A couple of days ago I noted that after two years of nothing but doom & gloom (and coming just a week after UnitedHealthcare pulled the plug on the individual market in over two dozen states) there seems to finally be some positive developments, with companies like Centene and Anthem reporting better-than-expected results. They may not be making a profit yet, but at least they aren't losing money hand over fist the way they did the first couple of years.
I also made a brief mention of the Maryland Co-Op, Evergreen Health, which reported their first quarterly profit since launching 2 1/2 years ago.
Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.
Thanks to Adam Cancryn for calling my attention to Molina's quarterly earnings report, which has this rather eye-opening section:
I've used Molina's Q1 2016 report, along with the Q4 2015 reports of Cigna and Humana, to further fill in the "Major Insurer" table I've been working on all this week; here's what it looks like now:
Ryan wants to end Obamacare cost protections for sick consumers
U.S. House of Representatives Speaker Paul Ryan called on Wednesday for an end to Obamacare's financial protections for people with serious medical conditions, saying these consumers should be placed in state high-risk pools.
In election-year remarks that could shed light on an expected Republican healthcare alternative, Ryan said existing federal policy that prevents insurers from charging sick people higher rates for health coverage has raised costs for healthy consumers while undermining choice and competition.
The rule, a cornerstone of President Barack Obama's Affordable Care Act, has been praised by patient advocates for providing access to medical care for people who previously could not afford private health insurance. The Affordable Care Act also bars insurers from excluding coverage for pre-existing conditions.
I was just informed by the MD Health Benefit Exchange that as of April, their effectuated individual enrollments are down to 139,379 people. That's a drop of just over 14%. This is completely in line with my numbers for 8 other states.
A few months ago I noted that while UnitedHealthcare and some other carriers may be losing money hand over fist on the ACA exchanges, at least some of them are making a profit, breaking even or at least cutting their losses down to a reasonable level.
As a simple reminder, competitive markets should see some companies make money and some companies that offer more expensive and less attractive products lose money. I would be extremely worried if everyone was making money after three years, just like I would be extremely worried that everyone was losing money after three years of increasingly better data.
Over the past week or two I've been compiling the currently effectuated exchange enrollments for as many states as possible (the official Q1 ASPE effectuation report likely won't be available until early June). So far I have the data from either February, March or April for 7 states: CO, CT, MA, MN, NH, OK and WA.
Today I can add Idaho to the list, and unlike some of the other states, Your Health Idaho's number appears to not only be cut & dry, but very good news indeed:
Hello Mr. Gaba,
Your Health Idaho’s effectuated enrollments for March stand at 95,522. Numbers for April are preliminary at this point.
Last fall, Centene's quarterly report stated that they had around 155,600 ACA exchange enrollees nationally, or just 1.7% of the total, so this might not seem that significant.
Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies.
Wellmark Blue Cross & Blue Shield has not participated in the Affordable Care Act’s online health insurance marketplace, which launched in the fall of 2013. The main effect of the company’s decision was that moderate-income Iowans could not choose Wellmark insurance if they wanted to purchase policies that qualified for new federal subsidies to help pay premiums.
At the time, I noted that unlike most states, their effectuated numbers seem to have increased from February to March (January doesn't really apply since Open Enrollment was still ongoing at the time):
January 2016 Exchange-Based QHP Enrollment: 49,937 (+33,604 PAP enrollees)
February 2016 Exchange-Based QHP Enrollment: 53,109 (+38,735 PAP enrollees)
March 2016 Exchange-Based QHP Enrollment: 55,212 (+43,732 PAP enrollees)
According to the Kaiser Family Foundation, California averaged around 7.8 million Medicaid/CHIP enrollees prior to the ACA; this number has since shot up about 58%, to 12.3 million people.
One of the chief arguments in favor of the ACA has always been that uninsured people tend to not get treated for ailments/injuries at all (for obvious reasons), and then end up going to the emergency room when that gangrenous foot leaves them no choice. Not only does this end up costing much more to treat, the hospital is also stuck footing the bill (no pun intended) since the uninsured also tend not to have any money to pay out of pocket either (if they did, the odds are that they'd have some form of insurance, after all).
The conservative Republican Study Committee (RSC) on Friday submitted its recommendations for a Republican replacement for ObamaCare as it seeks to shape a plan being formed by a group of House chairmen.
