Seeking solutions to the health-insurance quandary

OLYMPIA — Six years ago, Stephenie Jekel and her two children were living in a homeless shelter. They were broke and desperate but had health insurance through Medicaid.

Now Jekel is the busy owner of the Java Flow Coffee House in Olympia and two drive-through coffee outlets in Thurston County. Jekel's stores bring enough income that her family no longer qualifies for free insurance — but not quite enough that she can afford coverage on her own. Jekel decided to forgo insurance for her family and apply the $400-a-month savings toward providing her dozen workers, many of them single mothers, with subsidized health plans.

"A happy employee is a good employee," Jekel said. But she added, "I worry about going without" coverage.

As the state Legislature convenes today, Olympia is awash in ideas about how to dramatically expand health coverage for people like Jekel and her family.

Nationwide, an estimated 47 million people — including nearly 600,000 Washingtonians — lack health insurance.

Lawmakers in other states have made landmark strides toward offering universal health-care coverage. A similar effort is under way in Oregon.

In Washington, a slew of proposals — ranging from allowing parents to keep children on their health plans until age 25 to combining state employees, private individuals and the working poor into a megapool to negotiate insurance discounts — could bring about some of the state's biggest health-care changes in more than a decade.

"That's what got me into the Legislature in the first place — to get health coverage for more people," said Rep. Eileen Cody, D-Seattle, chairwoman of the House Health Care Committee.

Gov. Christine Gregoire and her fellow Democrats want all children under 18 to have health insurance by 2010. Since 2004, the state has expanded Medicaid coverage for poor children, helping to whittle down the number of uninsured kids by 25,000 to about 73,000. About 545,000 kids now are covered under Medicaid.

The number of uninsured adults, however, has risen in almost all age and income groups. Young adults 19 to 34 make up the fastest-growing group of uninsured people, totaling half of the state's uninsured adults, according to the 2006 Washington State Population Survey.

More people are losing employer health coverage. And the uninsured rate among upper-middle-class families — those making $80,000 or more for a family of four — is rising faster than in any income group except those living in extreme poverty.

A costly problem

One obvious solution would be to fund existing government health plans to cover all who are eligible.

About two-thirds of the state's uninsured people may qualify for the state-federal Medicaid program or the Basic Health Plan, a state-subsidized insurance program for the working poor.

"For heaven's sake, let's make sure those who are already eligible get on those programs," said state Sen. Linda Evans Parlette, R-Wenatchee.

But doing that would get mighty expensive.

Gregoire earlier this month proposed spending $31 million over the next two years on an aggressive campaign to track down and enroll an additional 32,000 children on Medicaid.

It would cost far more to provide coverage to all adults who might be eligible. The state already spends more than $200 million a year on Basic Health to cover 117,000 people. It would likely cost more than triple that amount to enroll everyone who qualifies.

Meanwhile, a bipartisan commission convened last year by Gregoire to find ways to improve health care already has sparked several legislative proposals.

Cody, for instance, wants to push for a public-private insurance pool of 600,000 or more people. State workers, Basic Health enrollees, small-business employees and individuals would band together to buy insurance and, the idea goes, use their collective clout to get better rates.

Cody envisions the new program offering four or five different insurance plans — ranging from a benefits-rich plan, similar to what state employees now get, to health savings accounts. Under the latter, consumers pay much of their own medical costs out of a savings account they manage.

Cody says lower premiums would enable more people without insurance through their employers to buy coverage and also would allow the state to subsidize coverage for more people through Basic Health.

The idea is loosely based on a program adopted by Massachusetts that has won high praise from conservatives. Residents there will be required to buy health insurance by July 1, 2007, or pay tax penalties. Cody does not plan to push for a so-called individual mandate.

Another idea being pushed by labor unions and other health-care advocates would require companies with more than 1,000 employees to spend at least 9 percent of their payrolls on health benefits. Those that pay less than 9 percent would be required to pay the difference to the state.

Some Democrats have suggested simply billing such employers to recoup the government's costs for covering their workers. Others are eyeing a new program in Vermont, which last year began offsetting the cost of state-subsidized coverage for residents by charging companies $365 a year for each uninsured worker.

Lawmakers also might look at giving insurance carriers more flexibility to offer reduced-benefit plans or plans tailored to low-risk young adults. In a handful of other states, young adults can buy insurance with low premiums but high deductibles.

Some urge caution

Even some who have long been critical of the Democrats' approach on health care are sounding optimistic.

"I'm tickled that there are things on the table that are Republican ideas," said Rep. Bill Hinkle, R-Cle Elum, who served on the governor's blue-ribbon panel.

Carolyn Logue, lobbyist for the state chapter of the National Federation of Independent Business, urged caution. She said it's too soon to begin copying the new programs in places like Massachusetts and Vermont.

"We haven't seen them in practice," Logue said. "Let's not experiment too much."

But Jekel, the coffee-shop owner, hopes for quick relief.

Though her shops are busy, she has owned the businesses for less than two years and is still struggling to build steady profits. Jekel, 33, pays herself a monthly salary of $2,100. Coupled with $700 a month in child support and a modest profit, Jekel's income puts her family just out of reach of Basic Health's discounted premiums.

Even coverage just for her daughter, Brittani, 12, and son, Patrick, 10, would ease Jekel's worries. A recent cold of Patrick's that turned into a sinus infection cost her $68 for a doctor visit and $132 for medicine. Though healthy, the family lives in fear of falling into some major medical misfortune — the one worry they didn't have when they were homeless and on Medicaid.

The irony isn't lost on Jekel that she became uninsured just as she got a foothold in the middle class. That's partly why she stretches to pay half of the $175 monthly health premiums for her workers. Jekel knows it's difficult enough to live on $8.50 an hour without worrying about insurance.

"It's a full-time job to be poor," she said.

Ralph Thomas: 360-236-8266 or rthomas@seattletimes.com

Kyung Song: 206-464-2423 or ksong@seattletimes.com