The Health Improvement Partnership, a Spokane nonprofit organization, is working through a community initiative called Expanded Choice to develop health-benefit options to offer to uninsured workers in an 11-county Eastern Washington area.


Sharon Fairchild, a Spokane health-care consultant and coordinator of the Expanded Choice planning team, says she expects the health-insurance program, which still is in its early stages, to be launched next year. It would offer bridge health benefits, designed to cover qualified low-wage workers only until they could transition into long-term, commercial health insurance, she says.


We see this as the start of a journey, Fairchild says. The program likely will be something that evolves over time to achieve the best possible penetration into the uninsured-worker population.


Expanded Choice is focused on uninsured workers because the vast majority of uninsured are employed, as Spokane County statistics and a recent national study bear out. The initiative, however, is just one of a number HIP is pursuing, under an umbrella organizational structure called Inland Northwest in Charge, that are aimed at improving the financing and delivery of health care to the uninsured here.


In Spokane County, at least 33,000 residentsincluding children and adults to age 64are estimated to be uninsured. About 75 percent of that number, or roughly 25,000, are believed to be employed adults, which would equate to about 13 percent of the total number of people in the county who currently have jobs, and Fairchild says, The level of uninsured (as a percentage of the work force) goes way up in the rural areas.


The goal of Expanded Choice is to reduce barriers that prevent employers from offering and employees from enrolling in health-benefit plans.


The timing is critical for the development of something that will enable small- to medium-sized employers to provide good options to their employees, Fairchild says. The economic downturn and several years of double-digit health-insurance cost increases put those employers in a very difficult position in terms of finding affordable options for their employee benefits plan, she says.


To come up with local solutions to health-care access problems, Inland Northwest in Charge is using a collaborative approach that involves health-care providers, hospitals, insurers, businesses, consumers, and others. To fund that effort, the organization earlier this year received a $916,000 grant from the U.S. Health Resources and Services Administration and a $700,000 grant from the Robert Wood Johnson Foundation.


Fairchild says the Expanded Choice planning team has been meeting twice a month since May and plans to issue detailed recommendations, including several options for state policy-makers to review, after actuarial and market studies are completed. The idea, she says, is to create or designate one entity that weaves together different public and private funding sources, government- and employer-sponsored health-benefit components, and eligibility criteria in a seamless way that appeals to uninsured workers and their employers.


The health-benefit options that emerge from the planning process will be tested through a pilot program in Spokane County. Well be trying to find where that (most appropriate) price point is, Fairchild says. Then, we would begin to go out into the rural communities and take our model that were using here in Spokane and adapt it to use in the rural markets. The cookie-cutter approach doesnt work in this state. Weve already found that out.


Fairchild, former president of the Spokane arm of Group Health Cooperative, left that health-maintenance organization in January 2000 and formed Fairchild Consulting LLC that summer. HIP has retained her to serve as a consultant on the Expanded Choice project.


Figures that Expanded Choice has gathered or extrapolated from state and local sources show the following:


Only about half of Spokane Countys more than 33,000 uninsured residents are eligible for state-sponsored insurance.


About 43 percent of the countys uninsured residents work for employers that dont offer insurance, and about 35 percent have an employer-sponsored plan available, but arent enrolled in it.


Fifty-eight percent are below age 35, and nearly half have household incomes below 200 percent of the federal poverty level. Adult males, at 57 percent, were more likely to be uninsured than females.


A total of about 70 percent of uninsured workers in the county are employed in one of three industriesretail, service, and construction, with the retail industry leading that list, at 31 percent.


About 70 percent of uninsured workers in the county work for private for-profit companies, about 19 percent are self-employed, about 6 percent work in government, about 2 percent work in a family business, and about 2 percent work for a nonprofit organization.


A disproportionate share of minority populations here were uninsured37 percent of blacks and 28 percent of Native Americans, for example, compared with 9 percent of whites. The countys percentage of Hispanic residents, however, decreased by more than half from 1998 to 2000, the figures showed.


The statistics jibe with findings from an Urban Institute research report released in August titled, Workers Without Health Insurance: Who Are They and How Can Policy Reach Them?


It concludes that workers without health insurance, now numbering more than 16 million in the U.S., tend to be employed by small businesses and to be low-wage, part-time and short-tenure workers who live in low-income households. The report recommends targeting subsidies, such as tax credits and expansion of public programs, at low-income workers as the best way to boost health-insurance coverage across the U.S.


The report can be found at www.communityvoices.org.