Health insurance premiums in Washington have risen more than five times as fast as family earnings since 2000, according to a new national study.

Lack of competition among insurance providers, the cost of caring for an aging population and the cost of emergency care for the uninsured all have contributed to the increase, says the nonprofit organization Families USA.

“The combination of stagnant wages and rising health care costs is placing a growing strain on family budgets, and many families have reached a breaking point,” the study concludes. “Quite simply, Washington’s families are being priced out of health coverage.”

The cost of health insurance premiums in Washington has climbed by 113.3 percent while family earnings have increased by only 21.6 percent over the decade, the study found.

“In real dollars, the increased cost is dramatic,” Families USA said in a statement. “The actual average cost of premiums for families of four rose from $6,496 in 2000 to $13,854 in 2009. For individuals, the increase is as dramatic, from $2,740 to $4,681. At the same time, wages increased for families by only an average of $5,769.”

The disparity means that if a family wanted to keep the same insurance coverage today that it had in 2000, “all of their increased wages would go directly to health insurance, and it still would not be enough,” the report said.

The Kaiser Family Foundation reported similar trends nationally in a study released this week that found the average annual premium for employer-paid health insurance had jumped 131 percent since 1999.

In Washington state

In Washington, Regence Group, Premera Blue Cross and Group Health account for nearly 60 percent of the private health insurance market, according to the Office of the Insurance Commissioner. In Clark County, Kaiser Permanente, a health maintenance organization, is a major player, covering nearly 100,000 county residents.

But a spokeswoman for Regence Blue Cross/Blue Shield of Oregon, which covers 14.5 percent of the Clark County market, said Regence operates in one of the nation’s most competitive markets and its premiums are subject to a “rigorous and thorough review” by state regulators.

“Many factors are responsible for the rising cost of health care, including the high rate of unnecessary medical treatment, hospital and facility duplication, technology, poorly coordinated care and personal habits,” Regence spokeswoman Samantha Meese said in a statement. “Families USA and others make the point that coverage is costly compared to income, but the real comparison is to claims costs.”

The cost of paying claims is rising faster than Regence’s growth in membership in both Oregon and Washington, Meese said.

Regence is working to reduce those costs by going after medical identity thieves, emphasizing prevention and early intervention, carefully reviewing pharmacy benefits and trying to reduce the incidence of medical harm that occurs in hospitals, she said.

Washington State Insurance Commissioner Mike Kreidler said controlling the cost of health insurance is a top priority for him.

“The only refuge we have from those dismal numbers is that the cost of health care is lower in Washington than in most states,” he said.

Individual employee contributions to employer-provided health policies averaged $569 annually in Washington last year, far less than the national average of $882, according to the Kaiser Family Foundation. But employer contributions in the state were higher than the national average.

The number of health insurance providers licensed in Washington actually has steadily increased over the past decade, according to the Office of the Insurance Commissioner. In 1998, 11 traditional health insurance companies and two health maintenance organizations did business in Washington. By last year, 25 health insurance companies and five HMOs offered policies here.

But competition varies from county to county.

Clark County has five options available for those seeking individual health care policies. Each of the state’s other urban counties — King, Pierce, Thurston, Snohomish and Spokane — has seven.

Even many low-population rural counties have more options available than Clark County. Cowlitz, Skamania and Wahkiakum counties all have six.

At least seven insurance companies offer employer-provided group plans in Clark County: Aetna, CIGNA, Health Net, Kaiser Permanente, Providence Health Plan, Regence Blue Cross/Blue Shield and United HealthCare.

Kreidler said the issue of increasing competition in the health insurance market is complex and does not lend itself to easy solutions.

“A big part of the problem is that you need economies of size,” he said. “You can’t be a small insurer in a big market. Efficiencies come in putting together provider markets. You don’t do that with a mom-and-pop operation.”