If you're reading this, it's too late to enroll in a new health insurance plan. Open enrollment (the time period when folks are allowed to sign up for health insurance without life changes like getting a new job) closed on Jan. 15 and won't begin again until Nov. 15.
Fortunately, it's never too late to complain about how crazy expensive it all is.
According to the Washington Office of the Insurance Commissioner (OIC), back in 2014 the average premium for health plans purchased on the Washington state Health Benefits Exchange was $295 a month.
A decade later, the average premium has more than doubled — to $628 per month.
Further analysis of the commercial health insurance market by the OIC shows that, between 2016 and 2019 health care costs increased by 13%, yet the rate of inflation was only 7%.
Still, more people are insured now than they were in 2014, the first year that the Affordable Care Act — Obamacare — required all people to get insurance. Though that requirement was later dropped under the Trump administration, the rate of uninsured Washingtonians has decreased from 14% in 2013 to 5% now.
So, more people are insured, but costs are higher than ever before. If you ask state Rep. Marcus Riccelli, D-Spokane, the path our health care industry is on right now is unsustainable.
"It's become increasingly harder to find primary care, and we all recognize that health care costs are bad right now," he says. "We're paying more [for health insurance] and getting less value — we have to be innovative."
Last year, state legislators approved extra funding for the OIC so it could review the main factors impacting health care affordability.
The office's preliminary report — a nearly 100-page document focused on health care affordability that was released in late November — included an overview of Washington's current health care system and several policy options that could make care more affordable.
"We regulate, review and approve the premiums that people pay for health insurance, but people still have trouble affording their health insurance," says Stephanie Marquis, OIC's spokesperson. "Until we understand the underlying costs of health care we'll never be able to reduce the cost of health insurance."
Consolidation in the health care industry has, in part, been "a key factor driving up prices," the report says. "Generally, consolidations do not improve quality of care, but rather, drive up prices and impact access to care for patients and working conditions for providers."
In Washington, consolidation is best seen in the growing concentration of hospitals in multi-hospital systems like MultiCare, Providence and others. From 1986 to 2017, the percentage of hospitals in multi-hospital systems increased from 10% to almost 50%. Of the 101 hospitals operating in Washington, 40 are part of the five largest hospital systems in the state. Another 15 hospitals are included in smaller multi-hospital systems like Astria Health and Confluence.
Eight multi-hospital systems — including MultiCare, UW Medicine, PeaceHealth and Providence — employ 65% of the physicians and physician assistants in the state, according to the OIC. These hospital systems also have more than 65% of the staffed beds in the state.
But, at the same time consolidation of hospitals occurred between 1986 and 2017, the statewide available beds decreased by more than 40%.
While the report includes 11 policy options that could affect the cost of health care — like establishing prescription drug pricing regulations, implementing a reform on facility fees, and even creating an all-payer model for hospital rates that would have everyone pay the same price for the same services at all state hospitals — Marquis says the OIC doesn't argue for or against any specific policy to ensure that the information is as fair as possible.
"We were charged with an overview of the systems today and some analysis of the most potentially impactful policies," she says. "We want the data to speak for itself, so it needs to be as unbiased as possible."
A final report including in-depth statistical and economic analysis of the policy options that interest legislators will be released in August.
Jim Grazko, a senior vice president at Premera overseeing its Washington and Alaska markets, says much of the increased cost that people are seeing in their insurance premiums comes from the increased cost of medicine. In his description, since medical providers are charging insurance companies more for services, that cost is then pushed to their customers in the form of higher premiums.
"Lifesaving care and medications that we couldn't have even imagined years ago all come with increased costs," he says. "A lot of our tech has advanced to where it's much better but much more expensive, and someone has to pay [for] that."
Grazko has been in the insurance business for about 30 years, and he thinks that rapid growth in health insurance costs will settle down in the next two or three years.
Health care costs have been rising for years and have increasingly affected how folks access care. Namely, some people refuse to go to the doctor to save money, only to then have to spend more on something that could have been prevented with an earlier diagnosis.
Riccelli says that when he was first campaigning he met with a constituent who was struggling with the cost of going to the dentist. However, because they waited to seek care, they ended up in the hospital due to an abscess, which, Riccelli says, led to their death at age 37. (Riccelli didn't provide a name or other identifying information.)
"This person in our state lost their life for something that could have been easily prevented early on," he says. "At some point, there will be too many who are not able to get the care they need."
Spokane-based insurance broker Julie Shepard Hall says anecdotes like this don't tell the whole story. Some people may avoid care to save money, but she says some folks overuse care and go to the emergency room for things that could be dealt with at home or by a primary care provider.
"Hospitals are managing these trivial cases that they shouldn't be, and it's driving up costs," Shepard Hall explains. "We as individuals need to be more proactive about how we manage our care."
Both Shepard Hall and Riccelli think that with the increasing costs for privatized health insurance we're moving toward a single-payer insurance system like in Canada or the United Kingdom. While there isn't a set definition of what this system would look like, single-payer is often understood as the state or federal government operating the same payment system for all residents.
"Single-payer is the direction that we would want to head, and I think that's something we'll see in our lifetime," Riccelli says.
By the end of 2023, more than 850,000 enrollees were receiving Apple Health coverage, Washington's version of Medicaid, according to the Washington State Health Care Authority. There was also a record number of Americans — 21.3 million of them —who signed up for an Affordable Care Act Health Insurance Marketplace plan in 2024.
"More and more people are qualifying for Apple Health, and that may be the step toward creating a single-payer system," Shepard Hall says. ♦
