Feb. 19--Health advocates say they're hopeful the trend of uninsured and underinsured residents relying on emergency rooms for care will reverse once a state-run health insurance exchange opens for business in 2014.

The exchange is how Washington is choosing to implement some provisions of the Affordable Care Act passed by Congress in 2010. It will offer subsidized private health insurance to eligible residents, who will pay a percentage of their income as premiums, said Richard Onizuka, the exchange's CEO.

That should help reduce the ranks of the almost 39,000 uninsured adults under age 65 living in Benton and Franklin counties, according to website www.countyhealthrankings.com.

The website estimated the number of uninsured in Benton County at 21,528, or 14 percent, and Franklin at 17,313, or 24 percent.

Compared with 2010 estimates from the same website, the number of uninsured adults in both counties increased over a two-year period. In 2010, 13 percent of Benton and 19 percent of Franklin adults were uninsured.

Carol Moser, executive director of the Benton-Franklin Community Health Alliance, said when people are uninsured, they're less likely to seek preventive care or have a family doctor.

"If they wait until they're really, really sick to seek care in an emergency room, it's more expensive," Moser said. "We're trying to address people getting access to health care. We see the exchange as critical."

The Office of the Insurance Commissioner estimates that almost 500,000 of the more than 1 million uninsured Washingtonians will be eligible for subsidies to help them buy health insurance through the exchange. Another 328,000 may be covered through a federally funded expansion of the Medicaid program for low-income people.

The Affordable Care Act in 2014 will require most people to have health insurance or pay a penalty to the federal government.

Part of the act required states to decide by Friday whether to set up their own insurance exchanges, enter into a partnership with the federal government to create an exchange, or leave the creation of an exchange entirely in federal hands.

Washington is one of 17 states opting to set up its own exchange, and began that work by legislative action in 2011. Seven states plan to enter into partnership with the federal government, while 26 states have chosen the all-federal option, the Washington Post reported.

Onizuka said the framework for Washington's exchange -- which is intended as an online marketplace where people can buy private health insurance -- has been designed and built, and is ready to test.

The exchange is a public-private partnership that functions in some ways similar to a state agency -- it's subject to the public records and open meetings acts, for example -- but is entirely self-contained and separate from the state. It has its own board and its own payroll, and no one who works there is employed by the state, he said.

A grant will support the exchange through 2014, but in 2015 it will be required to be self-sustaining.

Initially, plans will be offered for individuals and small companies with fewer than 50 employees. Eventually, it will become open to large companies.

There will be several tiers of health coverage so that consumers can choose what level of coverage they want and are willing to pay for, Onizuki said.

The online system called Washington Healthplanfinder will allow them to browse and compare plans anonymously. For individuals and families who qualify for the subsidy, the premium will be a percentage of their income.

Consumers must be legal residents or citizens of the United States to qualify, Onizuki said.

Judith Gidley, executive director of Community Action Connections in Pasco, said the subsidy will mean that many of the low-income Tri-Citians her agency serves will be able to afford health insurance and gain better access to health care. Many of them have no insurance now.

"I think it's going to be a really good deal for our clients," she said.

-- Michelle Dupler: 582-1543; mdupler@tricityherald.com; Twitter: @mduplertch

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