San Juan County residents face double health care crisis: ACA changes and Medicare telehealth cuts

By Darrell Kirk

Journal contributor

San Juan Islands residents are grappling with a health care crisis on two fronts as insurance carrier options dwindle and Medicare eliminates most telehealth coverage, forcing islanders into costly and time-consuming mainland trips for basic medical care.

San Juan County has become the only county in Washington state with just one health insurance option after LifeWise stopped serving the area, leaving only Ambetter Health available through the Affordable Care Act marketplace. The situation affects self-insured individuals and small business owners who rely on ACA coverage.

But the health care challenges extend beyond ACA insurance. Medicare recipients across the islands now face a new barrier: the elimination of telehealth services for most medical appointments, except for behavioral health and substance abuse treatment. Those specific appointments must now be made while at a provider's local office.

San Juan Island resident Ellen Roberts told the Journal the Medicare telehealth cuts affect her personally.

"I now have to go off island just to get test results in Sedro Woolley. You know how that goes, as it means a whole day trip plus the ferry fare," she wrote, "More importantly, this will affect everybody on our island who is on Medicare. And it will also affect people on all the other islands, too."

With a large population of Medicare recipients across the San Juan Islands, the telehealth elimination compounds an already difficult health care access situation.

During a San Juan County Council meeting held Nov. 4 at the Orcas Island Fire and Rescue Station, council members discussed the insurance crisis and planned advocacy efforts.

San Juan County Council chair Kari McVeigh shared a stark example of the ACA insurance challenges: "My friend, who is a small business owner without ACA coverage, told me that her monthly insurance costs will be $1,200 a month, and that's not sustainable. She's in her early fifties and will have no insurance because she simply can't afford it."

The insurance crisis isn't new to the islands. In 2019, Kaiser pulled out of San Juan County after denying a number of residents air ambulance flight coverage. The Lopez Clinic faced a situation just a few years ago when carriers threatened to pull out, requiring extensive last-minute advocacy to secure coverage.

San Juan County Council member Justin Paulsen acknowledged the uphill battle ahead: "We're advocating in a David versus Goliath situation. Unfortunately, every community in our country is in a David and Goliath situation with the insurance industry."

He warned that if the Affordable Care Act is eliminated, "this becomes a whole different discussion," and that employer-sponsored plans "are going to explode in cost."

The Council has been in contact with the Northwest Washington Representative for the Governor's Office, Chairman Jeremy Harrison-Smith and the Insurance Commissioner's Office, which has been receiving tremendous traffic on this issue and is actively working with legislators on the benefit exchange.

County staff have prepared a FAQ sheet to help residents understand that while health care insurance issues aren't within the jurisdiction of the County health department or hospital districts, residents can still advocate for themselves. Council members emphasized that this should be a legislative push led by elected San Juan County officials to avoid burdening already-stretched health and community services staff.

Roberts has contacted Sen. Patty Murray, Sen. Maria Cantwell and Rep. Rick Larsen about the Medicare telehealth cuts, hoping they can push legislation through while health care conversations are ongoing in Washington, D.C.

The hospital district commissioners plan to sign their own letter of support regarding the insurance crisis, which will accompany the County Council's correspondence to state officials.