The Patient Protection and Affordable Health Care Act of 2010 will be fully implemented by 2014. How will it affect Vashon Islanders?

Several people have told me that anyone on Vashon who currently needs health care can get it, implying that the act won’t make much difference. That’s not true.

Pharmacist Tom Langland explained to me that “most of the acute and emergent needs are taken care of.” He agreed, however, that “acute and emergent care” is not an adequate definition of health care. According to Wikipedia, “Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans.”

A 2011 Vashon survey that garnered 520 responses found that 21.8 percent had no health insurance; 25 percent had been turned away by a provider because they are on Medicare; 27.9 percent had been turned away for lack of insurance; 11.3 percent had children with no insurance, and 43 percent could not afford prescriptions.

I spoke with a number of employees at a small business on Vashon who have no insurance. One 36-year-old has been uninsured for 15 years; another, who is 52, currently has none. A 33-year-pays $174 a month for insurance but is being dropped because the company will no longer cover individuals. A University of Washington student is unable to afford the university-sponsored insurance, which costs $456 per quarter. Another spends $500 a month following a recent hip surgery. Her two daughters, 23 and 26, with no insurance go off-Island for their care to a doc-in-a-box.

At another business I visited, the two owners — a husband and wife team — said that half of their income in 2011 was spent on medical expenses, even with insurance.

How will the act benefit these Islanders and the rest of the country? Each state will establish Health Insurance Exchanges, lists of approved insurance plans. The act requires all Americans to purchase insurance if they are not already covered or face an annual non-compliance penalty. Those who can’t afford it — with incomes below 133 percent of the federal poverty level ($14,856 for an individual in 2012) — will be able to get their coverage from Medicaid. In addition, there will be federal assistance to purchase insurance in the exchange for those between 133 percent and 400 percent of poverty line. Unfortunately, the act specifically forbids any federal funds to provide for abortions.

Even with this act in place, however, many will still be uninsured. The Congressional Budget Office estimates that by 2019, the number of people lacking insurance will be reduced from 32 million to 23 million. Of those, 7 to 11 million will be undocumented immigrants, leaving another 12 to 16 million without insurance. After conducting several interviews and reading numerous articles, I can’t say for certain who those uninsured people will be — but some, clearly, will be those who decide they’d rather get fined for lacking insurance than buy it.

What’s more, even with the act in place, many will still lack affordable health care. According to the Physicians for a National Health Plan, “Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill.”

For insurance companies, is this a boom or a bust? According to provisions of the act, insurance companies will be required to spend 80 to 85 percent of premiums on actual provision of health care and no more that 15 to 20 percent on overhead and profits. A number of the larger companies are already leaving the field, including Aetna, Cignet and Principal Financial Group. Group Health, Blue Shield and Blue Cross are raising premiums at accelerated rates, building huge surpluses, according to a recent article in the Seattle Times.

Many hope the act’s profit limits will eventually lead to fewer insurance companies and to a national single payer system, heartily endorsed by U.S. Rep. Jim McDermott. Still others hope there will be an increased number of companies in each state competing for the huge influx of new enrollees — an influx that could bring about competitive offerings.

A serious problem with the act is about access, according to Islander Rick Skillman, a retired hospital executive. “This is a train going down the tracks toward collision.” There are not enough general practitioners to care for the millions of people who will be  newly insured. Therefore, in the future as now, many folks will go to emergency rooms, further crowding an already stressed system and resulting in longer waits for those with true emergencies. One Islander told me he waited nine hours in the emergency room with a failed kidney. Unless a huge number of medical students are already in residence preparing to become general practitioners, the train wreck Skillman projected will surely happen.

In two years, each state will have set up its own Health Insurance Exchange from which individuals and small businesses will choose coverage. The state Legislature is finalizing the rules for the exchange. The state Insurance Commissioner and the state Health Care Authority are establishing criteria for selecting plans and determining definitions of health care coverage. We on Vashon need to watch and engage them as they lay out the future of our care.

— Kate Hunter is a longtime Islander and civic activist.

For more information about the Act, see www.HealthCare.gov.