Before Congress Acts, the System Does

Washington State's health insurance system did not wait for Congress.

By early fall, insurers had submitted their 2026 rates to state regulators. Several carriers filed dual scenarios: one assuming Congress extends enhanced premium tax credits, one assuming it does not. The Washington Office of the Insurance Commissioner approved the higher rates. The 2026 market is now priced for coverage loss. That decision cannot be undone by later congressional action.

Around the same time, the Washington Health Benefit Exchange released estimates showing roughly 80,000 residents could drop coverage if subsidies expire1. Medicaid budgets were finalized with their own cuts. Each step followed a fixed calendar. None could pause for a congressional stalemate.

Much of the debate over health care has focused on whether Congress will act in time. This report looks at what has already happened. Drawing on newly approved rate filings, state enrollment projections, and Medicaid budget decisions, it shows how insurers and regulators in Washington have already adjusted for coverage losses expected in 2026, as Congress remains deadlocked.

Rep. Michael Baumgartner continues to support H.R.1 as these preparations to increase costs move forward.

What Changed Quietly in Washington

The Office of the Insurance Commissioner approved an average 21 percent increase for 2026 ACA plans sold through Washington Healthplanfinder2. That decision followed months of rate filings and actuarial review, locking prices into place well ahead of any congressional action.

The Health Benefit Exchange issued an unusually direct warning. In a marketplace serving roughly 300,000 people, the projected losses represent a meaningful contraction.

Regulators also adjusted the mechanics of the marketplace itself. For 2026, Washington required a uniform cost-sharing reduction load on silver plans sold through the Exchange. The rule changes how premiums interact with subsidies, raising benchmark prices to preserve federal assistance for some households while increasing gross premiums across the board. The Exchange also modified its Cascade Care Savings program and approved new plan designs intended to limit out-of-pocket exposure3.

None of these steps were framed as alarm. Officials emphasized stability, choice, and continuity. The filings tell a more specific story. Regulators and administrators altered pricing rules and plan structures because they expect affordability to worsen for many households.

For families in Eastern Washington, those technical choices matter more than the number of insurers listed online. Premium calculations, subsidy formulas, and plan design determine whether coverage remains workable month to month. That distinction matters less on paper than it does at the kitchen table.

Pricing for Loss, Not Exit

The clearest signal of what insurers expect in Washington is not whether they stay or leave. It is how they price.

When insurers filed dual rate scenarios, the difference averaged about four percentage points. That gap reflects expectations that healthier enrollees would leave the market first if premiums rose sharply. Regulators approved the higher scenario4.

Insurers are not guessing who drops coverage under pressure. They anticipate that households earning too much for Medicaid but lacking employer coverage will exit first. Rates reflect that assumption. Premiums rise to cover a smaller, sicker pool.

In WA-5, where many counties already have limited provider networks, those pricing decisions translate into hard trade-offs. Coverage may remain available, but deductibles climb and provider options narrow. For many households, the question becomes whether insurance functions, not whether it exists.

Washington's marketplace has not collapsed. Insurers and regulators have recalibrated the system for fewer participants. For ACA consumers in Eastern Washington, that recalibration defines the risk heading into 2026.

Why “No Insurer Exits” Misses the Point

State officials often note that no insurer has exited Washington’s ACA marketplace for 2026. The statement is accurate, but it offers limited reassurance.

Carrier exits are a late-stage indicator. Pricing decisions, benefit design, and network breadth shift first. Those changes shape affordability long before a company withdraws entirely.

Washington’s own records show this sequence. Regulators approved large, subsidy-sensitive rate increases. Insurers priced plans assuming adverse selection. The Exchange projected substantial enrollment loss5.

In rural Eastern Washington, the distinction is especially important. A plan can remain listed while becoming impractical to use. Networks tighten. Formularies change. Travel distances grow. Three plans on paper can still amount to no realistic choice.

Statewide participation counts can mask those effects. A new entrant in an urban county offsets strain elsewhere. What appears stable from Olympia can look very different from Colville, Republic, or the Palouse.

Apple Health: The Second Squeeze

For many WA-5 households, the ACA marketplace is not the starting point. Apple Health is.

Beginning January 1, 2026, Washington will implement a 1 percent cut to Apple Health managed care rates, roughly $90 million statewide6. The reduction appears in the state budget as a premium adjustment to managed care organizations. According to the Health Care Authority and hospital representatives, the savings will be achieved through lower provider payments and service reductions. Because Medicaid operates on thin margins, even small percentage cuts translate quickly into fewer services and reduced access.

Federal policy changes add a second layer of pressure. The Health Care Authority estimates 200,000 to 320,000 Washingtonians could lose Medicaid coverage as new eligibility rules take effect7. Work requirements place hundreds of thousands of adults at administrative risk. Even with Washington’s ability to delay implementation, agency documents show enrollment losses beginning in late 2026, following the mid-term elections.

