by Dr. Patrick Jones
Residents in the greater Wenatchee area appear to be suffering from a boomerang syndrome. No, that’s not a new bug from down under. It has to do with how residents access healthcare here.
As Trends indicator 5.4.1 reveals, the share of the population without health insurance plummeted in the immediate aftermath of the Affordable Care Act. For 2016, Census estimated the share to be 6.9%, about a third of where it stood three years prior! Recently released estimates, however, show that the reversal that began in 2017 has not stopped. For 2021, Census estimates that one out of every eight residents in the two counties lived without health insurance. That’s nearly 15,000 lives.
The boomerang syndrome is relatively unique to the two counties. It hasn’t occurred in the state and in the U.S., as indicator 5.4.1 shows. It is true that some eastern Washington metro areas, such as Yakima and Grant Counties, have experienced the same phenomenon. But for most metros east of the Cascades, the rebound has been much less pronounced. In fact, in Spokane, rates have continued to fall.
With the help of the source data, accessible to viewers of the Trends via the hyperlinks listed on the “More Info” page, we can uncover some of the reasons. One is the presence of invincibles in the area. These are the young who don’t establish a regular way of accessing healthcare.
In 2021, an estimated quarter of the local population between the ages of 19 and 34 reported no health insurance. Young adults often think that health challenges won’t visit them. In the greater Wenatchee area, that sense must be considerably stronger. Nationwide, an estimated 15% of this age group reported no health insurance, or 10 percentage points lower.
The same source data also points out that this is likely a male phenomenon. The Census table doesn’t break out gender by age, but it does show for the two-county area that males of all ages without health insurance are twice as many as females. This is much higher preponderance than throughout the nation.
Further, the same source data show that ethnicity is part of the phenomenon. The estimated rate of Non-Hispanic Whites without health insurance in 2021 was a little less than 8%. The rate for Hispanics? Nearly 22%. Since the Census source table doesn’t present age by race/ethnicity by insurance status, we don’t know what percentage of the young Hispanic/Latino population lives without health insurance. It’s this observer’s hunch that it is higher than the overall rate, however.
A few short years ago, the numbers of local young adults without health insurance were high, but not this high. In 2016, Census estimates put the share of young adults a little over 18%. What has happened since then to push up the rate by several percentage points?
Possible reasons
The reasons could be many. Has there been a greater influx of young migrant labor? Do the 20-somethings of today enjoy earnings high enough to disqualify them for Medicaid and do they find the Insurance Marketplace unaffordable? Has the community effort to enroll low-income residents into health plans stopped or sputtered? Do employers not reach out to their staff as much as a few years ago?
That young adults show the lowest health insurance rates among all age groups should not be too surprising. What surprises or even shocks is the boomerang effect for older working adults. In 2021, Census estimated the rate of the insured among 45 to 55-year-old residents at 18%, and for those 55-64 at nearly 13%. In 2016, the shares for the same age groups were 3.6% each! What can explain the tripling to quadrupling of the rates among older residents in the greater Wenatchee area?
It will take some effort to uncover the reasons for the slide by both young and older working adults What is clear from the data are the consequences.
Consequences
First are financial ones to providers. The quid pro quo accepted by the U.S. hospitals for the lower reimbursement rates embedded in the Affordable Care Act was an increase in paying patients. And a consequential decrease in charity care. According to data from the Washington Department of Health, this has not been the case here.
Charity care reported by Central Washington hospital nearly doubled between 2017 and 2021, ending the latter year at about $10 million. The increase in charity care at Wenatchee Valley Hospital & Clinics also climbed, from $4.1 to $5.2 million. At the same time, the use of the facilities by Medicaid patients, measured by patient days, either stayed the same (Central Washington Hospital) or actually declined (Wenatchee Valley).
A second consequence is the impact on residents’ health. There are no measures on the relative health of the uninsured versus those insured. But we might consider correlations. One is provided by Trends 5.1.4, Share of Avoidable Hospital Admissions. This is a relatively standard public health measure that tracks admissions due to conditions that could have been successfully treated in an outpatient setting, usually with preventive care. They encompass asthma, diabetes, hypertension, and immunization-preventable flu.
As the graph for Share of Avoidable Hospital Admissions lays out, these admissions enjoyed a steady decline from 2011 to 2017, then started to turn up. Due to the lengthy delay in securing health data, we don’t know the results from the past two years. It is this writer’s hunch, however, that the rise has continued.
It is everyone’s interest that future estimates of the uninsured will show that the boomerang effect has flattened or even started to reverse. If the trend continues, the greater Wenatchee area could be facing a return to pre-ACA conditions. That is in nobody’s best interest.