After a turbulent 2018 in Washington state’s individual health insurance market, the situation for people buying insurance independent of an employer appears steadier, if only barely, for next year.
Every county in Washington will have at least one insurer on the individual market in 2019, a departure from last year’s desperate effort to provide an option across the state.
State officials also announced Monday that insurance companies have proposed premium hikes of roughly 19 percent on average. While that’s a big increase, it’s a dip from last year’s 24-percent jump and a smaller rise in prices than many expected.
"We’re seeing what I’d like to think is some improvement," Washington state Insurance Commissioner Mike Kreidler said in an interview Monday.
Despite the sliver of good news, debate continues about what exactly is to blame for the continued premium increases.
State Rep. Joe Schmick of Colfax, the top Republican on the House Health Care and Wellness Committee, criticized the Affordable Care Act for restricting health insurance companies from charging rates based on certain health and lifestyle factors. The regulations end up saddling young and healthy people with higher rates, Schmick said.
Kreidler and some Democratic members of Congress from Washington say Republicans at the U.S. Capitol caused much of the turmoil by ending the penalty for not maintaining health insurance and stopping payments to health insurance companies that subsidize costs for low-income people. Insurance companies still must offer the subsidies, but they have boosted prices for other people to offset the loss of federal dollars.
“Clearly for somebody out there who doesn’t receive a subsidy, they’re finding it very, very difficult to keep their health insurance,” Kreidler said.
Within Washington state, individual health insurance markets vary wildly.
Fourteen counties will have one health insurance company on the individual market in 2019. Pierce and Thurston counties will have five insurance companies offering plans.
Premera Blue Cross, which offers health insurance plans inside and outside the state’s exchange marketplace, requested a premium increase of just 6 percent. Kaiser Foundation Health Plan of Washington, which will serve a state-high 19 counties, asked for a nearly 30-percent increase in rates.
The proposed rate increases aren't final as Kreidler's office still must review and approve them in mid-September. He said in an interview they don't typically change dramatically unless he finds the rate increase is completely unnecessary.
More than 268,000 people buy health insurance through Washington's individual market, according to the state. More than 60 percent of people using the state's insurance exchange get a subsidy that lowers premiums.
U.S. Sen. Patty Murray, D-Wash., also blamed Republicans for the proposed rate hikes.
Murray has been a leader on bipartisan efforts in Congress to reduce premiums and stabilize the individual health care market to the Affordable Care Act. That push ramped up after failed efforts to repeal the health care law in 2017. Legislation she worked on with Republican Sen. Lamar Alexander of Tennessee stalled in the GOP-led Congress, however.
In part, it would have funded payments to health insurance companies that subsidize low-income people using the ACA. Those payments, known as "cost-sharing reductions," were stopped in 2017 by the Trump administration, which said they were being illegally funded without Congressional approval.
"I want to work with anyone, from either party, who is ready to focus on lowering costs for patients," Murray said in a news release.
Kreidler also criticized the federal government for eliminating its requirement that people buy health insurance, which takes effect in 2019. Supporters say the so-called individual mandate keeps healthy people in the insurance pool, lowering costs for everyone. Opponents said the mandate was a case of government overreach.
Schmick said he believes those have contributed to rising costs. But he said he is generally in favor of repealing the ACA in the aim of lowering premiums and said there needs to be more flexibility in charging insurance rates based on a person's history. He wouldn’t say exactly what factors companies should be able to consider but said, “We need to take a look at where we were before the ACA went into effect.”
Schmick also said the Legislature has added to costs through programs such as requiring coverage of three-dimensional mammography. He said the program would save lives but also raise health insurance prices.
One area of agreement between Kreidler and Schmick: having a coverage option in every county is a relief.
“One isn’t a choice but I guess between one and none at least there’s an option out there,” Schmick said.