While rate of uninsurance has declined with implementation of Obamacare, a number of Americans continue to go without health coverage. The biggest reason, according to a new survey by the Kaiser Family Foundation, is continued lack of affordability. Nearly four in ten adults responded that they had tried to get coverage through the Affordable Care Act, but ultimately couldn’t afford it.

In Washington state, the uptake of coverage through Medicaid expansion underscores the urgent need for affordable coverage options for low-income persons. Nearly 425,000 residents newly enrolled in Medicaid from October 2013 through March 2014. Another 417,000 residents already receiving Medicaid chose to continue their coverage for a total of more than 840,000 Washingtonians currently receiving coverage through a Medicaid plan.

But a less-known option of the Affordable Care Act would increase access to affordable coverage for those who are ineligible for Medicaid but still living in poverty or near-poverty. The Basic Health Program (BHP) would provide federally-subsidized health coverage to individuals with incomes below 200% of the poverty level, including lawfully present immigrants who are not eligible to enroll in Medicaid.

The BHP presents a tremendous opportunity for Washington to lower rates of uninsurance and expand quality, affordable coverage to some of our state’s most vulnerable residents – using federal dollars! It’s also an opportunity for health plans to capture new enrollees, especially those that sought coverage through the state’s Exchange but found costs insurmountable.

Among the top advantages of the BHP is that the Program offers more consistent coverage and care for low-income residents, particularly those whose incomes fluctuate around the poverty level. Because those with lower earnings are more susceptible to disruptive changes in income, they are more likely to “churn” on and off Medicaid, even with very small changes in income. This makes it extremely difficult to maintain continuity of care and manage chronic health conditions. The BHP could be aligned with Medicaid plans to provide seamless transition between programs, while providing continuous coverage and consistent care.

To date, two states have opted to take up the BHP. Minnesota passed legislation in 2013, and earlier this year, New York adopted the BHP in its budget. Washington’s legislature has refused to act on legislation for the Program, despite the fact that it was modeled after the recently eliminated Basic Health Plan, under which the state provided subsidized care for low-income workers. It is anticipated bills to implement the BHP will be re-drafted for the 2015 legislative session.