One of every nine people in Spokane County is without health insurance, and Spokane-area medical providers dont get paid for almost $20 million in care they provide annually, says a new report by the Washington state Insurance Commissioner.


The 37,200 uninsured people in Spokane County are among the 549,000 throughout the state who have no coverage, the study says. Statewide, those uninsureds account for about $318 million in uncompensated health-care costs annually.


Three proposals are being researched, however, to address the problem. Theoretically, if all three proposals were put into action, an additional 14,500 people in the Spokane area would become insured, and $15.7 million would be infused into coffers of the medical community here by reducing uncompensated care, the report says.


One proposal would involve pooling money from health-insurance providers to cover high-risk patients, and another would require large employers to provide health insurance to their employees. A third would guarantee coverage for all minors in Washington state.


Garman Lutz, president and CEO of Empire Health Services, which operates Deaconess Medical Center and Valley Hospital & Medical Center, says the three proposals are a start in the right direction, but arent a panacea for the ills the health-care community is facing.


In some ways, each of these initiatives will have an impact, but they are not enough to solve the entirety of the problem, Lutz says.


He says larger problems in health care stem from the current state of Medicare and Medicaid, but those fall out of the purview of the insurance commissioner.


Michael Arnis, an Olympia-based senior health-policy adviser in the commissioners office, says the first two proposals would require action from the Legislature, but wouldnt require a significant amount of funding.


The insurance commissioners office is advocating the first proposal, and is calling it the Pooling Risk Reducing Cost proposal. Through it, health-insurance providers would be required to pool money earmarked for high-risk patients, and the pooled funds would pay the bulk of the expenses for policyholders whose annual health-care bills exceed $25,000.


The reasoning, the insurance commissioners office says, is that while only 2.4 percent of policyholders exceed $25,000 in medical expenses each year, those enrollees account for a third of all annual medical expenses.


The insurance commissioners office contends that its difficult for one health insurer to predict how many high-cost enrollees it will have to cover in a given year, so each insurer must keep large amounts of money in surplus in case it must cover expenses for a large number of such enrollees.


With such a pool, insurers could reduce the amount of reserves they would have to have to cover high-cost enrollees. Arnis says thanks to some $80 million in savings, the state believes that insurance companies could offer lower premiums.


With the savings in the market, premiums will be reduced and more people can buy into the market, he says. (Insurance) carriers would have a more stable market. (Health-care) providers come out ahead because they will receive more money for the uncompensated care.


As the proposal is currently envisioned, the state then would seek from insurers $30 million of that savings and use it to subsidize health insurance for low-income enrollees.


The insurance commissioners study predicts that if the risk-pool proposal were put in place, 2,460 more people in the Spokane area would become insured, and the medical community here would receive an additional $3.1 million a year in revenues through their coverage.


The other two proposals are being referred to as Washington Fair Share and Care For Kids, and both are being developed by state legislators.


Washington Fair Share would involve mandating that all large employersdefined as those with more than 50 employeesmust provide health insurance to their employees.


Statewide, 97 percent of large employers already provide health insurance to their employees, Arnis says. The Fair Share measure would target the 3 percent who dont, he says.


In Spokane, the study says, that measure would increase the number of people insured by 7,800 and would put $10.8 million into the coffers of the health-care community.


Arnis says the state House of Representatives Health Care Committee held hearings during the last legislative session on both the risk-pool and fair-share proposals. Bills containing those proposals didnt make it out of the committee, but Arnis expects similar bills to be introduced during the next legislative session.


The third proposal is newer than the others, Arnis says. Its being called Care For Kids and would guarantee health-insurance coverage for all children statewide. In Spokane, such an action would insure about 4,500 more people and increase health-care provider revenue by about $2.1 million.


Its unclear, however, how such a program would be funded.


The state report says that options to cut down on the number of uninsured people in Washington state need to be put in place, because the large coverage gaps affect everybody involved in the health-care system.


The study says that cost shifting occurs as a result of a large uninsured population, and the financial burden is placed on hospitals, medical-care providers, public health-care programs, and the private insurance providers. Consequently, insured people bear part of the burden through higher health-care costs and higher insurance premiums.


Spokanes nonprofit hospital operators, Providence Services Eastern Washington and Empire Health Services, each has laid off more than 100 employees in recent weeks amid growing operating losses, and both have cited rising uncompensated care costs as reasons for their recent struggles.