Bad news for buyers of Washington's state health insurance plans: Premiums are set to rise an average of 24 percent in 2018. The rate hikes, which were approved this week by the Washington Health Benefit Exchange board, will impact an estimated 180,000 customers.

“It’s difficult, we get it,” Michael Marchand, the state exchange’s marketing director, told KUOW. “You have to show empathy and you have to be able to say ‘hey look, there’s decisions you’re going to have to make this year that are going to be hard.’”

The spike comes, Marchand said, due to rising medical costs as well as a decline in the number of insurance companies willing to sell on the exchange. If customers are looking for someone to blame, they may want to glance toward the other Washington: Uncertainty about the future of the Affordable Care Act, which Donald Trump and the GOP have been slowly strangling to death, has prompted insurance companies to drop out of state healthcare exchanges altogether. In King and Pierce counties next year, the number of insurers on the exchange from will drop from seven to four; in Snohomish County it will drop from six to three, and in Kitsap from four to three.

While Republicans, despite dozens of attempts, have been unable to repeal the ACA, they haven't given up on sabotaging it from within: The Trump administration shortened the open enrollment period by 50 percent; cut 90 percent of the open enrollment advertising budget, a vital tool for informing people when they need to sign up; and cut funding for groups across the country that help people sign up for healthcare. Even more bizarre, the Department of Health and Human Services—an agency tasked with promoting the health of the American public and currently embroiled in a scandal of its own—has spent taxpayer money creating a series of videos designed to undermine the ACA, as the Daily Beast reports.

For those who do get their coverage from Washington's state exchange, open enrollment for next year is between November 1 and December 15. Expect to pay a bit more, but look for federal tax credits, which should help about 60 percent of those impacted offset the higher cost—at least until Trump takes them away.