Steep premium increases on Washington’s and Idaho’s health insurance exchanges haven’t stopped people from signing up for coverage this year.

But some returning customers are struggling to pay for plans when monthly premiums have jumped an average of 39 percent in Idaho and 36 percent in Washington.

Leigh-Anne Kelly, a stay-at-home mother of two, will pay $215 out of pocket for her health plan, up from $166 this year, an increase of about 30 percent.

“That might not seem like a lot for some people, but it’s half a week’s food budget,” she said.

She’s on a silver-level plan through Kaiser Permanente with a $750 deductible, which will fall slightly to $700 in 2018.

Silver is the middle of three tiers of plans offered on the health exchanges, and is supposed to cover about 80 percent of medical costs.

Kelly’s actual monthly premium this year was $280 a month, with a subsidy of $114 to offset the cost. For 2018, her subsidy rose to $198 a month, but her plan is up to $413.

Kelly recognizes she’s lucky to have insurance she can pay for, even if it’s difficult.

“I’m happy to pay it,” she said. “It’s a huge strain on our financial obligations from month to month to pay the policy even with the subsidy.”

Washington HealthPlan Finder reported that as of Nov. 27, some 17,842 new customers had signed up for health insurance through the state’s exchange, an increase of about 43 percent over the same period last year.

Washington’s open enrollment continues through Jan. 15, but customers must sign up by Dec. 15 to start coverage on Jan. 1. Idaho enrollment ends Dec. 15.

Washington’s exchange marketing manager, Michael Marchand, predicted total sign-ups, including Medicaid, would be around 200,000 by the end of the enrollment period.

In Idaho, about 88,000 people have signed up for plans, Your Health Idaho spokeswoman Karla Haun said. More than 90 percent of people who had a plan in 2017 have re-enrolled for 2018 coverage.

Federal subsidies for insurance coverage rise relative to the cost of the second-cheapest silver plan sold on the exchange, so customers like Kelly do get more help to cover costs.

“I’ve been pleasantly surprised that what the consumer pays hasn’t gone up all that much,” said Curt Fackler, the program manager for Better Health Together, which trains and manages health insurance navigators in the Spokane area.

Most people who make under 400 percent of the federal poverty level receive a subsidy. That cutoff is $48,240 for a single person, $64,960 for a couple and $98,400 for a family of four.

But the Affordable Care act also requires people to spend a certain percentage of their income on health insurance premiums before subsidies kick in, from about 2 to 9.7 percent depending on income.

For young people, especially students, premiums may be high enough that they’re difficult to afford, but low enough that there’s no help available to pay for them.

Fackler said he’s seen that with a number of Gonzaga students who aren’t covered by their parents.

“Those are the ones that are really hurting,” he said of the price increases.

Higher prices are causing more people to seek out advice from navigators, and are also prompting some people to downgrade to cheaper bronze plans that cover less care.

Julie Becker, who manages the navigator program for Community Health Association of Spokane, said its network of 18 navigators is getting more contact from people who are looking at switching to other plans because their costs have risen dramatically.

“There’s some sticker shock going on,” she said. “I think less people will sign up because it’s just unaffordable for those who aren’t getting the premium tax credits.”

Silver plans prices climbed far more than gold or bronze plans because of a decision by the Trump administration to stop reimbursing insurers for an extra subsidy given to some low-income customers.

Those payments, called cost-sharing reductions, were supposed to incentivize people to buy coverage they otherwise might not be able to afford. Insurance companies are required to subsidize those plans under the Affordable Care Act, even if they’re no longer receiving federal funding to do so. As a result, silver plan premiums went up more than their counterparts.

That’s resulted in a few people opting to move from a silver plan to a gold one because the gold plan is less than $50 a month more for much better coverage.

“It’s putting gold plans within reach for many people who are unsubsidized,” Marchand said.

Michael Cathcart, the 32-year-old director of Better Spokane, a pro-business and economic development group, is buying an indiviudal plan for the second time after seeking exchange coverage last year. He’s the organization’s only employee, so there’s no option for coverage through work.

He was paying $410 a month for a gold plan through Premera Blue Cross this year with no subsidy and said the coverage was decent, but made regular physical therapy for a shoulder injury impractical.

With a $1,000 deductible, he said he spent somewhere between $600 and $800 last year on care before he stopped because it wasn’t affordable to continue.

Keeping that plan would cost him $548 this year and his deductible would also nearly double, he said.

He’s shopping for other plans and trying to find something with a more reasonable month-to-month cost.

“It’s just really frustrating because you’re so locked in to what they give you,” he said. “It’s not like I was maxing out the plan or causing any reason to sort of see those price jumps. It’s just sort of a natural increase that Premera decided to implement.”

He said he’d like to see more options for non-work groups, like credit unions, to provide health coverage in bulk so they have some power to negotiate prices. More price transparency in health care would also drive costs down, he said.

Kelly’s husband makes about $40,000 a year at his job as a drafter. She said it’s not cost-effective for her to work because child care would cost about $2,000 a month, using up most of her income.

She could get coverage through her husband’s work plan, but said it’s even more expensive and has a much higher deductible than what she gets on the exchange.

Her 4-month-old and 2-year-old are covered through Washington Medicaid, but the family makes too much for her to qualify.

She said she’s lucky she can afford her plan this year, but still worries about her husband getting sick or injured.

“We’re in that margin of people who would be completely destroyed by one medical disaster or one financial disaster,” she said.