JACKSON: Increased health care premiums will affect individuals who buy insurance through the Washington Health Benefit Exchange and also small businesses.

Multimedia journalist Venice Buhain spoke to one Seattle smoothie shop owner facing higher costs next year.

ANDERSON PIERI: Toast, oatmeal, smoothies, juice, acai bowls.

We don't have a lot of ice cream in this area.

So we get to be not only like coffee, breakfast, but also healthy dessert.

Because we have acai bowls you could put like, chocolate hazelnut butter on top.

Put honey in and all that kind of stuff.

So it's like a sundae.

Alicia Anderson Pieri opened a Pure Green franchise in South Lake Union a year ago.

Providing good food wasn't her only consideration.

ANDERSON PIERI: When we decided to open this business like it was really important for our value system, that we were strong employers.

And then we were able to attract a good talent.

VO: And she's not alone.

According to policy group KFF about 34.6% of Washington employers with 50 employees or fewer offer health insurance to their employees.

ANDERSON PIERI: Offering health care was something we had in mind from the beginning.

And then when I started hiring employees before we opened, I was asking them about what was important to them when they were looking for a new employer.

And many of them told me that having co-sponsored health insurance was a non-negotiable for them.

Insurance Commissioner Patty Kuderer said that many employers in Washington are facing those same increased costs.

KUDERER: We have about 194,000 people enrolled in our small group market.

We'll see an average increase of 16.7% next year.

VO: Thats a big hit to an employer like Pure Green which covers half of their employees insurance premiums.

ANDERSON PIERI: In our system, in the US, that's really the best way to go because being on the individual exchange is so expensive.

VO: In Washington, premiums on the individual health exchange are rising 22%, which, coupled with the end of Covid-era health coverage subsidies, are expected to decrease how many people remain enrolled.

ZAICHKIN: When we started open enrollment last year, we were at a record high of folks who were covered through the exchange at about 290,000 people.

Today, we're at about 260,000 people, and we'll see what happens next year.

But we're expecting that there may be an enrollment loss of about the same proportion going into 2027.

VO: Kuderer said her office will propose exploring ideas for increasing health coverage in Washington.

KUDERER: I don't believe it's hopeless, but it's going to take states getting creative and showing what can be done under our own authority.

I'm talking about a bill that we will be bringing to the legislature, asking the legislature to give my office the authority to design payment program for universal primary care.

That's going to take a lot of time and work.

VO: US Sen.

Patty Murray said there needs to be a federal response.

MURRAY: I feel really fortunate to be from Washington state, where we do, do innovative things.

And the legislature really does work to try and deal with the problems as best as they can.

But when the federal government is cutting Medicaid by billions of dollars and taking away the tax credits, it makes it very hard, especially in the environment we have today.

We have got to reinstate the ACA tax credits.

We need to work really hard to undo the damage of the Medicaid cuts, and at some point work towards universal coverage.

VO: But in the meantime small business owners like Anderson Pieri will have to balance the needs of her business and her employees.

ANDERSON PIERI: It's something that we value as like the type of employer we want to be.

But obviously that comes as a cost.

That's a lot of pressure on a small business owner who's already juggling a million other things.

VO: For Cascade PBS, this is Venice Buhain.

JACKSON: I'm Paris Jackson, thanks for watching The Newsfeed.

To see this week's stories about how health policy changes are impacting Washington patients visit CascadePBS.org/thenewsfeed.