Caught in the gap: How Washington residents are navigating health coverage in the midst of a pandemic
The Clarks were moving from
The Clarks are still a few years away from retirement.
In summer 2018,
The couple knew they couldn't afford to keep the house if they had to pay off those debts out of pocket.
"If you didn't have a heart attack going in there, you certainly would have afterwards getting the bill," Mary said.
But then they were referred by
The Clarks qualified for the premium assistance program through Project Access, which enables patients to enroll in an insurance plan without having to pay monthly premiums.
To qualify, patients have to be referred by the hospital that pays for the plan along with donations to the nonprofit. Participants must live at or below 300% of the federal poverty level and file taxes in the
"We help enroll them, and the hospitals give them funds to enroll them in a Silver level plan, which is the most bang for the buck, so hospitals pay for those plans, and so they are invested in it all year," said
"Otherwise we would have had to sell the house, no doubt," Mary said.
Ray changed his diet, began exercising more frequently and lowered his cholesterol. He returned to work the week after his hospital stay. Mary was able to begin physical therapy for her degenerative disc disease, as well as visit a pain clinic and change her eyeglass prescription for the first time in a few years.
Then in
Despite all his work to adjust his lifestyle and keep his heart healthy, he'd had another heart attack.
With his health coverage, Ray finally saw a specialist who figured out an unusual issue that might be causing Ray's problems. He has high levels of lipoprotein-A, which is associated with coronary heart disease. Ray was put on new medicine to help address this specifically.
"The medicine helps stop the blockage and break up the proteins and the fats, platelets and things that plug you up," he said.
The couple was renewed for health coverage through the program in late fall 2018 and 2019 as well . The program covers the premium payments for a Silver plan through the Health Benefit Exchange that families get to choose, but the Clarks are still on the hook for copays for visits and medication costs.
Addressing the gap
The coronavirus pandemic has led many families to reevaluate or consider seeking health coverage, while in the past they might not have sought it out at all.
With no federal penalty for not having health insurance, the uninsured rate in
In January , 6.7% of
This is largely due to the loss of many people's health coverage tied to their employment, according to data from the
Depending on a family or individual's income, they might qualify for
In
About 94% of the Inland Northwest region's enrollment from March to September was for
"We continue to get a lot of calls from people who have skipped on insurance previously because it was too expensive, but now they are nervous," Poulsen said.
In
New public options
Open enrollment for health care coverage offered on the state insurance exchange began this month and runs through
This year
The Health Benefit Exchange began the procurement process for health insurance companies to offer Cascade Care plans early in 2020. Then the pandemic hit.
COVID-19 had a significant impact on the willingness and ability for some insurers to participate in the program, said
There are five insurance companies offering Cascade Care public option plans in 19 counties statewide.
"I feel really happy and pleased we're able to deliver five carriers," Marchand said.
The plans have what is called a "standard benefit design," meaning they will have similar copays and deductibles, as well as plans that cover more services, like primary care, mental health services and generic prescription coverage, before having to meet the deductible.
While getting Cascade Care plans to the finish line was an accomplishment, Marchand acknowledged that it might take a few years for the market to stabilize around a midpoint and drive prices down to a more affordable level.
"What we saw this year was insurance carriers being very conservative to a certain extent in terms of what their offerings were, at least in terms of public options," Marchand said.
State Sen.
And while the initial plan offerings might not have been as bountiful or at the price point imagined, Frockt said the legislation that authorized Cascade Care in the first place ended the way it did in order to become law.
"I think we did everything and got everything out of this particular bill we could have to get it to pass," he said.
Ultimately, driving down health care costs for
"The biggest complaint from my constituents in the marketplace is, 'I'm paying a ton of money for my family and myself,' " he said.
Part of the legislation that authorized the public option plans also included a subsidy study that could address the many
"I think we still have way too many gaps," Frockt said, noting something as simple as losing one's job can put an entire family into the 'uninsured' category.
Health plan enrollment up
Despite the chaos the pandemic has brought to the health care and health insurance industries,
More
As of
So far, Cascade Care plans make up 36% of plans selected.
The Project Access premium assistance program offered to the Clarks and 679 other
This year, the Clarks were worried about getting approved again, due to the influx of need brought on by the pandemic.
Earlier this month, Mary got the call that they were approved.
"We were very, very relieved, to say the least," she said.
The Clarks acknowledge that they are lucky having been referred to Project Access and continuing to access coverage that way.
In the nearly two years when the couple did not have health coverage, it could be stressful, Mary said, knowing that they might have to choose at some point among paying a bill or their mortgage and their health care.
"It's like, well, you know, do I get sick? Do I not get sick? The cost (of health insurance) was just exorbitant, quite frankly," she said. "And I'm sure we're not the only folks in this position."
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