Rhode Island: 21.7% avg rate hikes; over half caused by CSR sabotage

I first looked at Rhode Island's proposed rate hikes back in early July. At the time, the average increase for the two carriers participating in RI's individual market was 10.5% assuming CSR reimbursement payments are guaranteed for 2018. If they weren't guaranteed, however, I estimated at the time that an additional 19 percentage points would be added into the mix, based on an estimate by the Kaiser Family Foundation.

However, I realized a little later on that I was misinterpreting KFF's analysis; they were referring to how much they estimated silver plans would go up due to the lost CSR funds, not all metal levels. Furthermore, for Medicaid expansion states (which includes Rhode Island) they estimated the average was only 15%.. Based on these factors, the impact across the board on Rhode Island should have only been around 10.3%.

HOWEVER, according to this article in today's Pittsburgh Post-Gazette, the actual impact on Silver plans specifically will be around 18 percentage points (at least for BCBS of RI, which holds the lion's share of enrollment).

Rhode Island had approved rates based on the assumption that the federal payments would continue. In the days since last week’s announcement that the payments would end, the insurance commission is working through an elaborate procedure to replace the original rates with higher ones that the commissioner told the state’s two insurers in its ACA marketplaces to prepare over the summer, just in case.

“It’s not as easy as pressing a button,” said Cory King, the Rhode Island insurance commissioner’s principal policy associate. For Blue Cross Blue Shield of Rhode Island, the insurers with more customers, the change will cause the premium increase for “silver” tier plans - the level eligible for cost sharing reductions - from about 12 percent to about 30 percent.

In addition, it looks like I missed the press release about the approved rate hikes a little earlier; Neighborhood Health Plan stayed at 5% (now presumably 17.3%), but Blue Cross Blue Shield was knocked down a bit from 13.9% to 12.1%.

As a result, here's the approved (and presumably final) rate increases in Rhode Island with the CSR load added onto both carriers:

Yup, a full 57% of the inrcrease falls squarely on Trump's shoulders.

It's also worth noting that from the wording in the article, it looks like Rhode Island is either "silver loading" or "silver switcharooing", which is a good thing.