Demand for ACA health insurance plans soars to record high in WA

Jan. 23—More Washingtonians than ever before are enrolled in health insurance plans through the Affordable Care Act this year.

As of Jan. 15, the close of open enrollment, about 308,000 residents had chosen 2025 health and dental plans through Washington Healthplanfinder, the state's online marketplace for ACA coverage. The surge was largely driven by federal and state subsidies that have made premiums more affordable, the Washington Health Benefit Exchange said last week.

This year, more than 75% of customers benefited from federal premium tax credits, which were implemented by the Biden administration, Exchange CEO Ingrid Ulrey said in a statement. That plus Cascade Care Savings, the state's public health insurance option that allows certain households to further save on monthly premiums, "combined to enable this record high enrollment," Ulrey said.

As a result, people eligible for both federal and state support have bought plans for an average of $70 per month — compared with an average premium of more than $540 per month for a Cascade Care Silver plan before subsidies are applied, Ulrey said.

However, this level of enrollment might not be sustainable given current federal and state funding, she added.

"The enhanced level of the federal premium tax credits require Congressional action to continue beyond the end of this year," Ulrey said in the statement. In addition, Cascade Care Savings "proved so popular that demand outpaced the remaining funds appropriated" by state legislators, she said.

"System reforms are needed to address the underlying costs and in the meantime, it is crucial that both federal and state subsidies continue to keep coverage affordable," Ulrey said.

The enrollment figure, which is preliminary, includes people renewing their existing plans and nearly 50,000 new customers, according to the Exchange. In 2024, about 270,000 people enrolled in ACA plans.

State lawmakers reserved about $110 million for the Cascade Care program for the 2023-25 biennium, which ends June 30. This session, the Exchange is asking the Legislature for $75 million a year to continue state premium subsidies for the 2025-27 period, said agency spokesperson Tara Lee.

Sen. Annette Cleveland, D-Vancouver, who chairs the Senate Health & Long-Term Care Committee, said she's glad the subsidies are encouraging people to seek health insurance coverage, but acknowledged the state's multibillion-dollar budget deficit looming over this year's legislative session.

"It's no secret we're facing significant budget challenges this year," Cleveland said in an interview this week. "We're unsure about whether federal subsidies will continue. ... I hope Congress continues to recognize healthy citizens are integral to our country and economy."

She added she's "certainly looking at every possible way to continue our state subsidy program and try to meet need best we can."

Rep. Joe Schmick, R-Colfax, said he hasn't yet seen any proposals around extending Cascade Care subsidies and said he would have to look over the details of any plans before deciding if he'd support it.

"I think Cascade Care provides an option for people to get insurance," said Schmick, the ranking member of the House Health Care & Wellness Committee. "We learn more about it every year it's in existence. We just have to take a look at it and evaluate it and ask, 'Is it achieving what its goals were?'"

He expressed concern about expanding other programs that further increase access to health insurance, like Apple Health Expansion for undocumented immigrants, and said he wanted to instead focus on improving Medicaid reimbursement rates for providers.

"I struggle with that — because here we are expanding the amount of people that are eligible to get Medicaid insurance, but let's turn around and see that we're not able to pay our providers, the people providing the service with (adequate) Medicaid reimbursement levels," Schmick said.

Washington is not alone in its record ACA enrollment numbers. According to the Centers for Medicaid and Medicare Services, nearly 24 million people throughout the country selected 2025 coverage through federal and state marketplaces — about double the number of people enrolled four years ago.

The extra federal subsidies will expire at the end of 2025 unless congressional lawmakers vote to extend them or make them permanent.

In Washington, people who receive state subsidies will be covered for the full year regardless of what happens during the legislative session, as long as they remain eligible and their income doesn't exceed 250% of the federal poverty limit, Lee said.

"That is part of why we were keeping a careful watch on the remaining available funds this biennium, to ensure that those customers are covered for the whole year," Lee said in an email. "Obviously, we are concerned about the potential 1-2 punch that could come from loss of the federal enhanced subsidies and any reductions in the state subsidy."

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