Two rural Washington state counties have been thrust into the national health care debate after new rate filings showed that no insurers planned to offer coverage next year in the individual markets in Klickitat and Grays Harbor counties.
Democratic elected officials pounced, blaming the insurer pullout on uncertainty caused by Republican plans to repeal the Affordable Care Act.
State Insurance Commissioner Mike Kreidler said the pullout affecting an estimated 3,350 people "clearly indicates to me that the uncertainty the Trump administration and the Republican-controlled Congress has sowed for months is sabotaging the progress we've made."
U.S. Sen. Patty Murray, D-Wash., followed up with a statement saying the two counties "show exactly how President Trump is causing uncertainty" and hurting families.
But Premera Blue Cross, the last to offer individual insurance this year through the health care law in Klickitat and Grays Harbor counties, said that wasn't why it was getting out of the counties.
"No," said Melanie Coon, a Premera spokeswoman, when asked if uncertainty caused by the Republicans drove the insurer's decision.
Coon said rising costs prompted Premera to leave the individual markets in four rural counties, including Island and Skamania counties.
The decision "will help us keep cost increases lower for customers in other counties."
Premera and its subsidiary LifeWise will continue individual coverage in 23 Washington counties.
Rural counties have been historically hard to serve, before and since the Affordable Cart Act was enacted, Kreidler said. They have fewer customers, fewer providers and high administrative costs, he said. "Those being the ones falling out is not a surprise."
But Kreidler, who has been part of Washington Democrats' fierce defense of the Affordable Care Act, stuck to his response to Premera.
He said a number of insurers, including Premera, have told him privately that Republican plans _ particularly the lack of commitment to federal subsidies for lower-income customers _ are driving uncertainty among insurers.
He referred to an April letter that he and a state insurance-industry group wrote to the Trump administration saying the most significant drivers of market uncertainty include Repbulican efforts to weaken the health care law's cost-sharing subsidies and its individual mandate, which seeks to balance risks and costs for insurers by requiring healthy people to have coverage.
"I am not calling them a liar," Kreidler said. But Premera and other insurers are reluctant to criticize Republicans, who control all branches of federal government, he said.
"I just understand that insurance companies have a certain risk-averse nature and it doesn't mean alienating people by pointing at one party or another," he said.
Most Washingtonians have employer-sponsored health insurance. About 350,000 others are in the individual market, with most of those buying coverage through the state exchange created under the Affordable Care Act.
As for the 3,346 people in Klickitat and Grays Harbor who had insurance in the individual market this year, their fate has not yet been sealed by the rate filings. (The financial details of those filings become public June 17.)
Kreidler said he hoped to do what he could to persuade an insurer, or insurers, to step into the two counties. He has through August to make that happen before coverage plans are locked in for 2018.
If no insurer is available in a county, Kreidler said the only option under state law is coverage through the state's high-risk pool. That would not come with subsidies, making insurance prohibitively expensive for some, he said. One alternative, he said, is for state lawmakers to pick up the costs of subsidies in Klickitat and Grays Harbor counties.
