Working as “One King County” brings healthcare enrollment success

The broad, county-wide participation of all King County departments and agencies, the committed and supportive leadership, and Public Health – Seattle & King County as a strong coordinating organization helped make the first season of healthcare enrollment a success in King County.

More than 165,000 King County residents signed up for low-cost or free health insurance during the six-month period ending March 31.

A report by Elizabeth Ambriz, a Public Health intern and Masters of Public Health Candidate at the University of Washington School of Public Health, found that the coordinated efforts of all County departments and agencies was central to the success of healthcare enrollment in King County.

Each County agency and department participated in the enrollment effort, drawing on their unique expertise and points of contact with the public to help reach eligible residents with information on healthcare coverage.  Departments focused their work on four main strategies to provide healthcare reform information to the community: material distribution, presentations/briefings/trainings, digital/IT, and media/communications.

  • Material distribution: Posters, flyers, information cards for offices, County buildings, public areas, outreach events and activities, customer service areas, park venues, newsletters, action alerts, and listservs, mailers and mass mailing.
  • Presentations/briefings/trainings: Speakers for Employee Town Hall, employee orientations, trainings, internal teams, briefings for communities in unincorporated King County.
  • Digital/IT: Information and links on websites, social media (blog, Twitter, Facebook), e-signature lines for outgoing emails.
  • Media/communications: Public service announcements in high traffic areas and other venues, bus ads, ethnic media to spread the message.

Before the Affordable Care Act (ACA) implementation, King County had serious healthcare coverage inequities affecting some of the most vulnerable residents. People who live in south King County cities were more likely to be uninsured; adults in Des Moines were seven to eight times more likely to be uninsured than adults in Mercer Island or Sammamish. Latinos were nearly four times as likely and Black/African Americans more than twice as likely to be uninsured as whites.

“The approach we took on health enrollment builds on the approach we have taken in our Equity and Social Justice work, which predates our work on federal health care reform,” said Executive Dow Constantine. “In our Equity and Social Justice work, we made a conscious choice not to set up an Office of Equity and Social Justice off in the corner of the administration building.  We instead chose to make advancement of equity a responsibility that is owned by everyone – every agency, every employee.  So our work on health reform follows that approach.”

“This effort was a great opportunity to demonstrate how working together across departments helps us achieve common goals and outcomes for the people we serve,” said Bill Wilson, Department of Community & Human Services. “We want to better serve King County residents by providing services that are coordinated and streamlined.  Cross-agency collaboration builds on each agency’s unique knowledge and expertise to move us in that direction.”

Lessons learned from healthcare reform implementation

The qualitative report identifies lessons learned that might benefit future cross-agency work efforts:

  1. Cross-agency work is more effective than the traditional siloed approach.
  2. Cross-agency work is a catalyst for developing relationships across divisions and departments.
  3. Cross-agency work requires a significant investment in time and resources.
  4. Cross-agency work is an opportunity to leverage and maximize existing resources.
  5. King County’s approach of broad engagement of everyone – every agency, every employee in healthcare enrollment – is a model for other counties and the nation.

Looking Ahead

King County employees who participated in this effort see a long journey ahead before the elimination of inequities in King County but they are hopeful that the County is moving in the right direction in the path to increase equity and equal opportunity for all King County residents.

“I think we need to continue, we can’t give up,” said Jacqueline Blackwell of King County Elections. “I’ll continue to work for One King County, for that which is fair and just and look for ways in which things can be sustainable. We’re all part of One King County.”

Enrollment continues for anyone whose income qualifies for free Apple Health (Medicaid) coverage, or for anyone who experiences a qualifying life event (such as changing jobs or getting married).

For copies of the staff report, please contact Elizabeth Ambriz at

By Elizabeth Ambriz