KLICKITAT COUNTY, Wash. (KOIN) — Krissy Biernacki and her husband started the Blue Skies Bakery in Klickitat County 5 years ago. As small business owners, they and their employees rely on the Affordable Care Act and insured offered from Lifewise through the insurance exchange.
But residents are worried about the announcement by the county’s only ACA state exchange insurance provider to leave after 2017.
“A lot of people are insured under the ACA,” Biernacki told KOIN 6 News.
There are about a dozen insurance providers in Washington. Several are part of the Washington Health Benefit Exchange, the public marketplace for health insurance established after the passage of the Affordable Care Act. None of them are currently set to offer any plans in Klickitat County in 2018.
County residents said if they were forced to purchase insurance without subsidies provided with an ACA state exchange insurer, their premiums could jump from around $300 per month to more than $1000.
“It would tear our entire lives apart,” said Alicia Crockett. She already lost one child to cystic fibrosis and her surviving son also has CF. They rely on the ACA for affordable care.
“His medication expenses are between $10,000 and $40,000 a month. We can’t get by without insurance,” she said. “It would be impossible.”
Washington’s insurance commissioner estimates that 1000 people would lose affordable coverage in the rural county if the state can’t find another replacement by January 1, 2018.
“I’m still optimistic we are going to be able to fill that gap. We have a got little bit of time,” said Mike Kreidler, the Washington State Insurance Commissioner.
Although Washington does offer a catastrophic insurance as a safety net, many say the premiums are unaffordable.
“It’s a really sad state right now,” Crockett said.
Insurance commissioner’s worst fear
Kreidler said about 1000 people in the county rely on these insurers and have incomes too high to be eligible for Medicaid should the providers drop their plans.
“My worst fear is that if we can’t get an insurer in there, is that the only other option is to go to the high–risk pool which is expensive,” Kreidler said. “Comprehensive, but expensive.”
That pool, the Washington State Health Insurance Pool, was created initially to provide coverage to patients rejected by providers because of pre-existing conditions. After the Affordable Care Act prohibited such denials, the WSHIP remained in place to provide its service to those denied Medicare Supplement plans, which the ACA did not affect.
But, according to Kreidler, the WSHIP also exists as a sort of last resort if no other insurance is made available.
“It’s been a provision that’s been available when we have that kind of market collapse,” he said.
Because the WSHIP is intended for high-risk patients, premiums are of course much higher, so people in Klickitat County could end up paying exorbitantly even if they are healthy.
Still, Kreidler says, a safety net is better than nothing.
“At least insurance would be available to them,” he said. “The last thing we want to do is have them without health insurance.”
Kreidler says that insurance providers already have something of a history of abandoning rural areas like Klickitat County.
“Our problem right now is trying to keep them in some of these rural counties where they have some exceptional challenges,” he said. “It’s been tough to keep them there. Higher administrative costs for the insurance company. So it’s tough to do business in some rural counties.”
He says that nearly every year, companies try to pull out of rural areas, where it’s harder for them to make money. Last year 14 counties in the state had at least one insurer leave or try to leave – but no county ended up completely without commercial coverage. It’s an issue Kreidler says has been flying under the radar.
“I think if we hadn’t been so distracted by what’s happening in the nation’s capital, [for example] if we are going to have enforcement of the individual mandate… I think we probably would have spent more time working the rural county issue,” he said.
Klickitat is currently the only county in the state with no planned commercial coverage next year. Originally, Grays Harbor County had the same problem, but the state was able to rectify it and bring in an insurer – and Kreidler says there is still hope for Klickitat too.
“[We] spent a lot of time talking with [the insurer for Grays Harbor]. Reassuring them, making some adjustments as to what they had to do administratively that made it easier for them to come back. And I am still working at that for Klickitat. Hopefully we will be successful there too,” he said. “I’m working with a couple of insurance companies right now.”