Even during economic upswings, the number of Washingtonians without health insurance just keeps climbing as businesses reduce coverage. In 2002, three out of four Washington employers offered health coverage to full-time employees; as of 2010, only just over half were still offering health insurance. While nearly 7 in 10 Washington residents under 65 received employer-sponsored health insurance in 2001, just 6 out of 10 did so in 2010.
Washington’s Basic Health Plan is designed to fill the gap, but years of budget cuts have reduced enrollment from a high of 135,000 in 2002 to just 35,000 today. Today, over 157,000 Washington residents who qualify for Basic Health are wait-listed – while state legislators debate yet more cuts to the program. But further budget cuts won’t just undermine Basic Health – it may also harm the state’s still-fragile economic recovery, since the available data indicates that every $1 million invested in health care funds approximately 14 jobs across all sectors in Washington.
The weakening pulse of health insurance coverage in Washington
Employers are shifting costs for health coverage to their employees, and employer-provided health coverage rates have fallen even in periods of economic growth.(1)
In Washington, the proportion of employers offering health coverage to full-time employees dropped from 76% in 2002 and 2003, when the state was coming out of a recession, to 66% in 2007, when the state was experiencing strong economic growth. In 2010, just 54% of employers offered health coverage to full-time employees.(2) The share of Washingtonians under 65 receiving employer-sponsored health insurance fell from 66.9% in 2001 to 60.6% in 2010.
In 2010, nearly one million Washingtonians had no health coverage. Among adults aged 18-64, the rate of uninsured is now 22.4%, up from 20.8% in 2009 and 17% in 2008.(3) At least one in four Washingtonians are under-insured, according to the Washington State Office of the Insurance Commissioner (OIC) (4), and the rate of uninsured is not expected to drop when the economy recovers.(5)
Designed to fill the gap, Basic Health now undermined by repeated budget cuts
Washington’s Basic Health Plan (BHP) has provided medical insurance coverage for low-income Washington workers for nearly 25 years. The state subsidizes health insurance for eligible residents, who share costs by paying monthly premiums, annual deductibles and co-pays to receive care.
Premiums are based on gross family income – to be eligible, individuals and families must have income below 200% of the federal poverty level, or $3088 per month for a family of three.(6) Health care is provided by the private sector; organizations that partner with the state include Community Health Plan, Group Health and Molina.
Basic Health became a permanent state program in 1993. In 1995, the Republican-controlled Legislature retained and expanded Basic Health, even while dismantling Washington’s implementation of universal health coverage. At that time 37,580 Washingtonians were enrolled in Basic Health. By 1997, enrollment had rocketed to 124,348.(7)
As enrollment continued to rise in the years that followed, Washingtonians demonstrated their support for Basic Health. In 2001, voters overwhelmingly approved a tax initiative that dedicated the bulk of its revenue to expansion of Basic Health coverage: Initiative 773. The measure, which increased the tax on cigarettes by 60 cents, was approved by two-thirds of voters with the intent to increase the number covered by Basic Health to 175,000 residents.
However, over the last decade Basic Health has become a regular target for spending reductions; state lawmakers have decreased funding and lowered enrollment levels. As a result, coverage has fallen dramatically; in less than 10 years, about 100,000 people have lost Basic Health benefits. As the rate of uninsured has climbed, the wait list has swelled. Officially established in May 2009, the wait list has grown to more than four times the number of enrolled in just two and half years.(8)
Basic Health: A strategic investment in jobs and productivity
Basic Health doesn’t just protect the economic security of tens of thousands of workers in or near poverty – it also protects thousands of jobs in the health care sector, and helps maintain Washington’s economic productivity.
A healthy workforce is a productive workforce. The Commonwealth Fund found that worker health issues resulted in national annual economic losses of $260 billion, or 2.4% of gross domestic product (GDP). Commonwealth concluded that providing health coverage boosts worker productivity by increasing access to important preventative care, and maintaining worker health is a positive economic investment.(9)
Health care is a key sector of the economy in most regions of the state.(10) Not only do health care dollars directly impact local economies, they also support workers who put earnings back into the economy. This creates an employment multiplier effect: as workers spend their income, it indirectly maintains and generates job opportunities throughout the state. In Washington, every $1 million invested in health care funds an average of 14 jobs across all sectors.(11)
1. John Holahan, “The 2007-2009 Recession and Health Insurance Coverage,” January, 2011, Health Affairs 30, 1 (2011): 145-152.
2. Washington Employment Security Department, “2010 Employee Benefits Survey Report,” Labor Market and Economic Analysis, August 2011.
3. U.S. Census Bureau, 2010 American Community Survey, Tables DP03 and B27001 for Washington.
4. Mike Kreidler, “State of the uninsured: Health coverage in Washington State,” December 2011, Office of the Insurance Commissioner, www.insurance.wa.gov.
5. Mike Kreidler, “A problem we can’t ignore: The hidden and rapidly growing costs of the uninsured and underinsured in Washington State,” November 2009, Office of the Insurance Commissioner, www.insurance.wa.gov.
6. Washington State Health Care Authority, http://www.basichealth.hca.wa.gov/.
7. Washington State Office of Program Research, February 2, 2011 presentation to the House of Representatives Ways and Means Committee, http://apps.leg.wa.gov/cmd/default.aspx?cid=WAYS.
8. Washington State Health Care Authority, data request, received December 9, 2011.
9. Karen Davis, et. al., “Health and Productivity Among U.S. Workers,” August, 2005, The Commonwealth Fund, http://www.commonwealthfund.org/usr_doc/856_Davis_hlt_productivity_USworkers.pdf.
10. Mike Kreidler, “A problem we can’t ignore: The hidden and rapidly growing costs of the uninsured and underinsured in Washington State,” November 2009, Office of the Insurance Commissioner, www.insurance.wa.gov.
11. Office of Financial Management, “The 2002 Washington Input-Output Model,” http://www.ofm.wa.gov/economy/io/2002/default.asp.