What makes health insurance a public concern?

Adults without insurance are more likely to be poor, unemployed, and to have completed less education. Click to enlarge.

Public health often seems unrelated to medical care. One has its roots in public sanitation, while the other is symbolized by the doctor or nurse with a stethoscope.

But, as the Affordable Care Act begins to produce a reformed health care system, the silos separating these efforts may dissolve, revealing new opportunities for community-based investments, particularly in King County’s least healthy neighborhoods.

After all, access to health care and overall health are inextricably tied. According to data from Communities Count and the Behavioral Risk Factor Surveillance System, people in King County with the most unmet medical needs are also the people who are most likely to be uninsured. They also report the most unhealthy days and the lowest incomes, illustrating the vicious cycle of poverty and poor health outcomes.

King County is targeting these disproportionately affected communities. The central idea is based on fixing the fragmented approach of today, by integrating medical care with all the other things that impact health, as expressed in the King County Framework for an Accountable, Integrated System of Care for Low-Income Residents:

“For low-income residents of King County, the transformed system of care will place the individual at the center. Care will be coordinated through a person-centered medical home—sometimes also called a health home—that provides for or assures a broad range of culturally appropriate, integrated preventive, medical, dental, behavioral health, and social services—with a single point of accountability. This medical/health home will be embedded in a broader integrated system of care that includes access to an array of social services including housing assistance, employment, basic needs, family support services, legal assistance, income assistance, and crisis services. Healthy community environments will encourage recovery and promote individual and community wellness for all residents. The entire system of care will be responsible for the achievement of health and wellness goals for residents, and for managing costs. Proactive work with the payment, regulatory, and information technology systems at the local, state, and federal level will help assure that they support and enable this vision.”


Adults with lower incomes experience more unhealthy days every year.

Having health insurance becomes the glue that holds together the other pieces of the puzzle. This vision was endorsed in 2012 by the King County Health Reform Planning Team, and it motivates the historic outreach efforts in King County this fall, to enroll thousands of people through Washington Healthplanfinder.

In a recent Take the Lead post, Dr. David Fleming, Director and Health Officer at Public Health — Seattle & King County, underscores this framework:

“We can capitalize on this opportunity by partnering with health systems and hospitals, including working to leverage the ACA’s new expectations for community benefit and encouraging investment in community-level improvements in the catchment area census tracts with the worst health indicators.”

The new system should create incentives to invest in making neighborhoods healthier — for example, safer for walking and other types of physical activity, with better food options. As Dr. Fleming explains:

“Underlying poor average health indicators is a more specific problem of substantial local place-based health disparities. The solutions hinge on investment to improve the community-based policies and features responsible for producing poor health. Hospitals, health plans, community health centers, banks, community development corporations and financing institutions, housing providers, public health departments, and community organizations share many key goals.”

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