Copyright © 2001 The Seattle Times Company
Editorials & Opinion: Friday, June 08, 2001
Guest columnist

State's health-care arena pits poor against the weak

By Kathleen O'Connor
Special to The Seattle Times

They're back. But, where's the crowd? After not being able to buy an individual health-insurance policy in Washington state for over two years, the policies are back on the market. But folks aren't beating down the doors.

Anywhere from 690,000 to 920,000 people in our state have no health insurance - roughly the equivalent of everyone in Snohomish County on the low side or the combined population of Kitsap and Pierce counties on the high side. But only 14,000 people have bought individual policies since they became available again some six months ago.

By of the end of April, nearly 22,000 people had applied for individual policies and completed the lengthy health screening that was part of the deal to get individual policies back on the market. Over 1,700 did not pass the screen and were referred to the Washington State Health Insurance Pool (WSHIP) - a high-risk program for those who cannot get health insurance elsewhere. But only 240 people have enrolled in WSHIP since January and 144 had to leave the pool because they were too healthy. Another 667 have simply left and gone. Who knows where?

The good news in all this, however, is that now all counties have choices in insurance. They all have the Basic Health Plan, WSHIP and at least one commercial carrier. Ten counties have the choice of only one commercial product: Premera.

While people seem to want insurance, their interest dwindles, presumably, when they learn about the costs. Regence Blue Shield, for example, has received over 25,000 phone calls about its policies, but only 8,000 people requested applications. Their experience is no different from the other plans. In short, we have these individual policies back, but they are simply out of financial reach.

Individual policyholders faced rate increases of 21 percent in 2000; this year, rate increases range from 18 percent to 22 percent. Which means rates can be as high as $360 a month for a non-smoking, 60-year-old male. So, while individual policies are back, they are not affordable.

Now, with the erosion of state funding, the Basic Health Plan (BHP) is not an option for low-income people.

And now, the employers and insurers want the people in the WSHIP to pay larger premium increases.

This means we still have anywhere from 600,000 to 900,000 people without health insurance. They dangle above a fragile health-care infrastructure that is near collapse in some counties. And still no call to action from Olympia.

I have come to the reluctant conclusion that we have so divided ourselves in this state with initiatives that we have lost our sense of what is a good state, a moral state. We have lost our bearings, our moral compass.

We pit teachers against state employees; we pit the young against the old and we pit the poor and the disabled against transportation or education, take your pick. We have let the mob decide by initiative, like the mob decided about which gladiator would live or die - thumbs up, thumbs down.

How so? When it comes to maternity care in the individual market, one compromise was pregnancy - pre-natal care would be covered (the cheap part), but not delivery (the expensive part) if the birth happened before the pre-existing term expired. Which might explain, in part, why 42 percent of the WSHIP applicants in February were under the diagnosis of pregnancy.

The WSHIP Board is now facing resistance from insurers and the business community over premium assessments. The plans want the individual members to pay more of the premium dollar rather than increasing their assessment. They are concerned now that because only the sick and disabled are now in WSHIP - the very group these same people wanted out of the commercial market - that the rates are going to be higher. They think the people in the pool, rather than them, should pay more.

We have once again taken the poorest and sickest among us, and huddled them into smaller and smaller groups, so they are essentially voiceless in an industry that depends on the loudest shout. How have we gone so wrong that we think it is acceptable to pit the poorest and most vulnerable against each other? Tell me how that makes us a better state or society?

The silence from Olympia is deafening. Vox populi vox dei. But even Rome fell.

Kathleen O'Connor is an industry analyst, consultant, speaker and publisher of The O'Connor Report.

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