On January 1, 2014, the people of King County will benefit from the most significant advance in health care since the implementation of Medicare in 1965, when the Affordable Care Act (the health care reform legislation approved by Congress in 2010) goes into effect. On that date, most people in King County will be required to have health insurance, including nearly 184,000 people who will be newly eligible for free or reduced-cost insurance through Medicaid or the State of Washington health insurance exchange.

Today some 16.4% of King County residents are uninsured, a lower percentage than the 21% uninsured in the United States as a whole, but still a very large number of people who lack access to quality health care and whose health depends on luck and the emergency room. The Affordable Care Act will help 85% of people who are uninsured through three major mechanisms:

  • Employers of more than 50 people will be required to provide health insurance. This affects few people, since most employers of this size already do this. Employers of fewer than 50 people will receive tax credits if they provide insurance.
  • Low income people with incomes less than 138% of the Federal Poverty Level (FPL), currently $31,809 for a family of four, will become eligible for Medicaid. This will cover about 83,000 uninsured people.
  • An estimated 101,000 uninsured adults with household incomes between 139% and 400% of the FPL will become eligible for subsidized health insurance through Washington Healthplanfinder, our state’s health benefit exchange. These people will be able to select a health care plan from a menu of services and entities, and will be expected to pay a percentage of their income for the plan, with the rest of the cost subsidized. The amount subsidized varies by income level, but a family of four with an income between $31,809 and around $90,000 will be eligible for some assistance.

Only a small portion of the King County population will remain uninsured. Legal immigrants are not eligible for Medicaid until they have been in the US for five years, although they can qualify for coverage under the insurance exchange; undocumented immigrants are not eligible for assistance. There are also a few exemptions from the requirement to purchase insurance, and some people may choose not to enroll.

Two things need to happen in order to make this health improvement program effective. First, people need to enroll in order to get Medicaid and to be subsidized under the exchange. Enrollment in both of these opens on October 1. Education and assistance campaigns will begin in June to give people information and help them prepare to make decisions and join the system. This planning is coordinated and largely funded through the State. In King County a coalition of organizations and businesses is already in place and developing this campaign.

The second, and more challenging, task is to ensure that there will be enough services and providers to handle the expected new patients. Pressure on emergency services will be reduced, saving money and potentially freeing service providers who can be redeployed to other areas. However, it is likely that many people will seek a variety of new services, and some will be entering the health care system for the first time. The challenge of creating medical records and providing those services will be significant.  In principle, there will be funding available to cover these costs, but getting the dollars to the right places to match the new services that are being used will be a challenge, and no one can guarantee that there will be an exact match. And, even if the dollars flow appropriately, finding and hiring staff and providing facilities and equipment takes time and organization.

Intense planning is going on in the health care system to ensure that things work as smoothly as possible. It’s exciting, and also a bit scary! But the benefits will be incredible – a healthier society where so many more people have access to services and where children and adults can be freed from the risks of uncertainty and ill health to become productive and happier members of society.