Two Arizona health insurance companies have been placed under supervision by the Arizona Director of Insurance, Andy Tobin. Director Tobin filed an Order for Supervision on October 30, 2015, to place Meritus Health Partners and Meritus Mutual Health Partners into supervision. Meritus declined to consent to the Order for Supervision. The Meritus companies’ ability to write new policies or renew existing policies is suspended. The Centers for Medicare and Medicaid Services has removed the Meritus plans from the Marketplace. Director Tobin, appointed as Supervisor under Arizona law, will oversee the two companies.
More than 8 in 10 (86 percent) current Marketplace enrollees can find a lower premium plan in the same metal level before tax credits by returning to the Marketplace to shop for coverage. If all consumers switched from their current plan to the lowest-cost premium plan in the same metal level, the total savings would be $4.5 billion. In 2015, nearly one-third of consumers who reenrolled in a Marketplace plan switched to a new plan.
Last week, in light of the #RiskCorridorMassacre debacle, I tried to find some good news on the CO-OP front, and while I didn't find much to cheer about, there were some bright spots in Maine/New Hampshire (where one CO-OP actually turned a profit last year), along with Illinois, Montana, Idaho, Ohio and Wisconsin (where the CO-OPs are still losing money, but seem to have staunched the blood flow and claim to be stable now, to put it in medical terms).
HealthCare.gov is going to see some shrinkage in 2016.
The number of health insurance plans available on that huge federal Obamacare marketplace for 2016 is decreasing by up to 12 percent compared with this year, industry sources told CNBC.
And there will be an even sharper reduction — of more than 40 percent — in the number of health plans on HealthCare.gov known as PPO plans, which offer customers the most flexibility in where they can get medical services covered by their insurer, sources said.
At the same time, there will be a marked increase in the number of so-called HMO plans, which do not as a rule cover costs incurred by customers outside of the plan's network of health providers.
The decreases on HealthCare.gov — which serves residents of 37 states — come a year after federal officials boasted about a 25 percent increase in the number of insurers offering plans for 2015.
As regular readers know, I've been trying to figure out whether effectuated ACA exchange enrollments have dropped noticably since the second quarter or not. Since last November, the HHS Dept. has been projecting that the effectuated number will be down to 9.1 million enrollees by December from 9.95 milliion as of the end of June.
After the first Republican debate back in August, I wrote a piece over at healthinsurance.org titled "Has FOX News surrendered on Obamacare?" in which I noted that the ACA, which had been a near obsession on the part of the GOP for over 5 years, was barely mentioned:
In short, from what I can gather, the Affordable Care Act …
… the law which has consumed 99 percent of the Republican Party’s attention for the past 6 years or so …
… the law which has survived over 50 repeal attempts …
… the law which recovered from an unprecedented epic technical meltdown …
… the law which survived a federal government shutdown designed specifically to destroy it …
… the law which survived hundreds of millions of dollars worth of Koch Brothers attack ads …
… the law which survived two major Supreme Court decisions …
… proved to be worth perhaps three minutes of total airtime and discussion out of nearly four hours of Republican Party Presidential debate.
With the 2016 Open Enrollment Period quickly approaching, here's the most important advice I can give:
#1: SHOP AROUND. SHOP AROUND. SHOP AROUND.
Earlier today, the HHS Dept. released an in-depth analysis of the coverage decisions made for by the 4.8 million people who were still enrolled in HealthCare.Gov policies at the end of 2014 who went on to either renew their policies or switch to a different one for 2015 (note that the analysis only covers the 35 states run via HC.gov in both years. Oregon and Nevada ran their own ill-fated exchanges in 2014 and Idaho moved onto their own exchange in 2015, so these 3 states aren't included. Hawaii is moving to HC.gov for 2016 but was on it's own for both 2014 and 2015).
The report itself is quite detailed about how many people actively shopped around, how many of those kept their current plans, how many switched to a different carrier and/or a different metal level, but the bottom line is this:
The thought just occurred to me: Given that 9 of the ACA CO-OPs have closed up shop over the past few months...including no fewer than 6 in just the past 2 weeks (Kentucky, Tennessee, Colorado, Oregon, South Carolina and, just yesterday, Utah), along with at least two private insurers (WINhealth of Wyoming and, to a lesser extent, Coventry of Kansas) due specifically to wha
The HHS Dept's official exchange enrollment projection for the end of 2015 has always been that they expect roughly 9.1 million people to still be enrolled as of December (of which perhaps 8 million will renew their coverage for next year). If accurate, this would represent an 8.5% drop from the 9.95 million enrolled at the end of June.
As regular readers know, for the past couple of weeks I've been piecing together a theory, based on limited data, that ACA exchange QHP enrollment may have actually increased since June...or, at worst, only dropped slightly. Hard numbers from 8 states show a net increase of 2.7% from June through September; removing Massachusetts from the mix (special case) brings this down to a nominal 0.1% net drop:
After not one, not two, not three, but ten of the CO-OP organizations created by the ACA (and crippled from the get-go by being underfunded, not being allowed to advertise, not being allowed to arrange for additional funding and then having their sole lifeline cut off in the middle of the Open Enrollment period) melting down, you just knew that this was coming:
House Energy and Commerce Committee sets November hearing on ACA health co-op program
The House Committee on Energy and Commerce will hold a hearing on the Affordable Care Act's health co-op program in the wake of a string of collapses of consumer operated and oriented plans around the country, two sources familiar with the matter told SNL on Oct. 27.
Watch and learn. KFF does an excellent job of boiling down all of the insanity into just over 5 minutes (not that this reduces how stupid the system is, even under the ACA, but it at least explains it).
NOTE: The Open Enrollment dates listed at the end are obviously wrong because this video is from last year. For 2016, Open Enrollment runs from November 1st, 2015 through January 31st, 2016.
Thanks to Esteban B in the comments for the reminder.
