Health care provision

How is King County doing?

Access to appropriate screening, immunization and medical care and disease management prevents, cures or controls illness and disability. Insurance coverage is a major determinant of access to these services. More than 160,000 adults age 18-64 lack health insurance, about 12 percent of this age group in King County. The current trend is unclear. According to one random survey, the percent of adults who lack insurance has decreased from a peak in 2003, and the number of uninsured has also decreased. But according to another random survey the number and percent of uninsured adults has increased steadily from 2000 to 2008.

The percent of adults who have not received needed health care due to cost has also decreased during this period, and currently stands at 8 percent. Unmet medical need in the uninsured is more than six times more common than in those who have insurance. Approximately 17,000 children (4.3 percent of children) under 18 also lack insurance. Inequities within the county across racial/ethnic and income groups are very large and especially affect Latinos, African-Americans and the poor. The percent of King County adults who have received the recommended clinical preventive services--tests for colorectal, breast and cervical cancer; cholesterol; HIV; had a flu or pneumonia vaccination; or, if a smoker, have been told to quit--varies greatly. For instance, while 88 percent of adults have had a cholesterol test, only 63 percent have had the appropriate colorectal cancer screening and only 41 percent have been tested for HIV (2002-2006 average).

What else influences these indicators?

While most people access health insurance through their employers, the number of people covered by employment-based insurance has been declining nationwide and in King County. Publicly funded insurance rolls have been declining throughout Washington State. Although the Cover All Kids law of 2007 and its newly-passed 2009 amendment improves coverage for children, fewer adults are eligible for publicly funded insurance. Individual policies are unaffordable for most uninsured people. Due to budget reductions, Basic Health Plan, Washington's subsidized plan for low income adults, must disenroll approximately 40,000 members by no later than January 1, 2010. Basic Health Plan enrollment will be on a wait list basis as of May 4, 2009. Coupled with the current high unemployment rates, this will likely result in an increase in the number and rate of uninsured adults.

Availability of providers, particularly those that accept uninsured patients and those with publicly funded insurance, also influences access. Compared to other areas of Washington State, access to care is sometimes easier in King County, as it has the largest number of Community Health Centers providing services to those who cannot afford to pay. Language, immigration status, lack of transportation, fear or distrust of the medical system, and belief systems are other frequent barriers to care.

What role does King County government play?

King County's role is to help assure access to high quality health care for all populations by convening and leading system-wide efforts to improve access and quality, advocating for access to quality health care for all, forming partnerships with service providers, and directly providing individual health services when there are important public health reasons to do so.

As an employer, the county promotes access to wellness and preventive care. It seeks affordability of health insurance through the King County Health Reform Initiative. It plays a leadership role in the Puget Sound Health Alliance, which encourages employers to share health data, best practices, and health promotion strategies to control costs and improve health.

Over the last three years, King County has been leading the effort to expand health insurance and access to needed services for low-income children through the King County Children's Health Initiative (CHI), . CHI supports efforts to find uninsured children and enroll them in publicly-funded insurance, connect them to medical and dental homes and improve their health. County funding for this initiative ends in December 2009. It was hoped that state funding would cover these efforts beginning in 2010, however the state's budget deficit precludes any increase in outreach funding. The CHI program is expected to continue on a smaller scale supported by state, private and federal dollars.