Washington State Health Benefit Exchange is one of the national leaders among states in enrolling participants in qualified health plans, and Spokane County is one of the top counties for enrollment in the state, based on preliminary data compiled by the exchange.

The exchange, a private and governmental partnership that administers the Washington Healthplanfinder online enrollment program, signed up 146,000 people in qualified health plans between Oct. 1 and the March 31 deadline, says Bethany Frey, an Olympia-based spokeswoman for the exchange.

During the same period, Washington Healthplanfinder also signed up more than 550,000 new enrollees in the state and federally funded Medicaid program called Apple Health, and renewed Apple Health enrollment for another 408,000 people already receiving Medicaid benefits, Frey says.

Qualified health plans are operated by private insurers and are federally subsidized through income tax credits based on enrollees’ incomes.

“In every enrollment report I’ve seen at the national level, Washington is in the top three to five states in enrollment in private health plans,” Frey says.

Washington is one of 14 states and the District of Columbia with state-based exchanges as authorized under the Affordable Care Act, also known as Obamacare.

The rest of the states are served by the federal exchange, which the Obama administration claims reached its goal of enrolling 7 million formerly uninsured participants in qualified health plans by the deadline.

In Spokane County, Washington Healthplanfinder had enrolled more than 7,100 people in qualified health plans, 27,500 new Apple Health plan recipients and, renewed Apple Health coverage for 28,600 people.

“Spokane County is one of the top counties in the state in terms of enrollment,” Frey says.

Spokane County’s signup numbers are comparable to the total enrollment in Snohomish County, which has an estimated total population of 730,500, making it more than 50 percent larger than Spokane County’s population of 480,000, based on the state’s 2013 population estimates.

Frey attributes a good portion of the success here to the enrollment efforts of Better Health Together—one of 10 lead organizations statewide charged with providing in-person assisters to enroll uninsured residents who otherwise aren’t likely to use a website or call center to get information on health plans and subsidies.

About 2,000 insurance brokers statewide also are working with the exchange to enroll participants in qualified health plans, she says.

“Better Health Together was extremely successful in enrolling folks,” Frey says.

Better Health Together is a subsidiary of Spokane-based nonprofit Empire Health Foundation. Through an $858,000 federal grant, Better Health Together seeks to assist low-income people in Spokane County and 13 other Eastern Washington counties in signing up for Medicaid and private programs.

A month before the deadline, Better Health Together, had enrolled more than 27,500 people in Apple Health and qualified health plans—nearly 275 percent of its target enrollment of 10,026 people.

The target number was based on estimates of the uninsured population in Eastern Washington, says Curt Fackler, a manager at Better Health Together.

Better Health Together’s goal wasn’t to compete with insurance brokers in the private market, but to target people not likely to access health care coverage on their own, Fackler says.

In Spokane County, nearly all of those recipients qualified for financial assistance for health coverage, he says.

Adults in households with annual income of up to 138 percent of the federal poverty level, or $32,900 annually for a family of four, are eligible for Apple Health coverage, and children in families making up to 300 percent of the poverty level also are eligible for Apple Health benefits, Fackler says.

Adults in families that earn between 139 percent and 400 percent of the federal poverty level are eligible for some level of tax subsidies for qualified health plans, he says. For a family of four, 400 percent of the federal poverty level is $95,400, Fackler says.

“That’s why the majority of individuals in the Spokane area are getting some kind of subsidy,” he says.

Washington’s more populous counties—King, Pierce, and Snohomish counties—also met their enrollment goals, “but nowhere near like us,” Fackler asserts. They used a different model, based on marketing and outreach, to attract enrollees, he says.

Better Health Together devised an “in-reach” strategy through which it trained as in-person assisters the people most likely to be in contact with the uninsured population.

“We went to where uninsured are,” Fackler says. “We trained people in hospitals and clinics to ask patients if they were insured and, if not, to make sure they get insured.”

In all, Better Health Together trained 300 assisters, most of whom were employed by organizations that contact or treat the uninsured or underinsured people.

“Most were already doing a similar type of work,” he says, including for example, finance personnel at Deaconess Hospital and at Providence Sacred Heart Medical Center & Children’s Hospital, in Spokane.

“This gives them another tool,” he says. “If patients don’t have insurance, (assisters) can sign them up so the next time they visit the hospital or clinic, they have insurance.”

Not all enrollment sites were clinical settings, though, Fackler says, adding that the Spokane County Library District is one of only three library systems he knows of in the country that also helped sign up enrollees.

He says the organization trained librarians, who signed up a total of 300 people roughly evenly split between enrollment in qualified health plans and Apple Health plans.

“The librarians enrolled quite a few people in their 50 and 60s,” he says. “If they lived in Deer Park or the Valley, they didn’t have to go to Spokane for help to enroll. The library was a nonthreatening place to go.”

While the sign-up period for enrollment in qualified health plans for 2014 has expired, newly married or divorced people and some people who change jobs qualify for special enrollment outside of the open enrollment period.

American Indians and Alaskan natives also can enroll in qualified health plans year-round.

Washingtonians who had started the application process but hadn’t completed it by the deadline due to capacity problems with the Washington Healthplanfinder website might still qualify for special enrollment if they complete and submit their applications quickly, the Washington Health Plan Finder announced Tuesday.

Coverage for applications to be approved during the special enrollment period begins May 1.

The qualified health plan sign-up period for next year opens Nov. 15. Washington Healthplanfinders’ goal for the next enrollment period is to enroll 280,000 participants, or roughly 134,000 more than have signed up so far, by next Jan. 1.

Meantime, Better Health Together also has more work to do, Fackler says.

“There will be a program next year,” he says, adding that Better Health Together expects to hire an executive director in coming weeks.

“We enrolled a lot more people than they thought we would,” he says. “That could mean there will be fewer people to enroll next year, but nobody really knows how many people are uninsured. It’s a wild guess.”