This morning I noted a New York Times article regarding a whole bunch of ACA exchange enrollees who either forgot to/didn't realize they had to file a federal tax return in order to keep receiving their Advance Premium Tax Credits or who did file their taxes but forgot to include the subsidy reconciliation form when doing so.
At the time, I was so astonished at the idea that people who are receiving federal tax credits would not only not realize that they had to file a return, but would actually get angry when informed that they had to do so, that I completely missed out on the larger implications.
28,524 additional people were enrolled in July 2015 as compared to June 2015 in the 51 states that reported comparable July and June 2015 data.
Yes, that's right: The net total number of Medicaid/CHIP enrollees went up fewer than 30,000 people in July.
It's worth noting that the improving economy may be a significant part of this. Remember that this is the net number of enrollees; for all I know, 300,000 new people joined the program but 270,000 who were already on it left. Baseline churn is tricky to keep track of.
However, the more likely cause is far simpler: ACA Medicaid expansion has simply finally maxed out in most of the states allowing it, and most of the "woodworker" crowd has presumably finally figured out that they're eligible as well.
The next Open Enrollment period for the Health Insurance Marketplace begins on November 1, 2015 for coverage starting on January 1, 2016. According to an HHS analysis, about 8 out of 10 returning consumers will be able to buy a plan with premiums less than $100 dollars a month after tax credits; and about 7 out of 10 will have a plan available for less than $75 a month. Highlights of the 2016 Marketplace Affordability Snapshot include:
Late last night I posted a quick walk-thru of the all-new 2016 HealthCare.Gov Window Shopping tool. For the most part, it's a major improvement over the 2015 version (which itself was, of course, a massive improvement over the buggy, 78-screen original version launched for 2014 open enrollment).
However, there are a few improvements which can always be made, and for me, one of the biggest ones is right at the beginning. Immediately after entering your Zip Code, the very first question which pops up is "Are you enrolled in a 2015 Marketplace health plan?"
Aside from the fact that some people may not even know whether or not their current plan is "through" the ACA healthcare exchange or not ("Marketplace" is a pretty generic term, after all...) the problem is that if you choose "Yes", here's what pops up:
It asks you to enter your current 14-character Plan ID.
In July, the Internal Revenue Service said 710,000 people who had received subsidies under the Affordable Care Act had not filed tax returns and had not requested more time to do so.
If those people do not return to the marketplace this fall, they may be automatically re-enrolled in the same or similar health plans at full price. And when they receive an invoice from the insurance company next year, they may be shocked to see that their subsidies have been cut to zero.
Erin M. Lackey, 41, of Jacksonville, Vt., was one of many people who received letters from the I.R.S. saying they were at risk of losing their tax credits.
Her mother, Ruth J. O’Hearn, a nurse who helps her daughter with insurance matters, described her own reaction.
...and sure enough, even the Window Shopping experience has changed since last year; here are the new screens, step by step (I'm using fake data here):
Chock-full of negative spin, it's trashing the ACA for the following:
Lower than expected private policy enrollments (ie, exchange QHPs)
Not enough young people to keep the risk pool in check
Problems with the premiums and/or deductibles making exchange QHPs too expensive
the Medical Loss Ratio for 2014 being way too high (ie, some insurers losing money last year)
Now, all four of these attacks are partially valid. Yes, enrollment in private Qualified Health Plans via the ACA exchanges is definitely below expectations. Yes, the risk pool is skewing older than expected. Yes, (full price) premiums (to some degree) and (full price) deductibles (definitely) are a serious issue this year. And yes, some insurers did take a bath and even go belly up due to the first-year premium "blind dart throwing" (especially 9 ill-fated CO-OPs, along with at least one private insurer in Wyoming).
I'm not going to criticize the WSJ for several of their attacks; some are valid and some are outside my area of expertise. HOWEVER, I've found a couple of serious problems with the piece regarding the first bullet point.
I've held off posting an estimate of the weighted average rate increase for the final state on my list, Wisconsin, until now because there's a major gap in the data which likely makes my estimate off by quite a bit.
However, given that open enrollment is coming up a week from today, "window shopping" on HealthCare.gov is (supposedly) going live at any minute and the fact that with 49 other states (+DC) already included, I finally decided to go ahead and post this, along with a major caveat warning.
As y ou can see from the table below, there are two issues here. The first is a minor one: I have no idea what the rate change request from the Common Ground CO-OP is, except that it's under 10%. I also don't know exactly what Common Ground's enrollment figure is, other than "between 30,000-40,000" according to this article from February.
With all the bad news about the Colorado Dept. of Insurance pulling the plug on CO HealthOP a week or so ago, here's some (relatively) good news out of the Centennial State (and yes, I had to look that up to find out what Colorado's nickname is).
Colorado was one of the first states I included in my 2016 Weighted Average Rate Hike Project. At the time, I only had requested rate changes available, and was missing the requests and/or actual enrollment numbers for several insurance carriers. As a result, my estimate of the average requested rate hike came in at 13.1%, but was pretty fuzzy.
Thomas G. Stemberg, who cofounded Staples Inc. and invented the office superstore, died Friday at his home in Chestnut Hill, two years after he was diagnosed with gastric cancer. He was 66.
...With the backing of Bain Capital and its cofounder Mitt Romney, the first Staples store opened in Brighton in 1986. Growing rapidly, Staples took the top spot on the Globe’s 1991 list of the 50 fastest-growing companies in the state, with a sales growth rate of 83 percent. Today Staples is worth more than $8 billion.
...Romney also credited Mr. Stemberg with persuading him to push for health care reform in Massachusetts when he was governor.
As I noted a couple of weeks ago, for 2016 HealthCare.Gov has added several very welcome new features. Early window shopping at HC.gov will be starting later than expected this year due to some last-minute technical issues with two of the new tools, but it looks like they're going to resolve this by simply delaying the launch of some of them as necessary in order to bring the ones which are ready live. The following press release just showed up in my in box; assuming the listed improvements all work properly (!), all of these should be incredibly helpful in both streamlining and (hopefully) increasing enrollment for #OE3.
