How much more are ~250,000 WASHINGTON ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and recently it was confirmed that over 2.6 million ACA exchange enrollees had already been priced out of the market as of February, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of February have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plana with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at WASHINGTON:

Here's a look at ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

Like most states, Washington has seen enrollment plummet across most income brackets, especially among enrollees who earn less than 100% of the Federal Poverty Level (FPL), which is due to the Trump Regime eliminating subsidy eligibility for around 1.4 million low-income legally residing non-citizens.

Unlike most states, however, Washington has only seen a modest drop for enrollment over the 400% FPL threshold even though that population is also no longer eligible for federal tax credits...which I'm guessing is largely thanks to them newly implementing robust Premium Alignment pricing, which mostly benefits those who earn between 200 - 400% FPL but also partially helps those paying full price (ie, those earning over 400% FPL) by making the gross price of Gold and Bronze plans far less expensive.

It's also important to note that Washington is one of the states which offers their own supplemental subsidies to ACA enrollees who earn up to 250% FPL ("Cascade Care"), which I'm sure helped mitigate the drop-off.

Overall, however, plan selections have still dropped by 5.9%, or over 18,000 people versus OEP 2025...and since then, effectuated enrollment has dropped even further, with 46,000 fewer enrolled as of February 2026 than in February 2025.

Onto the main analysis:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by Actuarial Value (AV) category. The first table is based on official metal level tiers, but it's the second table which is critical, since a huge chunk of ACA enrollees are usually enrolled in CSR Silver plans (which include Cost Sharing Reduction assistance). CSR assistance dramatically boosts the AV of Silver plans up to Platinum levels in most cases.

As shown below, while some of the ~250,000 Washingtonians still enrolled as of February did "buy down" to a worse plan, thanks to the state ramping up Premium Alignment pricing, enrollment in Gold plans actually shot up dramatically.

As a result, the average actuarial value for enrollees only dropped slightly (from 76.2% to 75.8%).

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like so (unfortunately, unlike most states which have their additional state subsidies, I don't have the dollar amounts for Washington's Cascade Care program and therefore can't fill in the average per enrollee drop in premiums):

Even without accounting for the state subsidies, however, average net premiums only went up around 19% in The Evergreen State...again, thanks to the robust Premium Alignment pricing. Any other year this would be considered outrageous, but in 2026 it's actually at the low end compared to other states.

In addition, by my estimates, average out of pocket spending "only" went up around 20% as well this year (for the same reason), resulting in a combined average 19.4% increase in total net healthcare spending...which still amounts to around $1,000 more per year per enrollee, unfortunately.

Interestingly, based on KFF's net data, average deductibles actually DROPPED slightly in Washington State on average, by around $100 for single coverage. Huh. The maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this year as well, however, to $10,600 for single coverage.

Next up: WEST VIRGINIA.