If you are one of the thousands in Grays Harbor County who rely on individual health insurance, you’re likely worried by Insurance Commissioner Mike Kreidler’s announcement Thursday that as of the June 7 deadline not one insurance provider had signed up to offer that kind of insurance in the county for 2018. Monica Ewing, a health insurance expert at Durney Insurance in Hoquiam says that worry is legitimate.

“They kind of do have a pretty legitimate reason to worry,” she said. “Nothing will change immediately, but come January 1 of 2018, as things stand, there will be no insurance carriers for individual policies in Grays Harbor County.”

Those who are part of group insurance plans through their employers, or who pay for Medicare supplemental plans, aren’t affected.

Of the state’s 39 counties, only two — Grays Harbor and Klickitat — failed to attract even one provider for individual insurance.

Which begs the question, why us?

“I suspect the problem with Grays Harbor County has little to do with politics and much more to do with our local health rankings,” said a local physician who preferred not to be identified. “We lag well behind most counties in the state in health parameters — from obesity to smoking to health care access — making the county a poor ‘bet’ for insurers. It always comes down to a financial bottom line, even for insurers on the Exchange, and obviously they want to game the system such that they’re not going to lose money.”

Kreidler’s office said that in 2017, 2,227 people in Grays Harbor were enrolled in the individual market.

Ewing believes the number could be higher.

“I think that might be just those inside the Washington State Healthcare Exchange. I don’t know if it takes into account the number of people who work directly with other carriers, because if you don’t qualify for the tax benefit through the exchange there is no reason to go through it.”

Stephanie Marquis, a spokeswoman for the Insurance Commissioner’s Office, said that while there is reason to worry, the commissioner himself and other elected officials are working hard to find ways to get at least one carrier to come back into the county in 2018.

“I would like to stress this is not a done deal, and the commissioner is working very hard to see if he can get one or more providers to reconsider coming into those counties,” said Marquis. “We have until the end of the summer and even up into fall to get somebody on board.”

Ewing is also hopeful the efforts of Kreidler, Gov. Jay Inslee and Congressman Derek Kilmer will also pay off before anyone has to lose coverage.

“I very much hope so,” said Ewing. “I know they’re going to put pressure on providers to see if someone steps up to the plate. This would be unprecedented. Most of the people involved wouldn’t be able to afford insurance without the tax-credit help. That would leave people to choose to eat or choose health insurance.”

Under current state law, if no health insurer is available in a particular county, the only coverage option is through Washington state’s high-risk pool, referred to by the acronym WSHIP. However, because this program is not a qualified Exchange insurer, subsidies would not be available, meaning high premiums.

“If nothing changes the high-risk pool is about it,” said Ewing. “The bad part is the premiums are high and there are no tax credits to help pay them.”

Marquis noted the process for signing up for the high-risk pool is similar to signing up for insurance through the state. “But you don’t go through the Exchange, and the plan doesn’t qualify for subsidies so it’s generally much more expensive.”

WSHIP premiums are based on age, depend on the deductible you choose and also vary from region to region. According to the WSHIP website, in Grays Harbor County the basic plan monthly premium for a nonsmoker aged 20 and younger, with a $1,500 deductible, would be $719. For an individual age 65 and older, that premium skyrockets o $3,398. For a 35-year old person, nonsmoker, the basic plan monthly premium would cost $1,384.

Ewing noted that “Medicare supplements are not affected by this announcement, and neither are employer group plans. I’ve had people calling who think even if they have these plans they’re not going to have coverage,” and that is not the case, she said.

Marquis noted that the Insurance Commissioner’s Office has authority over rates and coverage when insurance providers file their intent to cover a certain county or area. They do not, however, have the authority to require them to cover a particular area or county; the choice to cover or not to cover in Grays Harbor County is up to the insurance companies.

“That doesn’t mean there aren’t other ways we could encourage them to do so,” she said about attempting to attract insurance providers to the county. “Whether it’s modifying regulations along counties, or it might take legislation to convince them to provide coverage.”

All of those options and many more are on the table as the state tries to get individual health care insurance back in Grays Harbor County.

“We’re going to do everything we can,” said Marquis. She said her office has spoken to Kilmer and says he’s “very worried.” Gov. Inslee expressed his concern and willingness to work with providers in a call to the commissioner’s office Thursday. “I think a lot of people are doing whatever we can do to bring coverage back to these areas,” she said.