UPDATE: Also, I've received confirmation from HHS Spokesman Aaron Albright that yes, Window Shopping at HealthCare.Gov will launch on Sunday, October 25th.
I admit that given the carnage of the past couple of weeks, I'm almost afraid to post this entry...but I had to write something positive about the CO-OP situation.
With the ACA-created CO-OPs seemingly dropping like flies due to the #RiskCorridorMassacre, I thought this would be a good time to flip things around and look at which CO-OPs are doing well (or at least not badly).
This isn't much, but it'll do for now:
Wisconsin's insurance department says it has no intention of shutting down its #ACA co-op, which appears it will remain solvent next year.
Fresh on top of the Covered California data drop, the Washington Health Benefit Exchange (the 3rd-largest state-based exchange after California and New York) has published an updated, detailed enrollment report:
The Washington Health Benefit Exchange, which operates the state’s insurance marketplace,Washington Healthplanfinder, today announced over 1.5 million Washingtonians accessed health coverage through wahealthplanfinder.org from Oct. 1, 2014 through Sept. 30, 2015.
The announcement was part of a new Health Coverage Enrollment Report that includes an updated enrollment total of 152,517 individuals in private health plans – called Qualified Health Plans (QHPs) – as well as executed enrollment for more than 1.4 million Washington Apple Health (Medicaid) eligible enrollees.
COVERED CALIFORNIA RELEASES REPORT ON CALIFORNIANS’ KNOWLEDGE OF THE AFFORDABLE CARE ACT IN ADVANCE OF UPCOMING OPEN ENROLLMENT
Awareness of Covered California Is High, but Many Who Are Uninsured Still Don’t Know They Are Eligible for Financial Help to Buy Insurance
SACRAMENTO — With new research showing that many uninsured consumers who can benefit most still do not understand they can get financial help to buy health insurance, Covered California announced on Thursday that it will launch its third open-enrollment period Nov. 1 by spotlighting basic information about health insurance offerings, enrollment and care.
“We cannot ignore the reality that too many uninsured Californians still don’t know they can get financial help to buy brand-name insurance through Covered California,” said Covered California Executive Director Peter V. Lee. “We are going to take to the airwaves and hit the road with a new campaign to make sure consumers know what we offer and where they can enroll.”
Just a quickie: Among the many, many attacks on the ACA over the past 6 years, one which never really took hold was the claim that the ACA would make things so cumbersome and unpleasant for physicians that it would cause a massive shortage of doctors to handle the burden (of course, the fact that the "burden" would consist of "millions of people receiving healthcare for the first time in years or decades" always seemed to be left out).
There’s unprecedented interest in becoming a doctor as applications to U.S. medical schools hit an all-time high this year of more than 52,000, according to the Association of American Medical Colleges.
The association, which represents all 144 accredited U.S. medical schools and nearly 400 teaching hospitals,said the 52,550 total applications this year were up 6.2% from 49,480 in 2014.
Consumers’ Choice Health Insurance Company Agrees to Wind Down Its Operations
COLUMBIA, SC – Consumers’ Choice Health Insurance Company (Consumers’ Choice) has agreed to a voluntary run-off and will not offer health insurance coverage in 2016.
“This was a difficult decision for the insurer and this agency, but this is what is in the best interests of South Carolina consumers and health care providers,” said Ray Farmer, Director of the South Carolina Department of Insurance.
“The recent announcement of a risk corridor reimbursement of just 12.6% cast doubt on the collectability of tens of millions of dollars through the federal risk corridor program and led to an unavoidable outcome,” said Jerry Burgess, President and CEO of Consumers’ Choice.
12 days ago, private Wyoming health insurer WINhealth, in business since 1996, was among the 5 (and counting) victims of the horrific Risk Corridor Massacre, which has already taken the lives of at least 4 ACA-created CO-OP insurers:
WINhealth sent along this release saying: As of October 8, 2015, WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program .
UPDATE: I'm promoting this to the top of the front page for a bit. I didn't think this particular bit of nonsense from the Heritage Foundation would gain much traction because it sounded so absurd, but it apparently is being spewed via FOX News, Hot Air and other right-wing outlets, so debunking it has taken on a higher priority. I've also tidied up some of the wording for better readability.
Before I get into this, let me make one thing clear: I have made plenty of factual data mistakes myself over the past two years, and there have been times when I've made overzealous claims which were later proven to be false.
I posted about the House v. Burwell federal lawsuit (aka "The Return of the King...vs. Burwell", or "King v. Burwell Part 2") twice before: First in July (only a week after the Supreme Court's King vs. Burwell decision), and then again in early September:
Nick Bagley, a University of Michigan law professor, said it's not an "earth shattering surprise" that the court is allowing part of the lawsuit to go forward.
But the judge also opened a pathway to the part of the lawsuit that could be most damaging to the law, he said.
"Holding that the administration lacks the authority to cover the cost of those reductions would create a real mess on the ground," Bagley said.
"It inserts the court into the middle of a political food fight," he said.
Rep. Rusche asked what our target enrollment is for this cycle and what barriers we see in making those targets. Mr. Kelly said the team is focused on the 80% goal of 92,000 as our enrollment target.Premium increases are a potential barrier. Net premium is a relatively small increase for most consumers, and each consumer will experience something different depending Page 5 of 14 on their plan, their location, their carrier, etc. We feel that while the premiums are increasing the relatively small net premium increase will mitigate this barrier to a large degree.
When I asked for clarification, they informed me that:
We currently have 86,659 effectuated enrollments with Your Health Idaho, as of September 15. The 92,000 would also refer to effectuated enrollments.
Connecticut has its lowest percentage of people without health care coverage ever, according to Lt. Gov. Nancy Wyman and Access Health CT.
Access Health, the state's Obamacare exchange, said 3.8 percent of Connecticut residents, or 137,000 people, are without any form of health insurance.
