In 2007, nearly 12.5 percent of Washington residents reported they were unable to see a doctor when necessary due to cost. Between 2003 and 2009, the health insurance premiums increased 38 percent for both family and single health plans.  Of the Washington residents who do have health insurance, 50 percent are covered through their employment. Public programs such as Medicaid and Medicare insure 31 percent of the population, and five percent of Washington’s citizens purchase individual private policies. Nearly one million people in Washington, 14 percent of the population, are uninsured. 
Who are the uninsured in Washington?
At all income levels, seven percent of Washington’s children are uninsured. This figure doubles to 14 percent for children living in households with incomes less than 139 percent of the Federal Poverty Level (FPL). Non-elderly adults, those younger than 65, living in these lower income homes are uninsured at a rate of 41 percent. 
Non-elderly Native Americans are uninsured at a rate of 23 percent in the state. Ten percent of Washington’s non-elderly Black population lacks health insurance. Among the non-elderly Hispanics, the uninsured rate is 21 percent. The uninsured rate for Whites in Washington is 12 percent, according to the 2008 Washington State Population Survey. 
How does the Affordable Care Act affect Washington residents?
The Affordable Care Act (ACA) requires states provide access to an online marketplace, also called an exchange, where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government. In December 2012, the U.S. Department of Health and Human Services gave the state conditional approval to operate its own exchange.
Under ACA, all new policies, and in-force policies upon renewal, must cover a package of essential health benefits, including hospitalization, emergency services and mental health treatments. Annual wellness checkups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the FPL may be eligible for tax credits to offset premium costs. A Families USA 2010 report estimates nearly 600,000 Washington residents are eligible for insurance premium tax credits.
Washington’s health insurance exchange
In May 2011, Governor Christine Gregoire signed into law legislation creating the Washington Health Benefit Exchange. The exchange, named Washington Healthplanfinder, is governed by an 11-member board of directors as an independent agency. Plans offered through Washington Healthplanfinder will cover essential health benefits based on Regence Blue Shield’s Regence Innova plan. The exchange will operate as a clearinghouse for all qualified health plans. In a May 16, 2013 press release, the Washington Health Benefit Exchange announced that nine insurers have submitted 57 qualified health plans with 229 plan options for inclusion in the Washington exchange. Washington residents may shop for and enroll in health insurance plans at Washington Healthplanfinder.
Plans are offered in four categories of coverage levels, with the least expensive plan, the bronze tier, covering 60 percent of medical costs. Plans in the silver tier cover 70 percent of costs. Gold plans cover 80 percent. The most expensive tier, platinum, covers 90 percent of medical costs. To estimate premium costs and subsidy eligibility, access the Health Insurance Cost Calculator.
Small Business Health Options Program (SHOP)
Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.
Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.
For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. Washington small business owners may access SHOP through Washington Healthplanfinder. For more information about the ACA and small businesses, visit the U.S. Small Business Administration.
Resources for Washington residents
- Washington Healthplanfinder
- Centers for Medicare & Medicaid Services
- Cover USA.org
- The Kaiser Family Foundation
- State Refor(u)m
- Washington State Health Care Authority
- Washington State Office of the Insurance Commissioner
 http://www.census.gov/hhes/www/poverty/publications/pubs-cps.html (CPS Annual Social and Economic Supplement or ASEC)
Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.