By Aaron Allen, The Seattle Medium
America is the only major industrialized nation without universal health insurance and the consequences are increasingly well known — inequities in access to care, avoidable mortality, poor-quality care, financial burdens on people who are uninsured or underinsured, and lost economic productivity.
Even though there has been a significant decrease in the number of uninsured people in America, there still are disparities that exists when it comes to ethnicity and income. According to data from the Common Wealth Fund, the percentage of uninsured adults (19 – 64) in the Unites States fell from 20.8 percent in 2012 to 12.1 percent in 2021. However, the percentage of uninsured African Americans in 2021 is 13.5 percent compared to 8.2 percent for whites, and it must also be noted that the percentage of uninsured African Americans in 2021(13.5%) is only slightly lower than the percentage of uninsured whites in 2012 (14.8%), just a few years after the Affordable Care Act (ACA or Obamacare) was signed into law.
Since the implementation of the ACA in Washington state, there number of African Americans without health insurance has been cut in half, from 22.4 percent in 2012 to 11 percent in 2021. However, 12.3 percent of African Americans were without health insurance due to cost in 2021 compared to 7.2 percent for whites, and 17.2 percent of all residents who earned under 199% of the Federal Poverty Level were without health insurance due to cost compared to 3.9 percent who earned over 400% of the Federal Poverty Level.
According to Daphne Pie, a Public Health Services Administrator with Public Health Seattle-King County, the number of people without health insurance is not just about barriers, but it is also about the lack of information and understanding of the various insurance options that are available in underserved communities.
“The one thing I can say is this is not about whether people understand the importance of health insurance and accessing health care services, they do,” says Pie. “What we have found is a lack of understanding as to what programs they can potentially be eligible for and the cost. So in marginalized communities if they believe that the only programs available to them is, for example, Apple health or Medicaid, and they know they are not eligible for Medicaid then they go without insurance. That is a lack of knowledge and that’s because the information is not getting to them.”
In an effort to better inform underserved communities, Pie says that outreach efforts/programs to inform the general public about enrollment, access and the cost of insurance has been a top priority of the health department in recent years. This is especially true in areas that lack an adequate number of health care providers for the population they serve.
“We are very strategic in that we create enrollment events within our communities every year,” says Pie. “Last year we did over 200 events.”
“Another barrier that we see, for lack of a better word, is provider desert,” continued Pie. “We have areas in King County where we lack providers that people want to go to. If you look at an area codes like 98118 which is predominately people of color living there, what kind of providers do they have? There is really a lack of providers there.”
“People want to be able to go to a doctor within their community and find the provider that they want,” she added. “So, those are the major issues that we are seeing, the lack of knowledge about what is available to them and really helping clients understand the cost and finding them the right provider.”
Danny Colombara, an epidemiologist for King County Public Health’s Assessment, Policy Development, and Evaluation Unit, says that it is important for people who do not have health insurance through their employer to be proactive when it comes to acquiring health insurance the themselves and their families.
“If you are not getting your insurance through an employer you have to be very proactive and try to get on an exchange which may not be very cost prohibitive,” says Colombara. “You might be eligible for Medicaid that would also take a lot of initiative.”
“Unlike the wealthier or affluent communities where cost is not an issue, there are just extra barriers and a lot more initiative that must be taken. And that’s just talking about American born, but if you’re not American born there are concerns on eligibility that may impact their citizenship,” added Colombra. “So, there are other additional concerns amongst immigrant that don’t exist for native born populations.”
Data experts like Colombra says that you can clearly see the impact of the ACA when it is embraced and properly implemented at a local level. When you look at the numbers in Washington and Oregon compared to other states like Texas and Georgia that rejected key components of the ACA when it was first passed, there is a stark difference in the success rate in reducing the number of uninsured Americans. Both Texas and Georgia still have a relatively high number of uninsured people in their states, at 24.3 percent and 18.2 percent respectively, while the rates in Washington and Oregon are at 9.2 percent and 8.8 percent, respectively.
“If we look at the data after the ACA and when the ACA went into effect, they were pretty dramatic improvements across the board,” says Colombra. “For Washington and the region, there has been dramatic drops across all demographics. It has been universal and a success.”
While their efforts to reduce the number of people without health insurance continue to be successful, Pie says that providing access to qualified health insurance options is only half of the battle, the other half is making sure that people have the proper knowledge so they can take advantage of all the options that are available to them.
“After doing surveys we discovered what people are thinking,” says Pie. “The people are saying ‘we need the information brought directly to us, we need to know what we are eligible for.’ So, when we sit with clients, we actually dive in deeper on what a qualified health plan is and what the cost are, and it makes a difference.”
