Island Health sees looming insurance changes hurting Anacortes-area residents

NICHOLAS JOHNSON

Skagit Publishing

An estimated 1,700 people within Island Health’s service area stand to lose their Medicaid insurance coverage by 2027 under President Donald Trump’s One Big Beautiful Bill Act.

Many more, however, would feel the effects as uninsured patients show up in the Anacortes hospital’s emergency department for basic health care and help with preventable or chronic illnesses.

“It affects everybody in the community, not just those on Apple Health,” the rural health system’s CEO, Elise Cutter, told U.S. Rep. Rick Larsen during a sit-down meeting earlier this month.

“It backs up those services and takes away our ability to manage effectively for when people do come to us in an emergency.”

That was Cutter and her colleagues’ main message to the Democratic congressman when he stopped by to discuss the impending impacts of the Republican legislation signed into law on July 4, also known as H.R. 1.

Larsen has been meeting with health care providers throughout the 2nd Congressional District, including those at SeaMar in Mount Vernon, since the federal government shut down Oct. 1.

To pass, that bill needs support from more Democrats, who are instead pushing to extend and expand subsidies for people who buy health insurance through the Affordable Care Act.

Those subsidies, also known as enhanced premium tax cuts, will expire in December without congressional action.

Without the subsidies, an estimated 80,000 of the roughly 216,000 lowand moderate-income Washington residents who rely on those tax credits to afford health insurance through the state’s Health Benefit Exchange are expected to forgo coverage when open enrollment begins Nov. 1.

That’s because premiums are expected to rise 65% for people who rely on the subsidies.

“It’s a very real problem that we’re facing,” said Larsen, noting that about 25,000 people in his district — which covers Island, San Juan, Skagit and Whatcom counties as well as the western part of Snohomish County — received tax credits when buying health insurance through the state exchange last year.

“That is why, on my side of the aisle, we’re pushing back hard to get this deal done now, so these rates, these tax credits, can be folded in now, rather than wasting a year.”

Health insurance rates are set to rise 21% this year in Washington, where the federal subsidies save enrollees an average of $1,330 on premiums, according to the state insurance commissioner.

Fortunately, Larsen said, Insurance Commissioner Patty Kuderer has filed two sets of rates — one that includes the subsidies and one that does not, allowing the state to offer those subsidized rates if Congress acts to extend them.

Many other states didn’t do that, he said.

“Some states will be locked in all year next year,” Larsen said, “because they filed rates in their states that included insurance plans in their exchanges for the full year and without the tax credits, and to change that is a longer process in those states.”

Losing those tax credits would only add to the looming Medicaid challenges that Island Health and other rural hospitals are currently bracing for, Cutter said.

“Those are folks that are living and working in our community that will now lose access to health care,” she said.

Come 2027, an estimated 320,000 people statewide could lose Medicaid coverage, Larsen said.

“No one brags about their health insurance plan,” he said. “So no one knows who has what kind of health care. But people will start finding out, because they’re going to find out their friends are having to pay X amount percentage more because of cuts to Medicaid, or they’re going to lose health insurance altogether.”

Last year, Island Health served 5,935 Medicaid patients, Cutter said, and 30% are expected to lose coverage.

“Those folks will be sicker because they didn’t have access to preventative care,” she said. “They will come to our emergency department, which will increase volumes.”

Jennifer Graham, Island Health’s chief nursing officer, said that without insurance coverage, people with chronic illnesses might delay care until they show up in the emergency department, where they have to wait to be transferred to another hospital because Island Health doesn’t have what they need.

“It limits access to beds,” she said, “and so folks who need true urgent care, true emergent care, have to wait longer.”

Cutter said the estimated annual cost of H.R. 1 to Island Health will be about $7.6 million — $4 million in Safety Net Assessment Program payments from the state and $3.6 million in charity care, or uncompensated care.