People who buy their own health insurance in Washington are facing another sharp premium increase just as state officials warn that hundreds of thousands of people could lose Medicaid coverage under new federal rules.
Insurance Commissioner Patty Kuderer has approved an average 22.2% rate increase for individual health plans sold through the Washington Health Benefit Exchange beginning Jan. 1. The increase follows an average 21% increase this year.
Nearly 250,000 Washington residents bought individual plans through the exchange in 2026, including self-employed workers, early retirees and some small-business employees.
Jim Freeburg, executive director of the Patient Coalition of Washington, said the consecutive double-digit increases are putting insurance out of reach for many families.
“To pay 20% more for the same plan you got last year, that might have even higher deductibles, means it’s going to be harder for people to afford health care,” Freeburg said.
Freeburg used his own family as an example.
“For my family of four, my wife and I buy our insurance through the exchange,” Freeburg said. “We pay $36,000 a year for our insurance, and it’s not even great insurance. That comes with a deductible that’s almost $3,000.”
Officials said the increase reflects rising costs for medical care and prescription drugs, greater use of health services and a change in the makeup of the insurance pool after healthier customers dropped coverage.
“They say labor costs are going up and things are more expensive, and while that may be true, we can’t afford the product they are selling right now,” Freeburg said. “One of the reasons for the increase in costs is massive consolidation in our health care system. Hospitals are merging together and every time they do that they just charge more and more, and we’re not getting a better product or service out of it.”
The affordability concerns come as Washington prepares for major changes to Apple Health, the state’s Medicaid program. The overhaul was set in motion under H.R. 1, President Donald Trump’s federal budget law.
The federal law will tighten Medicaid eligibility for lawfully present immigrants beginning Oct. 1. Additionally, in January more than 600,000 Washington residents will face new work requirements to remain enrolled in Apple Health. They will also have to renew their coverage twice as often, according to state officials.
Kevin Wren has Type 1 diabetes and is too medically frail to remain employed. Instead, he depends on Apple Health for his medication.
“I’m scared for people like me who are on Medicaid who can fall through the cracks. Just simply a missed letter can mean your life is at risk,” Wren said. “Tying work requirements to Medicaid doesn’t put people to work. It just puts people at risk of losing their insurance because of paperwork.”
Gov. Bob Ferguson signed an executive order directing state agencies, hospitals and health care organizations to coordinate a response, monitor coverage disruptions and help residents keep their insurance.
Even with those efforts, Ferguson’s office projects that more than 200,000 Washingtonians could lose Apple Health coverage by the end of 2027 because of the federal changes.
State officials urged Apple Health recipients to update their contact information and watch for notices about their coverage.
“What the governor is doing is taking some good first steps. They are long overdue. What we really need is awareness,” Freeburg said. “People need to be checking their mail, they need to keep their information current, but we need more from the governor to make sure we are doing absolutely everything to mitigate the crisis.”
When it comes to the increases for coverage on the Health Benefit Exchange, Freeburg said there are many approaches policy makers could take to hold down costs. One measure would be to lower the interest rate on medical debt to make it less burdensome on people while at the same time giving more scrutiny to consolidations and mergers within the health care industry.
“We could also be investing more in primary care to make sure people have access to a cheaper service that is not in the ER or urgent care,” Freeburg said.
The next open enrollment period for the state Health Benefit Exchange begins Nov. 1 and runs through Jan. 15.