The U.S. Census reported in September that the number of uninsured Connecticut residents fell sharply in 2014, by 85,000 to 245,000, or 6.9 percent. That was down from 9.4 percent in 2013.
The Census number is the lowest figure it has reported in at least 20 years, and Access Health said its number — determined through an analysis of 2015 coverage by Acturus of Farmington — is an all-time low.
As I noted in my #OE3 projection methodology breakdown the other day, among the 32.3 million uninsured individuals in the country, around 4.9 million of them aren't legally allowed to receive federal financial assistance (tax credits/CSR) to enroll via the ACA exchanges because they already have a standing offer of ACA-compliant health insurance from their employers, but have (so far) refused to sign up for said coverage. The New York Times explains why many of them haven't done so:
But 10 months after the first phase of the mandate took effect, covering companies with 100 or more workers, many business owners say they are finding very few employees willing to buy the health insurance that they are now compelled to offer. The trend is especially pronounced among smaller and midsize businesses in fields filled with low-wage hourly workers, like restaurants, retailing and hospitality.
Two big ACA-related stories in the New York Times this morning; each is worthy of a full entry, but I don't have time today so I'm lumping them together:
First up: The Times' editorial board has blasted the GOP over the CO-OP failure debacle. They give a concise summary of how the CO-OPs were created and why they're facing so many problems now:
[GOP critics] neglect to mention that the nonprofit plans, known as health insurance cooperatives, were created as a weak, underfunded alternative to a much stronger option that the Republicans blocked from passage.
...Their problems have been attributed to wrong estimates for how many people might enroll and to setting premiums too low to cover the cost of care, as well as severe reductions in the amount of money available to the co-ops from federal loans and for risk adjustment payments, both the result of Republican opposition to supporting the plans.
It is with a heavy heart that I write to you today. This morning, the Colorado Division of Insurance (DOI)announced Colorado HealthOP will not be selling plans through the Connect for Health Colorado marketplace.
Please be assured that, as a Colorado HealthOP member, your coverage will remain in effect through December 31, 2015, so long as you continue to pay premiums. In two weeks, on November 1, 2015, the Connect for Health Colorado marketplace will open and you will have the opportunity to find another health insurance provider that will begin coverage for you on January 1, 2016.
Needless to say, we are astonished and disappointed by the DOI’s decision. We believe it is both irresponsible and premature.
I've already laid out, in exhaustive detail, my rationale for projecting that 14.7 million people will select qualified health plans (QHPs) via the various ACA exchanges during the 2016 Open Enrollment Period (11/1/15 - 1/31/16...possibly with another week tacked on in an "overtime" period).
As always, I could very well be dead wrong about this. For all I know, the HHS Dept's far more conservative target range (11.0 - 14.1 million) could prove to be correct, or it could surprise the hell out of everyone and come in closer to the Congressional Budget Office's estimate of 20 million (although that number actually reflects their projection of the average number of people enrolled year-wide, which would require more like 25 million to select a plan by the end of January.
As I noted back in April, the New York Affordable Care Act exchange (NY State of Health) will become the second state (besides Minnesota) to offer a "Basic Health Plan" under a fairly little-reported on provision of the ACA:
The BHP will offer qualified individuals and families a choice of plans from high-quality, private health insurers through NY State of Heath (NYSOH), the state’s official health plan Marketplace. New York State health insurers were invited to offer plans through the BHP when the NYSOH plan invitation was issued today to New York State licensed health insurance companies. The invitation includes requirements for insurer certification and recertification for Qualified Health Plans and Stand-Alone Dental Plans, and for the new Basic Health Program which will start on January 1, 2016.
While I'm at it, I might as well try and project the rate of enrollments. Again, remember that this is not about how many people actually have their enrollment policy effectuated, nor is it about how many are still enrolled at the end of 2016; this is purely about how many select private policies via the ACA exchanges, which is the heart & soul of this website (after all, it's called "ACASignups", not "ACA Effectuated Enrollments at the End of the Calendar Year").
In computer science, GIGO means that a faulty input will result in a faulty output. Perhaps GIGO in the specific area of Obamacare enrollment projects should be Gaba In, Gaba Out since many leftwing sites are currently singing the praises of one Charles Gaba, a blogger who is projecting incredibly high Obamacare numbers. And now the Washington Post's Wonkblog writer, Jason Millman, is the latest person to be enthralled by the very convenient Obamacare numbers served up by Gaba. Here is Millman singing his Gaba paean:
The Obama administration on Monday announced that 5 million people had signed up for Obamacare exchange plans. Hours earlier, a self-employed Web developer from Michigan had already predicted the milestone would be hit on Monday.
UPDATE: 1/13/15: I've modified my final #OE3 projection; I'm now projecting a range of anywhere between 13.8 - 14.2 million (but I'll still be judging myself based on how close I came to the 14.7M figure, however.)
That's 2 in one day, the 8th to fold to date and the 4th one which can be specifically connected the Risk Corridor Disaster:
Health Republic Insurance Not Offering Plans in 2016
Lake Oswego, Ore. (Oct. 16, 2015) –Health Republic Insurance, a non-profit health insurance carrier, announced today that it will not offer small group or individual plans on or off exchange in 2016. All current Health Republic individual and small group policies remain in full effect through the end of 2015. Members can continue to see plan providers and claims will be paid under plan terms.
The federal government recently announced it would pay insurance companies only 12.6% of their risk corridor receivable for the 2014 plan year and has created industry-wide concern about when, or if the 2015 risk corridor would be paid.
The program has been under siege from the start, including from the insurance industry. Before the law’s passage, government grants to help them get going were switched to loans. None of that money could go for advertising — a wounding rule for new insurers that needed to attract customers. Moreover, the amount available was cut from $10 billion to $6 billion and then later, as part of the administration’s budget deals with congressional Republicans, to $2.4 billion. Federal health officials abandoned plans for a co-op in every state.
