There are a lot of reasons sign-ups for individual health insurance are falling below expectations as the deadline for 2015 strikes on Sunday. One big one may be that many people are finding they just can’t afford to pay for a policy, even if it means a potential penalty.

Share story

As the second round of open enrollment for individual health insurance draws to a close Sunday, the number of people signing up in Washington likely won’t meet expectations.

And though there are plenty of reasons for the lackluster turnout — technical problems with the Washington Healthplanfinder exchange website, confusion over renewals, higher-than-expected Medicaid enrollments, more people with jobs providing insurance benefits — many are staying uninsured because the cost of coverage is too expensive for them.

While the Affordable Care Act strove to put insurance within everyone’s reach through subsidies and by expanding Medicaid, that hasn’t been enough for many people. Now state lawmakers are considering taking a closer look at the problem to help those who remain uninsured.

Sunday deadline to sign up for health insurance

If you want health insurance in 2015, you need to select and make the first payment on the plan before 10 p.m. Sunday. Go to Healthplanfinder at www.wahealthplanfinder.org to enroll in the exchange.

For enrollment help, contact the state’s call center at 855-923-4633 or King County’s help line at 800-756-5437.

There are multiple events this weekend where trained navigators will be available to help. Find a full list at wahbexchange.org/how-enroll/community-events/.

King County events include:

• Saturday from 11 a.m. to 4 p.m. at The Commons mall in Federal Way, 1928 S. Commons.

• Saturday and Sunday from 10 a.m. to 5 p.m. at Metro Seattle, 201 S. Jackson St.

• Saturday and Sunday from 8 a.m. to 5 p.m. at SeaMar Seattle Clinic, 8720 14th Ave. S.

• Sunday from 10 a.m. to 4 p.m. at Valley Cities Counseling in Kent, 325 W. Gowe St.

Nick Dobie has met some of the people who slip through the cracks between Medicaid and affordable coverage. Dobie works at Country Doctor Community Health Centers in Seattle’s Capitol Hill neighborhood, helping people sign up for coverage through the Healthplanfinder exchange.

A few weeks ago a woman in her early 60s came to the clinic to renew her coverage for 2015. The woman, who works as a waitress, had a plan last year that cost $42 a month with subsidies, but this year her coverage shot up to $110.

“She just looked at me, and she’s like, ‘I can’t do that. I can’t make it work,’ ” Dobie said. He’s found that for many clients, their tax credits went down while monthly premiums rose.

A woman in her mid-20s who works at a tech startup also wanted to enroll. She qualified for a $15-a-month subsidy, and the cost of the least-expensive silver-level plan — coverage that offers middle-of-the-road benefits — was $150 a month.

“I could just hear her trying to sort things out, but with rent and other expenses, she couldn’t make it work,” Dobie said. The woman was also paying student loans and recently had moved out of her parents’ house.

Both of the women are going without insurance, which means they face a penalty on their tax returns next year for being uninsured.

Last year, the exchange had more than 164,000 customers at the close of the first open-enrollment period in March.

In this second round of enrollment, which began in November, only 139,000 customers had signed up a few days before the Feb. 15 deadline. The state had set a goal of 213,000 customers.

Bethany Frey, spokeswoman for the Washington Health Benefit Exchange, which runs the insurance marketplace, advised people to shop around and consider changing plans if they need a cheaper option.

“If people did see a decrease in their tax credit, it doesn’t necessarily mean they have to pay more,” Frey said.

The amount available in tax subsidies is pegged to the price of the second-cheapest silver plan sold in a customer’s geographic area. That price decreased across Washington, so the subsidies shrank, too. The precise amount a person receives is determined by his or her income.

Monthly premiums for exchange plans rose a modest 2 percent for 2015. But insurance prices also go up each year according to a customer’s age.

Despite the exchange’s better showing last year, it appears that costs were a struggle then as well. Slightly more than half of the exchange customers missed at least one month’s payment last year. And by the end of December, roughly 44,000 had outstanding balances on their accounts.

“We hear there is an affordability issue,” said Molly Firth, director of public policy with Community Health Network of Washington, an umbrella organization for community health clinics.

“We’ve heard it the last two years,” she said. “We want to understand what is the problem and what is the solution to it.”

In Olympia, state lawmakers are considering HB 1669 and SB 5625, legislation to conduct a study and form a task force to better understand the hurdles to coverage.

“This is the first step (to) identifying why people aren’t getting the care they need,” said Rep. Marcus Riccelli, D-Spokane, sponsor of the House bill, which had a hearing Wednesday.

Some of the solutions could include allowing nonprofit groups to pay the premiums for low-income people. Washington also could adopt the federal Basic Health Program, which provides additional subsidies for people who fall above the cutoff for Medicaid but below an income of up to 200 percent of the federal poverty level. An individual must make less than $16,105 a year to qualify for Medicaid.

Despite their concerns, those working with low-income residents applaud aspects of the Affordable Care Act, particularly the expansion of the definition of who is eligible for Medicaid, locally called Apple Health.

The program, which used to cover only low-income children and elderly people, pregnant women, people with certain disabilities, and foster kids, and was a temporary aid to the neediest families, now provides health care for 1.7 million residents.

Thanks in large part to the Medicaid expansion, the rate of people uninsured in Washington dropped to 8.6 percent by last summer, down from 14.5 percent before the health-care overhaul, according to the state Office of the Insurance Commissioner.

But those people caught between Medicaid and affordable insurance will continue relying on charity care and community health clinics like Country Doctor for discounted prices for routine services.

“The safety net is still here, and the safety net, unfortunately, continues to be needed,” said Linda McVeigh, Country Doctor’s executive director. “And that’s the disappointment with the Affordable Care Act.”