and yesterday, the number of people on the waiting list for BHP has grown by over 14,000 people. That’s an average of 386 per day.


This year the state will take an enormous step backwards in our commitment to ensuring quality and affordable health insurance for all. It is a step that could have been ameliorated by a modest sales tax increase.

Series on the State Budget Crisis: Part Two, Cuts to Vital Programs

As we mentioned in yesterday's post, almost every state in the nation is facing budget deficits because of the weakened economy. The federal American Recovery and Reinvestment Act includes roughly $140 billion in fiscal relief for state governments. But the recovery act funding will only be enough to fill about 40 percent of the $350 billion to $370 billion shortfall that states will face in the next two-and-a-half years.

According to a new report from the Center on Budget and Policy Priorities, at least 36 states have addressed their shortfalls by cutting spending. As the report notes, cuts in state budgets worsen the recession by reducing overall economic activity. Reductions in state spending translate into fewer state jobs, canceled contracts with vendors, lower payments to businesses and nonprofits that provide services, and cuts in benefit payments to individuals.

Importantly, cuts in state spending also particularly hurt the most vulnerable residents in the state. The report outlines five areas in which states have made cuts. Washington State has made cuts in all of these areas.

• Public health programs: At least 19 states have implemented cuts that will affect low-income children’s or families’ eligibility for health insurance or reduce their access to health care services.


• Programs for the elderly and disabled: At least 21 states plus the District of Columbia are cutting medical, rehabilitative, home care, or other services needed by low-income people who are elderly or have disabilities, or significantly increasing the cost of these services.


• K-12 education: At least 22 states are cutting K-12 and early education.


• Colleges and universities: At least 30 states have implemented cuts to public colleges and universities, resulting in cuts in faculty and staff and tuition increases of 4 percent to 15 percent.


• State workforces: At least 39 states and the District of Columbia have made cuts affecting their state workforces. At least 27 states and the District of Columbia have instituted hiring freezes, 10 have announced lay-offs, 15 have reduced state worker wages, and several have delayed scheduled pay increases (including cost of living adjustments).

Click on the chart to see a state-by-state view of cuts in these budget areas.


Tomorrow we will post on states that have raised taxes to help close budget deficits during the current recession.

A Fair Sales Tax for Health and Economic Security

The House Health and Human Services Appropriations Subcommittee passed a referendum to temporarily raise the state retail sales tax from 6.5 to 6.8 cents to generate revenue for essential health care investments. The proposal includes implementing the Working Families Tax Rebate to offset the costs of the tax increase for lower income families. This policy protects the health and well-being of lower income adults and children in Washington during the economic recession and recognizes the need for progressive tax reform in our state.

To read a statement by the Budget & Policy Center on this policy proposal, click here.

For more information on the Working Families Tax Rebate, click here.

Four Facts About GA-U#1: GA-U is an Important Part of Our Health Care System

Today is the first installment in a special series on General Assistance-Unemployable, a state program that provides assistance to adults who cannot work because of disability and are not eligible for other programs.

State investments in health and economic security ensure that everyone can meet basic needs in times of financial hardship. The General Assistance-Unemployable (GA-U) program provides temporary assistance to Washingtonians that are unable to work due to disability. The program plays an important role in the state’s health care and economic security infrastructure by providing medical benefits and modest financial assistance to those who are not served by other public assistance programs.

The medical benefits provided to GA-U clients are part of a larger systemic effort in Washington to broaden access to health insurance. This effort includes lower-income workers who receive benefits through Basic Health to children who are covered under the state’s Apple Health for Kids. Maintaining funding for GA-U reflects our state’s long term goal of expanding access to the uninsured to improve health outcomes and better manage costs.

GA-U clients range from those who suffer from physical ailments stemming from injuries to others with debilitating mental illnesses. Health issues are a primary concern for clients in the GA-U program, many of whom suffer from co-existing physical, mental, and substance abuse problems. There are 21,000 people enrolled at any given month in the GA-U program and clients can be found in every county of the state.

Importantly, GA-U fills gaps that would otherwise exist in our state’s health care infrastructure. Eligibility for other assistance programs is very limited for adults who do not have children at home, even if they are unable to work to support themselves. And federal programs do not cover adults whose disability is considered to be temporary. For these Washingtonians, GA-U provides access to much-needed medical help and the chance to avoid deep poverty and homelessness.

Budget Cuts Hurt Working Families

With unemployment expected to rise to record levels, opportunities to achieve economic security through employment are diminishing. Families who are struggling during these difficult times need state investments in health, education, and economic security more than ever. The proposed budget cuts in the Governor's and Legislature's budgets will come as a double-hit to working families who may no longer have market-based resources to rely on. Two examples are health care and education:

• Health Care - Job loss is often accompanied by loss of health insurance. And during recessions, employers may eliminate coverage in order to save costs. Losing health insurance could have a devastating impact on the health and finances of working families. The proposed state budget cuts would remove access to affordable health insurance for many Washingtonians. For example, Basic Health, a state-funded health insurance program that provides coverage to lower income families is facing cuts that would eliminate coverage for 40,000 people.