So, let's see here: You're trying to create start-ups to enter an existing, mature market which is already dominated by major, behemoth-sized competitors which have almost unlimited funds. Naturally it makes total sense to a) make the seed money a loan with a tight payback time table; b) prevent them from advertising in a saturated market; and c) slash their budget by 75%.
Hold on tight, this is gonna be a big one; it covers stories dating back several weeks, so some of these might be completely irrelevant at this point, but...
I've promised not to reveal the actual number anywhere else until tomorrow, so you'll have to read the full piece to get my call...but I do have some important caveats, disclaimers and additional points which I can make here as well:
*IMPORTANT: This assumes that everyone currently enrolled sticks with their current policy next year. If enough people shop around and consider their options, the average premiums for various plans, various companies, in vartious states and nationally could end up being considerably lower (possibly coming in under 10% overall).
Again: Do not blindly autorenew! Contact your ACA exchange website/call center (or your insurance carrier, if you're enrolled directly through them) and check out your options before committing to your existing plan! In many cases, there will be a different plan which is a better value for you!
At last!! It's been extremely frustrating trying to lock down the 2016 average premium hikes for Pennsylvania, especially because their Insurance Dept. website has actually been very good about posting every requested rate change in an easy-to-read, comprehensive fashion.
The problem with PA's rate filings hasn't been on the percentage change side, it's on the covered lives side. I was able to compile enrollment numbers for some carriers but not others...including First Priority, which was requesting a 29.5% rate hike. Without knowing whether they had a huge chunk of the market or not, posting the "average" rate hikes without including theirs was kind of meaningless, since it could potentially jack that average up or down dramatically.
So, I finally kind of gave up on it, figuring that even when the approved rates were posted, they probably still wouldn't include the number of covered lives for each insurance company.
A quick update from Connecticut: Last month it looked like effectuated QHP enrollment at AccessHealthCT had increased a bit between June and September, from around 92.2K to 96.6K.
However, just moments ago at the AccessHealthCT board meeting, this graph was displayed, showing that effectuated enrollment has actually been dropping off gradually since March, which is actually exactly what you'd normally expect via normal attrition anyway.
In any event, according to this slide, CT currently has 95,601 effectuated QHP enrollees: 71,022 receiving tax credits (74%), 24,579 without (26%), which is down slightly from September. This is right in line with my (revised) national attrition estimates, which should taper off at around 9.7 million effectuated enrollees by the end of the year.
With things ramping up for the 2016 Open Enrollment Period (#OE3), there's not much point in my continuing to track 2015 QHP selections. The June CMS report confirmed that off-season enrollments have been tracking pretty closely to my estimates (slightly higher, actually, although the number later dropped from their plans due to legal residency issues also turned out to be much higher than I had expected).
In general, however, it's been averaging roughly 8,000 - 9,000 new QHP selections per day during the off-season, and will likely continue at about that rate for another few weeks (hitting roughly 13.9 million by the end of October) before tapering off as the 2016 enrollment season kicks into gear. I'm pretty certain that it'll close out the year with around 14 million QHP selections even, of which around 12.6 million will actually be paid for and around 9.7 million will still be enrolled as of the end of December.
With that in mind, here's the last 2015 Graph I'll be posting, which I've also superimposed over the full-year 2014 Graph for comparison (as always, click on the images below for the high-resolution versions):
But yes, Clay County, TN Director of Schools Jerry Strong is indeed blaming the Affordable Care Act for his county's decision to pull the plug on the entire district in the middle of the school year:
The economy is so bad in Clay County, Tennessee that school is canceled indefinitely.
The decision to ebb budget concerns by shutting academic doors came down on Thursday when Clay County Director of Schools Jerry Strong quite literally decided to lock the doors of the county’s schools. He was particularly concerned with partially unfunded government mandates and what he believed to be the effects of Obamacare making it impossible to keep funds in the green.
By contrast, the damage from the Risk Corridor program being crippled is specific, quantifiable and obvious: Company X lost $22 million in 2014; they were supposed to receive $20 million (or whatever) back in risk corridor reimbursements; the CMS dept. only has $2.5 million to pay them back with, period, so they have to eat the remaining $17.5 million loss until next year or the year after...if they're able to stick it out that long.
The Kentucky Health CO-OP couldn't stick it out that long...and it's possible that similar press releases may be forthcoming for a few other CO-OPs (and/or other smaller insurers) over the next week or so.
Republican lawmakers in Utah voted in a closed-door meeting on Tuesday to shelve a plan to provide health care for about 95,000 of the state’s poor.
After months of negotiations earlier this year, the Health Reform Task Force unveiled a scaled down of the Healthy Utah plan for Medicaid expansion called Utah Access Plus. Under the new plan, the federal government would pick up about $450 million. An additional $50 million would be funded by taxes on doctors, hospitals, pharmaceutical companies and other medical providers.
On Tuesday, the Republican caucus gathered behind closed doors to determine whether it would allow the new proposal to move forward. According to KUER, lawmakers decided to kill the plan, leaving the future of Medicaid expansion uncertain in Utah.
Strike That: Apparently the Republicans immediately followed up crushing the spirits of 95,000 of their fellow Utahns by...eating birthday cake.
President Barack Obama's landmark health care reform law -- one of the most contentious political issues of the past six years -- received all but no attention during the Democratic debate Tuesday tonight. But considering that all five Democrats on the stage were supporters of the Affordable Care Act, perhaps it's not surprising that CNN opted to raise issues more likely to provoke confrontation.
Unfortunately, I don't have time to write about most of that today, as I'm concentrating exclusively on a Special Project: My Official 2016 Open Enrollment Projection piece...which isn't quite ready yet.
It's fitting that I'm working on that story today, however...because today happens to also be the 2nd anniversary of this website!
While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point) is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.
A couple of weeks ago, both Louise Norris and I crunched the South Carolina data and came up with different estimates of the weighted average requested 2016 rate hikes for the ACA-compliant individual market. She used a worst-case scenario and estimated it to be around 16.8%; I took a slightly more optimistic approach and came up with 15.2%.