The recommendations come from the RSC’s already-existing legislation, the American Health Care Reform Act, which would completely repeal ObamaCare and replace it with a new system.
AT LAST!! A completely new "system"! Let's take a look:
The proposal would replace ObamaCare’s refundable tax credits with a tax deduction, which tends to provide less help to low-income people by reducing the taxes people owe rather than allowing for the possibility of getting money back in a refund.
Ah, yes...because "less help" is exactly what low income people need most these days. Go on...
In a classic case of missing the forest for the trees, I posted two very wonky, detailed entries over the past couple of days about Minnesota and Connecticut's latest enrollment numbers...but completely missed one crucially important data point.
There's a bunch of different numbers there, but as far as I can tell, the one I'm looking for is "Effectuated Enrollments with APTC/CSR (medical)" combined with "Effectuated Enrollments Without APTC/CSR (medical)". That's 69,519 + 46,371 = 115,890 effectuated, individual, medical QHP enrollees as of 3/31/16.
Based on that discrepancy, the MA Health Connector has increased their enrollment by either a nominal 0.6% or an impressive 9.5%, depending on what you use as the starting number.
Well, this morning I've found a similar report for the Washington exchange, and this one makes even less sense to me because it not only contradicts the ASPE report, it seems to contradict the WA exchange itself.
I noted last month that the Massachusetts Health Connector had increased their effectuated QHP enrollee total by around 12,000 people in the first month of the off season, which goes against the expected net attition expected once Open Enrollment ends.
However, I also noted that MA is unusual in that most of their exchange QHPs are in the form of "ConnectorCare" plans, which are availble for enrollment year round, just like Medicaid and SHOP enrollment. As a result, this increase, while legitimate, can not be used to extrapolate anything nationally.
As everyone who's been following the ACA over the past few years knows, the October 2013 launch of HealthCare.Gov and 16 state-based marketplace websites was not one of the prouder moments in the Obama administration's history. The federal exchange (which covered 35 states at the time) was a disaster out of the gate, as well about half of the state-based websites.
Over the past three Open Enrollment Periods, of course, most of the technical headaches have been worked out of most of the sites. HealthCare.Gov operates like a dream now (update: well, relatively speaking, anyway) and major improvements have been made in most of the state exchanges as well. In 5 cases, the solution was to either scrap the original platform and start over (Maryland and Massachusetts) or to say "to hell with it", drop their own platform completely and move home to the Mothership (Oregon and Nevada in 2015; Hawaii starting this year). Washington State kept their own platform but gave up trying to handle billing for their enrollees, joining just about every other state in letting the carriers handle payments directly.
Tracking ACA Enrollments: Figuring Out How Many Grandfathered/Grandmothered Plan Are Still Around
In this week’s entry, Charles Gaba of ACASignups.net gives us a breakdown of a tally of Grandfathered and Grandmothered plans in the individual market. He did, in his own words, a “back of the envelope” calculation and, with input from Louise Norris of healthinsurance.org, came up with an estimate of those old plans still hanging around. Charles says, “My Conclusion? There should be roughly 1 million people still enrolled in Grandfathered policies and perhaps 1.5 million in Transitional/Grandmothered plans today.”
The go-to journalist in Connecticut for all things Obamacare-related is Arielle Levin Becker. Judging from her feed this AM, it sounds like she's livetweeting the monthly AccessHealthCT board meeting. Here's her key points:
CT exchange enrollment down about 9.2 percent from end of open enrollment. Also about 2% shift from subsidized to unsubsidized.
During the official Open Enrollment Period, MNsure enrolled 85,390 Minnesotans in Qualified Health Plans. Unlike most of the state exchanges (and HC.gov itself), MNsure has been dutifully continuing to update their data every month or so during the off season, providing an interesting glimpse into how the Special Enrollment Period (SEP) is going:
3/07/16 - 4/17/16: 90,696 QHPs Cumulative since 11/01/15 (+3,840, or 91/day); 55,357 MNcare; 156,983 Medicaid
Didja notice that? While the private QHP enrollment rate obviously dropped off tremendously after open enrollment closed (duh!), the SEP enrollment rate has dramatically increased since then, from 21/day in early February, to 55/day in late Feb/early March, to 91 per day over the past month. While it's still just 10% of the Open Enrollment rate, over 4x as many people are signing up for QHPs via MNsure now as were at the start of the off season.
