By Rep. Jim Walsh

We all flinched a bit when Grays Harbor County made the news recently about the possibility that no insurance company would offer individual health coverage here in 2018. Since then, state insurance regulators have coaxed one insurance company into reconsidering and offering coverage. This solution fixes the immediate crisis. But it’s a thin bandage on a deep wound.

Our health care status quo — a combination of the Affordable Care Act at the federal level and the Washington Health Benefit Exchange system at the state level — isn’t working for rural parts of the state. In order to improve our local health care market, we need major reforms. Most of those reforms need to happen at the federal level, in Washington D.C., But some can take place in Olympia. And some, locally.

A few elected officials are trying to make health care reform a partisan political issue. That’s a shame. Partisan finger-pointing doesn’t help anyone on the Harbor get better health coverage. I prefer to focus on what we can do to actually help people here. This process starts with an essential question: Why is good health care so hard to get on Grays Harbor?

That question reaches back before the current crisis of insurance companies leaving. Before this, we had a crisis of doctors leaving. Last year, a group of local parents protested the lack of pediatricians practicing on the Harbor. Our local hospitals have become dependent on “locum” physicians — basically, temp doctors.

This happened because our local economy doesn’t generate enough private sector jobs to support the vibrant health insurance market we need. Instead, we’re stuck with a quasi-single-payer system, in which Medicaid plays an unusually large role. So, the Affordable Care Act’s Medicaid expansion piece — which helped cover the uninsured in other places — didn’t help as much here. But the law’s lower Medicaid reimbursements — a mere nuisance in places with healthier levels of private-sector health coverage — were a market-killer here.

This adds insult to injury. For decades, rural Washington has suffered a steady decline in jobs and local industry — the results of bad public policies from Olympia and D.C. These bad policies have encouraged young people and working people to move away. This exodus becomes a self-reinforcing trend, further damaging the demographic balance we need to support a healthy insurance market.

Insurance companies and state insurance regulators talk a lot about how “sick” Grays Harbor County is. They point to troubling statistics: our high rates of obesity and diabetes; our heavy use of tobacco, alcohol and opiates; and our generally poor mortality numbers. But, when I speak with insurance executives, they mention our economic sickness first. The real disease destroying our communities is a lack of private-sector jobs. No jobs means no employer-sponsored health insurance and not enough cash in most people’s pockets to buy individual coverage.

When insurance companies do offer plans, they come with large hikes in the premiums. Premera has agreed to offer individual coverage in 2018; but it will raise premiums by almost 28 percent above 2017 levels, which were already high. This trend hurts more than just working people or people living on fixed incomes. Small business owners, farmers and the self-employed — the most critical contributors to our rural economy — simply can’t afford the rising prices of group or individual coverage.

Also, we can’t ignore the role that Grays Harbor Community Hospital has played in our health care woes. In the three years since we voted to restructure GHCH as a taxpayer-supported public hospital district, its management has made numerous choices that have alienated insurance companies and local people. Those choices include a feud with Molina Healthcare that reduced Molina’s activity in Grays Harbor — and soured other insurance companies on the area. While GHCH’s questionable choices aren’t the leading cause of our problems, they’ve contributed.

So, what can we do to improve health coverage for rural communities? Look for short-, mid- and long-term solutions. At the same time.

The Premera deal is an adequate short-term fix, which will get us through the next 18 months. Beyond that, we need legislative action.

Recently, I introduced the Washington Patient Choice Act — House Bill 2228 — which makes targeted reforms of the state Exchange system. It exempts counties with one or fewer insurance companies offering individual plans from state rules that exceed federal law. This will provide more choices to rural residents more effectively that other reforms being considered in Olympia. One insurance company writing coverage is better than none; two or three are better than one—better in terms of access, better in terms of cost. HB 2228 is a good mid-term fix.

Long term, the ACA and Washington Exchange need more substantial reforms to bring clearer pricing signals to the health insurance market. That means more focus on individual coverage, not less. And offering more coverage options from which individual consumers can choose, to express their preferences. Clearer pricing signals will also bring providers — including pediatricians — back to rural markets. That will be the surest sign that our health care market is finally, permanently fixed.

Jim Walsh is a Republican from Aberdeen and represents the 19th Legislative District.