Cowlitz County, WA state see lag in healthcare marketplace signups

Congress is set to vote in December on whether to extend tax credits that help many Americans afford health insurance. In the meantime, surrounded by warnings about rising premiums, fewer Cowlitz County residents appear to be signing up for 2026 marketplace plans.

State officials report seeing a similar delay, even though Washington offers its own marketplace subsidies which could help those who lose federal tax credits.

Jim Coffee, CEO of the Cowlitz Family Health Center, said the clinic has had around 10 people come in to sign up for marketplace health insurance in the two weeks after enrollment opened on Nov. 1. During past open enrollment periods, it typically saw five to six per day, he said.

He guessed that the drop in interest was at least partially caused by concerns about the cost.

"It looks like a lot of people have just given up based on the news rhetoric coming out of D.C.," he said.

However, those who did visit the clinic did not see the same large increases to their premiums that other healthcare consumers are reporting, he said. Some received a small increase, while others saw no change at all.

State data, White House plan

The Washington Office of the Insurance Commissioner approved a 21% rate increase in 2026 for insurance plans sold on the Washington Health Benefit Exchange, which manages state marketplace plans.

The office reports reasons for increased rates include uncertainty about the enhanced premium tax credits extension, as well as the rising costs of health care and prescription drugs.

Tara Lee, chief communications officer for the Exchange, said the local hesitance mirrors state trends. The Exchange is seeing more interest in marketplace health insurance than last year, but people are slower to commit to purchasing a plan, she said.

She said many customers are likely waiting to see whether Congress will vote to extend Affordable Care Act tax credits, as losing them will affect what kind of health insurance they're able to afford.

The majority of Exchange clients in the state qualify for the tax credits, which are set to expire at the end of the year unless Congress votes to extend them.

The Associated Press reported Monday that the White House is considering a proposal to extend the tax credits for people making up to 700% of the federal poverty level. It would also require all Affordable Care Act plan holders to pay for some portion of their premium.

Under the current tax credit system, some low income households qualify for subsidies that pay their entire health insurance premium.

KFF, a nonprofit policy research organization, reported in April that marketplace enrollment nationwide had reached record highs for four years in a row. It attributed this growth largely to the introduction of the expanded tax credits in 2021.

In Washington, marketplace enrollment increased by 45% between 2020 and 2025, KFF reported.

State subsidies

Washington also offers its own health insurance subsidies for marketplace clients, called Cascade Care Savings. People must apply to join the program, which is available to households with an income of up to 250% of the federal poverty level. In 2025, that means $39,125 per year for an individual, or $80,375 per year for a family of four.

The U.S. Census Bureau reports that the median yearly household income in Cowlitz County in 2024 was $74,460. About 9.6% of county residents fall below the federal poverty line.

Coffee said he suspects local clients are not aware they may have other options for financial support if the federal tax credits expire.

"Washington state is not like the rest of the country," he said.