• Education -Rising unemployment often increases the demand for workforce training and higher education. These programs have long term benefits for workers and the economy. Even one year of higher education can increase an individual’s lifetime salary and help workers meet the needs of employers when the economy recovers. But the proposed deep cuts to funding for community colleges and public universities will reverse this trend by reducing access to higher education for students and workers in the state.
  

Maintaining Our Priorities
Deep budget cuts are not the only solution to our state's fiscal problems. Washington lawmakers should consider raising revenue to avoid dismantling our important public infrastructures and use the Working Families Tax Rebate to offset the disproportionate impact a regressive tax increase would have on lower income families.

Update on Basic Health Cuts

We argued in a previous post that despite some claims, the proposed cuts to Basic Health will require disenrolling thousands of currently insured members. Steve Hill, the head of the Washington State Health Care Authority agrees that disenrollment will be necessary (see video from TV-W below). They will begin by identifying members who are eligible for Medicaid, but it is likely that many others will become uninsured.

Senate Budget Proposes Devastating Cuts to Basic Health

Basic Health is a core component of the state's commitment to ensuring affordable access to health insurance for all Washingtonians. It is more important than ever in this economy.

The Senate budget proposes reducing the number of people receiving health insurance through Basic Health from 100,000 to 60,000 (see graph).


Often, cuts in Basic Health are reached by closing enrollment; when people leave the program, the state does not open that slot for new applicants. By doing so, the state restricts the availability of public health insurance, but does not immediately kick people off the program.

Contrary to some claims, it is unlikely that limiting new enrollments and other measures will be enough to cut enrollment to 60,000. The Senate budget documents acknowledge this by giving the Health Care Authority the ability to "disenroll" members with incomes as low as $18,310 (for a family of three).

28 Percent of Lower Income Parents Uninsured in 2008

For two decades, Washington State has been a national leader in providing health insurance to those who would otherwise be uninsured. Most recently, policymakers made a commitment to provide health insurance to every child in the state by 2010, a commitment that was put into law with the "Cover All Kids" legislation passed in 2007.

While significant progress has been made in providing health insurance to children, we have not done as well providing health insurance to parents. In early 2008, more than one in four lower income parents remained uninsured, compared to just 6 percent of higher-income parents (see below). Parental health insurance promotes financial security for lower income families and increases the likelihood that more children will be enrolled in public programs and have better access to care.


The graph above likely understates the problem. The data were collected in early 2008. Since then, unemployment in the state has spiked and is expected to reach 10 percent by next year. The proposed deep cuts in public health care investments would come at a time when those investments are more needed than ever.

Community Health Centers and the State Budget

Deep spending cuts, such as those considered in the Governor's proposed biennial budget, would have severe effects on essential components of the state’s health care infrastructure, such as community health centers. Altogether, it is estimated that the Governor's budget would amount to a $250 to $350 million hit to community health center system. The table below summarizes the impact of selected cuts (click on it to see a larger version).


Community Health Centers have a unique role in the state’s health infrastructure. They provide a comprehensive scope of services to Washingtonians who would otherwise have limited access to quality affordable care. And they do so without regard to their ability to pay. In fact, 32 percent of their patients in 2007 were uninsured (see graph)


The cuts described above understate the situation faced by the community health center system because it also faces the impact of the recession. As people lose their jobs and therefore access to private health insurance, they are likely to become uninsured community health center patients. The need for these centers rises while their revenue falls.

Counting up the number of people who will directly lose coverage because of budget cuts also understates the effect on individual health care consumers. As community health centers reduce their services, it will have a detrimental impact on many more Washingtonians with lower incomes and special health needs.

UPDATE: Governor's Budget Proposes Deep Cuts

The Governor’s 2009-11 budget released today proposes deep cuts in all areas of the state budget, including state-funded health care, assistance to people with disabilities, and education. The Governor’s reliance on budget cuts and resistance to options of increasing revenue and ending certain tax exemptions severely limits our ability to pursue important priorities during these difficult economic times.

UPDATE

During a time of broad economic insecurity, the impact of these budget reductions will fall disproportionately on lower income people who are employed or are unable to work due to disability. Twenty percent of the $3.4 billion in cuts in the Governor’s budget focus on two important programs:

• Currently, about 100,000 people receive health insurance through the Basic Health program. The governor’s budget would cut this program by 42%, suggesting that 40,000 or more people would lose health insurance. This cut in Basic Health would mean a reduction of $275 million dollars

• The General Assistance for the Unemployable Program provides health care and cash assistance to 20,000 adults who are unable to work because of disability. This program is entirely eliminated, saving $400 million.