Shawn Vestal: More people have health coverage, but we need more care providers

It’s a Puyallup-sized ripple effect.

As Obamacare enters its third full year – with new penalties looming and the repeal arguments still sputtering along – it has had an unmistakably major impact in Spokane County. Around 37,000 more people had health insurance in 2014 than in 2013.

It’s like Puyallup picked up and moved here, poised to start seeking doctors’ appointments. But a bunch of new docs did not pick up and move here in 2014, and local health care officials say the system is struggling to absorb new patients.

“I think it’s going to be pretty painful over the next couple of years,” said Alison Carl White, the executive director of Better Health Together. “There are fundamentally not enough providers out there.”

White’s organization is primarily responsible for the dramatic rise in Eastern Washington insurance enrollments under the Affordable Care Act. Better Health Together is an umbrella group of regional health providers run by the Empire Health Foundation, formed to seek and manage funding under the ACA. The organization deployed 300 “navigators” and coordinated with 25 organizations around the region to help people sign up for insurance.

“They’ve done an exceptional job,” said Dean Larsen, CEO of the Spokane County Medical Society. He said Washington and Spokane’s efforts have “been a standard bearer for the nation as far as getting people enrolled.”

But Larsen agreed that the city’s health care infrastructure is straining to keep up.

“The number of providers hasn’t changed,” he said. “We’re continuing to try and bring providers into the area.”

In a town like Spokane – with our hospitals, fledgling medical schools and scores of health care jobs – the effect of all these new patients has been and will be significant. How will efforts to address access problems play out? Will added costs associated with Medicaid be sustainable? What about the remaining population of uninsured people – still significant – and how will the more punitive stage of the law affect them?

At this point, though, Obamacare is delivering on one chief goal: insuring more people.

According to census statistics recently compiled and evaluated by the Community Indicators Initiative of Eastern Washington University, the first year of the Affordable Care Act had a bigger-than-average effect here, driving the uninsured rate down from 17.4 percent in 2013 to 8.2 percent in 2014. In real numbers, that represented an estimated 70,000 people who were uninsured in 2013, falling to 33,000. That drop of 9.2 percent was much bigger than the reduction statewide (4.1 percent) and across the nation (3.5 percent.)

A key piece of all this is that Washington expanded eligibility for Medicaid. This has been a political Mason-Dixon line, with conservative states resisting the expansion. Given Spokane’s many low-income residents, the Medicaid expansion here affected a lot of people – nearly 80 percent of those newly insured early in 2014 were on Medicaid.

By comparison, Idaho – which did not expand Medicaid access – has almost twice the percentage of uninsured residents as Spokane County. Idaho’s uninsured rate went from 20 percent in 2013 to 15.2 percent in 2014, according to federal statistics.

Medicaid patients often report having a difficult time finding providers to accept them. Add this to an already burdened system – where most of us wait months for basic doctors’ appointments. White said that a variety of efforts are underway to attempt to improve access – including increased medical training, programs emphasizing preventive care to free up services, and changes in the model of how we pay for care – but they are likely to take time. In the meantime, our region has provider shortages across the board, from primary care docs to dentists to mental health care, she said.

Programs that focus on low-income patients have seen a surge; the CHAS network of clinics showed a 5 percent increase in the number of patients and a 10 percent increase in “patient encounters” during 2014, according to an agency report.

So far, Spokane County has been a model for how the new law can work toward the important goal of providing people with health insurance. It’s putting down roots, and they are thick ones. But there’s a ways to go before our new Puyallup’s worth of coverage equals care.

Shawn Vestal can be reached at (509) 459-5431 or shawnv@spokesman.com. Follow him on Twitter at @vestal13.