As you can see, even though there are only 5 carriers operating on the ACA exchange and another 5 offering policies off-exchange only, the overall average is still 15.9% either way:
Ever since I laid into Congressional Republicans on Friday for deliberately sabotaging the funding program for the ACA's CO-OP Risk Corridor program last December, several people have correctly pointed out that, while having federal funds cut for this program cut off was certainly a major factor in at least one of the CO-OPs going under (the Kentucky Health CO-OP), there was a different policy change--made nearly 2 years ago--which may also contributed to their financial woes (and which may have played a role in some of the other 4 CO-OPs which fell apart prior to the risk corridor debacle hitting home a week or so ago).
The Massachusetts Health Connector held their monthly board meeting last week and have released their September dashboard report with a whole mess of demographic data for Baystate-obsessed nerds to revel in.
Effectuated QHPs have reached 179,470 enrollees...a whopping 38.930 higher (28%) than at the end of Open Enrollment.
While the national effectuation number is likely around 3% lower today than it was in March (9.9 million vs. 10.2 million), in Massachusetts it's 45% higher. There's two main reasons for this, both connected to "ConnectorCare", which is unique to Massachusetts. ConnectorCare consists of the same low-end Qualified Health Plans that anyone can purchase (ie, they're still counted as QHPs in the national tally), except that in addition to the federal Advanced Premium Tax Credits (APTC), enrollees in ConnectorCare also receive additional state-based financial assistance, making them even more attractive to enrollees. In addition, however, unlike "normal" APTC or Full Price QHPs, which are limited to the official open enrollment period for most people, ConnectorCare enrollment, like Medicaid/CHIP, is open year round. That makes a dramatic difference, as you can see below; the vast bulk of the net QHP enrollment increase since March is thanks to ConnectorCare additions.
In addition, MA is the only state I know of which actively reports their attrition numbers--that is, so far this year they've had just 17,246 people drop their QHP policies, meaning a total of 196,716 people have selected a plan and paid at least their first monthly premium.
Assuming a 90% payment rate (confirmed for Massachusetts back in April), this also suggests that the cumulative QHP selection total should be roughly 218,000 people to date, which is only significant to me and The Graph.
But wait, there's more! Look below and you'll see a whole mess of pie charts, bar charts and line charts, breaking out everything from Metal Level selections and Market Share by Provider to SHOP enrollments (5,562 lives covered as of October 1st) and even Dental Plans!
This may seem like common knowledge now, but in 2014, it felt like I was one of the only people who recognized that there were millions of people enrolling in ACA-compliant policies off of the ACA exchanges, directly via the insurance carriers themselves. My best estimate for 2014 was that in addition to the 7 million or so exchange-based individual market enrollees, there were another roughly 8 million people who enrolled off-exchange (although several million of those were in non-ACA compliant policies).
This time around, however, the victim (well, in addition to its current enrollees) is a private company, albeit a not-for-profit one: WINhealth Partners:
We’re a not-for-profit managed care company founded by professionals, and we’re changing the way that healthcare works for you – because we believe your insurance should help you to be at your best in life.
The nonprofit, consumer-governed health plans were included in the law as an alternative to the so-called public plan option. Modeled on successful health insurance cooperatives such as Group Health Cooperative in Washington, the CO-OPs were designed to broaden the coverage options available to consumers, inject competition into highly concentrated health insurance markets and provide more affordable, consumer-focused alternatives to traditional insurance companies.
To help these new plans find footing, the health law offered low-interest loans that were tied to a number of requirements designed to differentiate CO-OPs from traditional insurers (which were barred from the program). Recipients were required to:
The short version is that there were 3 funding programs put in place under the Affordable Care Act designed specifically to help smooth the waters and keep insurance carriers afloat for the first few years until they got past the bumpy transition period. One of these was called the "Risk Corridor" program. Basically, the carriers who lose their shirts the first 3 years were supposed to have at least a portion of their losses covered to tide them over; call it "training wheels" for the insurance industry. The funding was supposed to come partially from the other insurance companies which did better than expected...but any shortfall was supposed to be covered by the federal government, with the caveat that any surplus paid to the government stayed there as a type of profit.
In my most recent Maryland exchange update, I noted that after months of ACA exchange enrollments increasing during the off-season (if slowly), net policy cancellations finally started to outweight off-season additions starting in August:
As of Aug. 13th, 606,226 Marylanders have enrolled in quality, affordable health coverage for 2015 through Maryland’s state-based insurance marketplace.
That includes 123,673 people enrolled in private Qualified Health Plans (QHP) and 482,553 people enrolled in Medicaid through the marketplace since open enrollment for the year began on Nov. 15, 2014. Nearly 94 percent of all Marylanders who have enrolled through Maryland Health Connection for coverage this year received financial assistance.
Today, the exchange tweeted out a quickie update ahead of the 2016 Open Enrollment period:
A couple of days ago I noted that Covered California is adding a very good feature this year: They're opening up 2016 enrollment nearly 3 weeks early...for those who are already currently enrolled. Starting this monday, Oct. 12, current enrollees will be able to renew or switch to a different CoveredCA plan, 19 days ahead of he official Nov. 1st Open Enrollment launch.
I clicked through and saw this listed under the Frequently Asked Questions:
1. How do I enroll in kynect?
Simply visit kynect.ky.gov or talk to your insurance agent. If your insurance plan is up for renewal, you may be eligible to enroll through kynect today. You can also call Customer Service at 1-855-4kynect (459-6328).
My entry was about how the AP utterly misrepresentated the actual security situation a year ago, then compounded their mistake (I'll be gracious and assume it was done out of ignorance, not malice) a year later in their follow-up story. As for the actual HC.gov security situation, the short version was:
Those who follow me on Twitter know that I almost always include 3 hashtags with every Tweet: #ACASignups, #ACA and #Obamacare. During the 2016 Open Enrollment Period, I'll be changing the #Obamacare tag to simply #OE3, not out of any disrespect towards the President but simply because of the character limit.
