City council tour de force: 37 presentations in 60 days or less

Where the uninsured are in King County: Maps showing "hot zones" of uninsured residents -- before and after health reform.

Maps showing “hot zones” of uninsured residents — before and after health reform.

Leaders of nearly every city and town in King County are getting prepped for the new health insurance system — and learning how they can turn their piece of the pied county map blue.

Leaving no corner untouched by health reform outreach, King County has scheduled a total of 37 meetings with city councils and unincorporated councils in King County. These presentations brief local leadership about resources available in their communities, including enrollment events and organizations that provide In-Person Assistance.

The briefings also allow communities to see where they stand in terms of the number of uninsured people, and how many stand to benefit from low-cost or free insurance through Washington Healthplanfinder. Data from each city also show a forecast of how the rate of uninsured can improve if outreach efforts succeed. (See below for links to city-level data.)

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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:

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The 4 most basic health reform questions, answered

Public Health – Seattle & King County staff have identified the questions many people seem to have and the answers everyone should know:

1. What’s the Affordable Care Act (“Obamacare”)?
The Affordable Care Act gave each state the option of both expanding Medicaid and starting a “health benefit exchange” in order to reduce the number of uninsured.

2. Who’s paying for this?
The State of Washington opted to extend Medicaid benefits to all individuals who fall within 138% of the Federal Poverty Level (up to $15,865 in annual income). Currently, the state is responsible for covering 50% of the costs of the Medicaid program, but the full costs of the expanded Medicaid program will be covered by the federal government for its first three years. The federal government’s share will gradually decrease to 90% by 2020.

3. What’s an “exchange” and who can use it?
The State of Washington agreed to plan and implement a state-based health benefit exchange, which is a marketplace for individuals and small businesses to compare and purchase health insurance. Individuals and families with incomes that place them between 139 percent and 400 percent of the Federal Poverty Level will be eligible for subsidies (technically a tax credit, but available immediately) through the exchange, making insurance options more affordable. The state’s exchange, called the Washington Healthplanfinder, will begin enrollment on Oct. 1, 2013, and insurance coverage will begin on Jan. 1, 2014.

4. Who’s left out?
Some individuals will remain uninsured, even after Medicaid expands and the Health Benefit Exchange is in place. These populations include undocumented immigrants, who are not eligible to receive Medicaid or purchase insurance through the exchange, and individuals who choose to pay a fine in order to opt out of coverage.

Courts, cooks and health insurance — no stone unturned

Connecting jury duty to health insurance

The strategy for healthcare enrollment initiated by King County Executive Dow Constantine takes the unprecedented step of asking every department and division within county government to help people get insurance.

The Executive notes that more than 180,000 people in King County are living without health coverage.

“In my State of the County address, I set the ambitious goal of full enrollment for those 180,000 uninsured people. To reach them, we are mobilizing every County agency that has direct contact with the public,” Executive Constantine said during an Employee Town-Hall-style meeting.

Courts, schools and restaurants

Each agency has been looking for ways to participate, within their normal business. For example:

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How 23 enrollment partners are reaching niche communities

King County establishes in-person assister community network.

A huge on-the-ground campaign, involving 23 community organizations, will play a central role in getting King County residents enrolled in affordable healthcare insurance. Representatives from each partnering group will be trained as “in-person assisters” — specially certified community members who can help people enroll in the new insurance exchange.

The assisters will focus on providing answers to questions about health coverage options, and how to get financial help that will be offered to qualifying consumers. This is especially important for those folks who are not likely to use a website or call center. Additionally, partner organizations are using their own community ties to augment outreach efforts, making sure that everyone who’s eligible for coverage is connected with the right information and resources.

Coordination for the 23 groups comes from Public Health – Seattle & King County. The organizations not only increase the manpower for health enrollment efforts, they also have experience working with specific hard-to-reach populations, including low-income residents, those with limited English proficiency, and the homeless.

The 23 organizations include:

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King County maps strategy to reach 180,000 uninsured people

Where the uninsured are in King County: Maps showing "hot zones" of uninsured residents -- before and after health reform.

Maps showing “hot zones” of uninsured residents — before and after health reform.

With the help of a map and the support of a lot of outreach partners, the team at Public Health — Seattle & King County is using a unique strategy to find the uninsured residents in their communities.

“We looked at all 39 cities in King County,” says program manager Daphne Pie. “We looked at who is currently doing outreach in those cities and what agencies do we need to reach and how can we ensure that clients wouldn’t have to travel … to get insured.  So we have outreach in all of our cities.”

King County is working with 23 partners to help people enroll in affordable health insurance this fall and winter. They’ll give special attention to neighborhoods and districts with high numbers of uninsured people. This strategy, of geo-targeting and working alongside organizations that have a strong presence in each community, is a unique approach developed in-house.

“We knew we couldn’t do it by ourselves,” says Pie. “(Our partners) are embedded in the communities. They know the communities.”

Lisa Stiffler wrote in a recent Seattle Times article that explains the effort:

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