Medicaid churn does not stay contained. People who lose Apple Health often attempt to move to the Exchange. Others fall into coverage gaps when premiums prove unaffordable. In rural areas, reduced Medicaid payments and ACA instability affect the same clinics and hospitals8.

The result is compounding strain. Apple Health tightens as the ACA market prices for loss.

Where Representation Becomes Responsibility

At this point, the sequence matters more than the rhetoric.

Congress has known for years that enhanced ACA premium tax credits expire at the end of 2025. Insurers flagged the risk in earlier filings. Federal analysts modeled the losses. Washington state agencies incorporated those assumptions into 2026 rates and enrollment projections. None of this emerged suddenly.

As the deadline on expiring ACA premium subsidies approaches, Rep. Michael Baumgartner continues to support H.R.1, most recently through public backing of a “clean” continuing resolution that omitted any reference to healthcare affordability while highlighting military construction and base infrastructure at Fairchild Air Force Base.9

That position has a concrete effect. It ensures that insurers must price for a worst-case scenario. It forces regulators to approve rates that assume healthier enrollees leave. It leaves families to make coverage decisions months before Congress resolves anything.

This is not a dispute about motives. It is a matter of available options. Congress could act narrowly and early to prevent coverage losses. It has chosen not to. Baumgartner’s continued support for that strategy places him squarely inside the decision, not outside its consequences.

For households in Washington’s 5th District, this distinction matters. By the time Congress debates fixes, premiums already rise, plans already change, and budgets already strain. The harm does not wait for final votes. It arrives on schedule.

Delay, in this context, does not preserve leverage. It transfers risk downward, from Congress to insurers, from insurers to states, and from states to families. That transfer is now visible in filings, projections, and approved rates. It is no longer theoretical.

What WA-5 Families Should Watch

The effects described here will surface gradually.

The earliest signal is effectuation: how many people who select 2026 plans actually pay the first premium. Drops in effectuation often appear before enrollment declines.

Next are plan changes. Deductibles, drug coverage, and provider networks shift quietly, especially in rural counties where options are already limited.

For Apple Health households, warning signs arrive through renewal and verification notices. Administrative churn, caused by new regulations and confusion, has removed coverage quickly in the past.

Finally, provider strain shows up in appointment delays and service reductions. In Eastern Washington, access often erodes before statistics catch up.

These indicators follow from decisions already made.

Bottom Line

Washington’s insurance system is already adjusting to the expectation that fewer people will be covered in 2026. That assumption is built into rate filings, confirmed through regulatory approvals, and quantified in state enrollment and budget projections. Congressional gridlock does not stop these processes; it leaves them in place. For WA-5 families who rely on the ACA or Apple Health, the effects are no longer hypothetical. They are unfolding on a calendar Congress has chosen not to interrupt.

End Notes

[1] Washington Healthplanfinder, "2026 Cost Increase Information," consumer guidance on premium impacts if enhanced federal tax credits expire.
https://www.wahealthplanfinder.org/us/en/2026-cost-increase-information.html
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[2] Washington Office of the Insurance Commissioner, "Average 21% Rate Increase Approved for Washington's 2026 Exchange Health Insurance Market," September 2025.
https://www.insurance.wa.gov/about-us/news/2025/average-21-rate-increase-approved-washingtons-2026-exchange-health-insurance-market
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[3] Washington Health Benefit Exchange, Board materials and carrier certification for the 2026 plan year.
https://www.wahbexchange.org
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[4] Washington State Standard, "Sticker shock: WA health insurance buyers confront steep price hikes," October 22, 2025.
https://washingtonstatestandard.com/2025/10/22/sticker-shock-wa-health-insurance-buyers-confront-steep-price-hikes/
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[5] Axios Seattle, "WA Democrats warn ACA credits expiring could leave thousands uninsured," September 12, 2025.
https://www.axios.com/local/seattle/2025/09/12/wa-democrats-warn-aca-credits-expire-coverage-gap
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[6] Washington State Health Care Authority, "Managed Care Rate Reductions: Guidance and FAQ," October 2025.
https://www.hca.wa.gov/assets/program/managed-care-rate-reductions-guidance-faq.pdf
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[7] Washington Health Care Authority, "Apple Health (Medicaid) in Washington," fact sheet, July 2025.
https://www.hca.wa.gov/assets/program/medicaid-in-washington-state-fact-sheet.pdf
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[8] Washington Health Benefit Exchange, "Federal Policy Impacts on the ACA Marketplace," legislative and policy analysis.
https://www.wahbexchange.org/legislation
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[9] U.S. House of Representatives, Office of Rep. Michael Baumgartner, "Baumgartner: Now It's Time to Get Government Working Again and Put Everyday Americans First," press release on passage of the continuing resolution, November 2025.
https://baumgartner.house.gov/media/press-releases/baumgartner-now-its-time-get-government-working-again-and-put-everyday
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