Twitter followers also know that my personal feed (@charles_gaba) also includes all sorts of non-ACA-related stuff. If you want to keep up with my ACA-specific stuff but don't care for my unrelated political rantings, just follow the official@ACASignups Twitter account instead!
I planned on posting about this earlier today, but had to deal with a crisis for one of my Day Job clients (yes, I still have one believe it or not).
Early this afternoon, Covered California, the largest state-based ACA exchange in the country, held a conference call accompanied with a lengthy press release and a very nice slideshow full of pie charts and data points, giving a comprehensive overview of where things stand in the Golden State.
I've said before that there are a few areas of the ACA which I simply don't consider myself knowledgable enough about to try and explain to others in depth. One of these is the so-called "Cadillac Tax" on high-end employer sponsored insurance policies. The other (well 3 others, really) are the "3R" programs which were set up to try and smooth out the transition period for insurance carriers for the first few years. The "3 R's" are "Risk Adjustment", "Reinsurrance" and "Risk Corridors".
Risk adjustment is a process that deters insurance plans from trying to attract healthy enrollees (“cherry picking”), and protects companies that may—by chance or because of their particular benefits—attract sicker than average customers (“adverse risk selection”). Though the Affordable Care Act bans carriers from turning people down or charging them more based on their health, the incentive to attract healthier enrollees remains because healthier customers increase profits by reducing companies’ payouts.
This is really more for budget wonks than healthcare wonks, but still kind of interesting: The Congressional Budget Office just issued their September 2015 Monthly Budget Review report. Since the fiscal year runs from October through September each year, this means that they're basically closing the books on 2015 from a budgetary POV:
The federal government ran a budget deficit of $435 billion fiscal year 2015, the Congressional Budget Office estimates—$48 billion less than the shortfall recorded in fiscal year 2014, and the smallest deficit recorded since 2007. Relative to the size of the economy, that deficit—at an estimated 2.4 percent of gross domestic product (GDP)—was slightly below the average experienced over the past 50 years, and 2015 was the sixth consecutive year in which the deficit declined as a percentage of GDP since peaking at 9.8 percent in 2009. By CBO’s estimate, revenues were about 8 percent higher and outlays were about 5 percent higher in 2015 than they were in the previous fiscal year. CBO’s deficit estimate is based on data from the Daily Treasury Statements; the Treasury Department will report the actual deficit for fiscal year 2015 later this month.
This is a pretty minor 2015 exchange enrollment update, and one of the last ones I'll be doing before the 2016 Open Enrollment period kicks off, but I should squeeze it in:
From October 1, 2013 to September 23, 2015, 166,789 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:
24,663 people enrolled in a private qualified health plan,
120,739 people have been determined eligible for Medicaid, and
21,387 people enrolled through the DC Health Link small business marketplace (includes Congressional enrollment)
As always, the DC exchange insists on giving cumulative totals since 10/1/13 instead of the 2015-only numbers, which isn't particularly useful. However, by comparing it against their earlier update, I can figure out the difference since then:
From October 1, 2013 to June 7, 2015, 125,478 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:
The tweet includes this graphic, which seems pretty clear cut to me:
I noted yesterday that 3 states (Maryland, Idaho and California) have already opened up window shopping to prospective 2016 enrollees.
However, it was my understanding that no one was allowed to actually enroll (ie, "select or renew a Qualified Health Plan") until 2016 Open Enrollment officially starts on November 1st.
Not sure why this is being treated as such a revelation this morning, but Public Policy Polling just released new, extensive national polling results, and among the various topics they asked about was this bit regarding the Affordable Care Act:
Evidence continues to mount that the Affordable Care Act is just not a liability for Democrats anymore. Nationally we find that 42% of voters support it to 40% who are opposed. Those numbers are in line with what we've found in most swing states where we've polled on it over the course of this year. It's a far cry from when we used to consistently find voters opposed to it by a 10-15 point margin nationally and in key states. One big reason for the change is that Democrats (73%) are more unified in their support of it than Republicans (70%) are in their opposition to it. There isn't the sort of pro GOP intensity gap on the issue that there used to be.
For all of the improvements made to the federal exchange website, HealthCare.Gov, last year (ie, reducing the number of account creation screens from over 70 to just 16; optimized formatting for smartphones; working properly in general), there were still several major features missing. According to a new AP story, at least two of these have been addressed for the 2016 Open Enrollment period starting November 1st:
Consumers shopping on the government's health insurance website should find it easier this year to get basic questions answered about their doctors, medications and costs, according to an internal government document.
A slide presentation dated Sept. 29 says HealthCare.gov's window-shopping feature is getting a major upgrade.
...Previously, it could take considerable digging to find out plan details. Now consumers would be able to enter their doctors, hospitals and medications as they browse online. When they go to compare plans, they would see whether those doctors, hospitals and drugs are covered.
As it happens, at least two other state-based exchanges have done so as well:
COVERED CALIFORNIA: It's pretty obscure for the moment, but if you click the "Shop & Compare Tool" link at the lower left-hand corner of the CoveredCA website, you'll be given the option to shop around for 2016 plans (you can also choose 2015 plans in case you've had a qualifying life change and need coverage for the last 2 months of this year, or even 2014 plans if you still need that information for tax purposes or whatever):
Two more health insurers in North Carolina are asking to increase their already-proposed rate increases.
UnitedHealthcare, which had requested an average rate increase of 12.5 percent, now is asking regulators to allow an an average increase of 20.4 percent. The range is 2.5 percent to 50.3 percent.
Humana had requested 11.3 percent and is now asking for an average of 24.9 percent.
Last month I wrote a quick post about the Montana individual market; with only 3 players, all of whom had requested >10% increases, it was pretty easy to plug the numbers in: 22.2%, 29.3% and 34.0%.
