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Why is it hard to give away free health insurance?

Lynn Kelley Author
Having insurance makes it more likely you'll get preventive medical care

You might imagine everyone without health insurance will gladly sign up for free or subsidized coverage once it’s available this fall, under the Affordable Care Act.

However, it hasn't worked out that way for children. A high-profile effort to cover all the uninsured kids in Washington has stalled.

Back in 2005, newly-elected Gov. Chris Gregoire said one of her top priorities was to make sure every child in Washington has health insurance. By 2007, the Legislature expanded the state’s free and subsidized insurance program, re-branding it as “Apple Health for Kids.”

At the time, about 70,000 children had no insurance. 

Today, there are still more than 70,000—possibly as many as 100,000—without insurance.

“What's important  is, we want our families insured. If people are eligible, we want them to get it,” says MaryAnne Lindeblad, director of the Washington Health Care Authority, which oversees Medicaid and other low-income insurance programs.

Lindeblad says the economic recession is partly to blame. The state scaled back its enrollment efforts and funding in 2010. Still, tens of thousands of children who are eligible for free or subsidized insurance are not getting it.

"Maybe they think because they are not eligible for any coverage [as adults], their children aren't either." Liz Winders of HealthPoint

“We have definitely  increased our focus on why aren’t these kids getting signed up,” says Liz Winders, who oversees outreach for HealthPoint community health centers in King County. She works with parents to help them find free and low-cost insurance.

Many reasons parents don’t sign up

“People just simply aren’t aware that there's coverage available. Maybe they think because they are not eligible for any coverage [as adults], their children aren’t either,” says Winders.

In other cases, the parents are illegal immigrants and don’t want to be in a database, she says.

State officials also see awareness as a problem, which is why they keep funding marketing campaigns, including one that’s running this spring. Advertisements and flyers highlight “no co-pays or deductibles” and “it’s easy to apply.”

Another effort this spring is targeting low-income parents in Pierce County, by holding health fairs with bouncy rides to attract families.  It’s sponsored by a group of five health insurance companies that have contracts with the state to run the Medicaid program. Organizers admit they’ve struggled to get much interest. 

Implications for Obamacare

All of this is like a dress rehearsal for next fall when the new federal health care program opens for business. That whole project depends on getting hundreds of thousands of people to sign-up for insurance. In Switzerland and the Netherlands, they discovered they had to figure out "why people eligible for coverage don’t enroll and to craft responses that will overcome enrollment barriers," according to a new study published in Health Affairs.

By re-energizing their efforts with kids now, Washington's health officials have a head start.

One lesson they’ve learned from the struggle to enroll children: Simplify the paperwork.

“It can be a very personal thing, I think, applying for insurance, and having to go through your income and circumstances with a stranger,” says Winders.

What if you work part-time jobs and your hours keep changing? You have to report it to the state, and your eligibility might go away. The current Medicaid program also requires parents to re-enroll every year.

Those enrollment obstacles are supposed to go away with the new health insurance exchange, which will sign-up uninsured adults and families this fall. That creates a single portal for all types of subsidized programs, and streamlines the enrollment process.

Keith Seinfeld is a former KNKX/KPLU reporter who covered health, science and the environment over his 17 years with the station. He also served as assistant news director. Prior to KLPU, he was a staff reporter at The Seattle Times and The News Tribune in Tacoma and a freelance writer-producer. His work has been honored by the American Association for the Advancement of Science (AAAS) and the Knight Science Journalism Fellowships at Massachusetts Institute of Technology.