Two rural counties in Washington have become embroiled in the national health-care debate after the last insurer to offer coverage in the individual markets there indicated it was pulling out. It’s not clear, in a supercharged political environment, if Republicans are to blame.

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Two rural Washington counties have been thrust into the national health-care debate after new rate filings revealed that no insurers planned to offer coverage next year in the individual markets in Klickitat and Grays Harbor counties.

Democratic elected officials pounced, blaming the insurer pullout on uncertainty caused by Republican plans to repeal the Affordable Care Act (ACA).

State Insurance Commissioner Mike Kreidler issued a news release Thursday saying the pullout affecting an estimated 3,350 people “clearly indicates to me that the uncertainty the Trump administration and the GOP-controlled Congress has sowed for months is sabotaging the progress we’ve made.”

U.S. Sen. Patty Murray, D-Wash., followed up in a few hours with a release saying the two counties “show exactly how President Trump is causing uncertainty” and hurting Washington families.

But Premera Blue Cross, the last to offer individual insurance this year through the ACA in Klickitat and Grays Harbor counties, said that wasn’t why it was getting out of the counties.

“No,” said Melanie Coon, a Premera spokeswoman, when asked if uncertainty caused by the GOP drove the insurer’s decision.

Coon said rising costs prompted Premera to exit the individual markets in four rural counties, including Island and Skamania counties.

The decision “will help us keep cost increases lower for customers in other counties.”

Isn’t that another way of saying the ACA, also known as Obamacare, wasn’t working as hoped in those four abandoned counties? Couldn’t Republicans seize on the filings with Kreidler’s office to hammer their point that the ACA’s individual markets are a disaster?

They could, except Premera and its subsidiary LifeWise will continue individual coverage in 23 Washington counties. Pulling out of four rural counties would “help us achieve our goal of serving our individual market customers for many years to come,” said a statement from Coon.

Rural counties have been historically hard to serve, before and during Obamacare, Kreidler noted. They have fewer customers, fewer providers and high administrative costs, he said. “Those being the ones falling out is not a surprise.”

But Kreidler, who has been part of Washington Democrats’ fierce defense of the ACA, stuck to his response about Premera.

He said a number of insurers, including Premera, have told him privately that Republican plans — particularly the failure to commit to federal subsidies for lower-income ACA customers — are driving uncertainty among insurers.

He pointed to an April letter that he and a state insurance-industry group wrote to the Trump administration saying the most significant drivers of market uncertainty include GOP efforts to weaken the ACA’s cost-sharing subsidies and its individual mandate, which seeks to balance risks and costs for insurers by requiring healthy people to have coverage.

“I am not calling them a liar,” Kreidler said. But Premera and other insurers are reluctant to blast Republicans, who control all branches of federal government, he said.

“I just understand that insurance companies have a certain risk-averse nature and it doesn’t mean alienating people by pointing at one party or another,” he said.

Kreidler maintained that the “one big variable” for insurers next year compared to this year is “what’s happening in Washington, D.C.”

Senate Republicans this week said they are closing in on a bill to repeal the ACA, with a plan that, according to The New York Times, diverges from the House on pre-existing medical conditions and may try to maintain federal subsidies that proponents see as essential to stabilizing insurance markets.

Most Washingtonians have employer-sponsored health insurance. About 350,000 others are in the individual market, with most of those buying coverage through the state exchange created under the ACA.

As for the 3,346 people in Klickitat and Grays Harbor who had insurance in the individual market this year, their fate has not yet been sealed by the rate filings. (The financial details of those filings become public June 17.)

Kreidler said he hoped to do what he could to persuade an insurer, or insurers, to step into the two counties. He has through August to make that happen before coverage plans are locked in for 2018.

If no insurer is available in a county, Kreidler said the only option under state law is coverage through the state’s high-risk pool. That would not come with subsidies, making insurance prohibitively expensive for some, he said. One alternative, he said, is for state lawmakers to pick up the costs of subsidies in Klickitat and Grays Harbor counties.

Outside those two counties, the rate filings showed a total of 11 insurers would still be offering individual market coverage around the state.

“We’re lucky we’ve kept the number of insurers pretty static. Some ebb and flow is natural,” Kreidler said. But “the wound of two counties that don’t have any insurers in the individual market caught me by surprise.”