Commissioner Monica Lindeen's office says the average rate increase for all plans next year will range between 22 percent and 34 percent. For the popular Silver plan, the increase will range from $80 to $88 a month for a 40-year-old person.
Lindeen said Thursday the rates affect about 41,000 people. They don't include people who receive federal tax credits or those who have insurance through their employers.
The "good" news here is that the affected number is only 41K instead of the 76K I had on record. It's possible that the middle carrier had their rates changed, but overall it looks like the commissioner just signed off on the original requests, for a roughly 26% average increase.
When I ran the numbers for Georgia's individual market in August, I didn't have a whole lot to work with. The requested rate changes were only publicly available for carriers representing around 222,000 enrollees, out of a state-wide individual market of (likely) around 750,000. The weighted average increase for the companies I had data for was around 18.3%; all I knew about the rest of them is that they had asked for hikes of under 10%. My best ballpark estimate was that Georgia residents were likely looking at roughly a 10-13% increase overall.
Today I ran across an article in the Rome News-Tribune which gives some of the final, approved rate hike numbers for 2016...but just bits and pieces, nothing to hang your hat on:
Many Georgians buying individual or family health insurance will see double-digit increases in their premiums for 2016.
For 2016, HMSA has proposed a 45.5 percent rate increase for their individual HMO plan, and nearly a 50 percent rate hike for their individual PPO plan (49.1 percent overall). The carrier justified their rate hikes based on claims costs, explaining that while virtually everyone in Hawaii was already insured, the uninsured pool – many of whom purchased new ACA-compliant plans – had significant medical needs.
Ouch. Yup, that's a pretty ugly requested increase, no way around it.
The following day, Kaiser proposed an 8.7 percent rate increase for their individual market policies.
If approved as is, this would have resulted in a 33.7% average rate increase, when weighted by market share between the two companies.
About a month ago, I crunched Nevada's individual and small group rate hike numbers and concluded that the overall weighted average hike in the Silver State next year (assuming everyone stays put and doesn't shop around) will be roughly 9.6% on the individual market and just 5.3% for small businesses.
Now, it's not the lower rate which caught my eye; the 8.7% figure only includes exchange-based carriers, of which there's only three this year, versus the dozen or so who operate throughout the state (there are 9 more insurance carriers who are only operating off of the exchange).
What I'm puzzled by is this part...which also includes some good news:
I realize this is mostly off-topic (although certainly gun violence overlaps with healthcare, both in terms of emergency room expenses as well as mental health services), but I couldn't resist posting about it.
Some relatively welcome news going into the home stretch: After a series of ugly (over 20%) rate hike averages from Alabama, Delaware, South Dakota and especially Minnesota, I've just completed the Virginia analysis:
Unlike many other states, there's no guesswork or educated guesses here; the Virginia Dept. of Insurance SERFF filings are quite complete and straightforward, so I have every company providing individual and/or sm. group coverage listed, both on and off the exchange, with the exact average rate changes and affected enrollee numbers for pratically every one of them.
The only exceptions are Piedmont Community Healthcare HMO, whose SERFF filings, oddly, included the enrollee count but not the rate change (usually it's the other way around). In addition, there's a couple of new additions to each (UHC of Mid-Atlantic on the indy market, Federated Mutual on the sm. group market). However, none of these have large enough enrollment numbers to amount to more than a rounding error in either category.
CodeBaby, a provider of Intelligent virtual assistant technology, today announced Connect for Health Colorado® and Access Health CT have expanded the use of CodeBaby as a way to increase consumer education and improve the online experience for customers purchasing health insurance during the 2016 open enrollment period.
Connect for Health’s virtual assistant, Kyla, can be found at key points in the website, presenting important information in a clear manner, assisting users in making informed decisions, and providing decision support for critical choices. In time for this year’s open enrollment, Connect for Health has expanded Kyla to the Subsidy Eligibility System so that the avatar can answer questions, help people determine if they are eligible for subsidies, and walk them through the enrollment process.
Gov. Shumlin Updates on Vermont Health Connect Progress
MONTPELIER – Gov. Peter Shumlin, representatives from Vermont’s insurance carriers, and officials and staff from Vermont Health Connect (VHC) gathered today to update on the health insurance marketplace’s progress. The Governor announced that the technology upgrade necessary for a smooth open enrollment has been delivered and tested and will be deployed starting this evening; the backlog of change of circumstance cases has been cleared; VHC is now operating at a vastly improved customer service level for change requests; and customers will be able to report many changes online starting Monday. Meeting those milestones is consistent with the schedule laid out by the Governor in March 2015 and in legislation passed later in the spring.
NOTE: I originally posted this at 3:00pm October 1st. Shortly after that, I heard the news about the Oregon massacre. I seriously debated changing the headline, but decided that it was completely appropriate under the circumstances. If you disagree...well, we just have to disagree.
In 1991, conservative writer/humorist P.J. O'Rourke wrote a book called, fittingly enough, "Parliment of Whores". It was, as the title explains, "A Lone Humorist Attempts to Explain the Entire U.S. Government". The 9th chapter is entitled "Would you kill your mother to pave I-95?" The main point of this chapter, as you can probably imagine, is that there's a limited amount of money in any budget which can be set aside for various programs and departments, which in turn means that Tough Choices have to be made all the time:
When I crunched the numbers for Minnesota's requested rate hikes, the results were pretty scary-looking; based on partial data, I estimated that the weighted average was something like a 37% overall requested increase:
Note that there were several crucial missing numbers: I didn't know the actual market share for several companies (I made a rough guess based on an estimate of the total missing enrollments), nor did I know what the requested increases were for Medica or PreferredOne, other than thinking that both were under 10%.
With the 2016 Open Enrollment Period quickly approaching (it launches on November 1st), the Maryland Health Connection has already officially launched 2016 Window Shopping!
They even whipped up a simple video stepping you through the process (oddly, the background music seems to have been lifted from "There's Something About Mary", which is either a good or bad omen depending on your POV):
