Grays Harbor and Klickitat counties will have no individual health care insurance options in 2018, according to information filed with the Office of the Insurance Commissioner (OIC) last week. Based on the filings, residents will have no options on the Washington Health Benefit Exchange or individual market. Commissioner Kreidler and his staff are engaged in negotiations to see if a willing insurer can be found. OIC is also exploring longer-term market stabilization options. WSHA will be involved in the longer-term work. We are very concerned about the lack of options and their impact on access to health care in rural areas.
While Grays Harbor and Klickitat counties face the prospect of no individual insurance options in 2018, four counties (Ferry, Pend Oreille, Skagit and Skamamia) will have only one insurer. Additionally, Callam and Wahkiamkum are offered coverage by two insurers, but through the same parent company. These counties could be vulnerable to losing individual market coverage options in future years. According to information provided by the OIC, 11 health insurers intend to provide plans in the individual health insurance market in 2018. Six will offer plans in the Washington Health Benefit Exchange, seven will offer plans outside the exchange, and two will offer plans both in and out of the exchange. Two insurers who had provided individual market health insurance decided not to participate in 2018. A detailed chart of the insurers and proposed individual market plans is available here. There are differing views on the causes for insurers to exit the individual market. Interestingly, OIC has asked all health insurers that submitted individual market plans for 2018 to state the insurer’s assumptions related to assumptions about the future of the Affordable Care Act and specific provisions.
Impact in Grays Harbor and Klickitat counties
According to the OIC, 1,119 people in Klickitat County and 2,227 in Grays Harbor County were enrolled in the individual market. If no insurer offers a health plan in Grays Harbor and Kilickitat counties, the insurance options for residents are minimal. For providers and hospitals in rural areas, lack of insurance coverage increases the cost of providing care to populations that are often less healthy and poorer than their urban counterparts.
Under Washington State law, if no health insurance is available in a county, the residents may seek coverage through the Washington State high-risk pool (WSHIP). However, the high-risk pool is intended to provide insurance to patients with highly complex, expensive health needs. This means the premiums are often quite expensive. Further, no subsidies are available to offset high WSHIP premiums because it is not qualified to offer insurance on the Washington Health Benefit Exchange. If residents cannot afford WSHIP plans and lack insurance coverage, they may be reluctant to seek necessary health care or find difficulty accessing care.
Market stabilization efforts underway
The OIC is actively exploring strategies to stabilize the individual health insurance market in Washington State. This work will include state and federal options, both short term and long term. WSHA is actively engaged in this work and appreciates the attention and expertise the OIC and an array of stakeholders bring to this effort. The current and future stability of health insurance in Washington State is an important part of the mission of hospitals and health systems to improve the health of our communities. (Zosia Stanley)