UnitedHealthcare is operating on the ACA exchanges in 34 states this year. I assumed that they'd announce which states they were staying in or dropping out of all at once during yesterday's quarterly earnings conference call, but apparently not. Instead, the status of each state has been dribbling out one by one over the past week or two.
I haven't posted anything about Louisiana's ACA Medicaid expansion since back in January, just before newly-elected Democratic Governor John Bel Edwards took office. At the time, it looked like the program wouldn't actually kick off until July, and would enroll perhaps 300,000 people.
La. Governor Announces Medicaid Expansion Will Begin June 1, Save State $677M Over 5 Years
About 375,000 people in Louisiana are expected to enroll in the program for low-income residents. At the same time, officials in Arkansas continue wrestling with the governor's plan to end the political impasse over expansion.
However, it's also worth keeping in mind that in many of these states, United has a pretty small presence to begin with. Case in point: Connecticut:
LT. GOVERNOR WYMAN, ACCESS HEALTH CT CEO WADLEIGH STATEMENTS ON UNITED HEALTHCARE ANNOUNCEMENT
(HARTFORD, CT) – Lieutenant Governor Nancy Wyman, Chair of the Access Health CT (AHCT) Board, and AHCT CEO Jim Wadleigh today issued the following statements on the announcement that in 2017, United Healthcare is pulling out of most state healthcare marketplaces:
For nearly 7 years now (starting well before the Affordable Care Act was even voted on, much less passed or signed into law), the Republican Party has been promising their own comprehensive plan to replace it.
One of the best running jokes in American politics is the one about Republicans releasing their own alternative to the Affordable Care Act. Any day now, GOP leaders have been saying for many years, they’re going to have a plan that rivals “Obamacare,” and it’s going to be awesome.
As I've stated many times in the past, I'm in favor of ultimately phasing out most of the private, for-profit insurance industry. My timeline and specifics differ greatly from, say, Bernie Sanders's proposed single payer plan, and I think there's room for the private market for supplemental insurance, but I'm no fan of keeping things as they are. While not every carrier is guilty of doing so, the health insurance industry as a whole has repeatedly proven itself to have a hell of a lot of bad corporate citizens over the years, to put it mildly.
Having said that, there are some criticisms which aren't always warranted, and one of these just came up today in light of UnitedHealthcare's decision to pull out of the ACA exchanges in most of the 34 states they're currently operating in...or more specifically (since United wasn't even participating the first year), the losses sustained by many other carriers during the first 2 Open Enrollment Periods for 2014 and 2015.
UPDATE: Zachery Tracer of Bloomberg News and Phil Galetitz of Kaiser Health News have confirmed that UnitedHealthcare will stay in Virginia and Nevada next year, but they won't stay around in Connecticut. More details as they come in....
Update 4:10pm: According to Zachery Tracer, UnitedHealthcare to pull out of Texas, Pennsylvania, North Carolina, Tennessee and Missouri as well.
As you'll recall, until now I had data on "grandfathered" and "grandmothered" policy enrollment from 3 states: Alaska, Florida and Kentucky. However, even that limited data is kind of iffy, because most of it is from either 2014 or 2015, making it difficult to pin down the current numbers as of Spring 2016. Here's a summary of what I have so far:
Based on these numbers, I've extrapolated out to estimate perhaps 1.1 - 1.6 million grandmothered (transitional) enrollees and 800K - 1.4 million grandfathered enrollees nationally.
You'll notice that I left a blank line; that's because as always, Louise Norris has come through with some hard numbers out of The Big One: California:
@charles_gaba Got some more date from CA. It's as of 12/31/14, but they said the 12/31/15 report should be out very soon. CA has 2 reports..
As a patient, all you need to do is go to the doctor and show your insurance card. Bernie’s plan means no more copays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges.
In my response, I noted that aside from anything else, getting rid of all co-pays and deductible altogether sounded a bit...off...to me. To the best of my knowledge, no other country in the world, even those which have single payer-like systems, cover 100% of everything without any out of pocket expense to the patient...and with good reason. While it doesn't specify anything about "no insurance premiums", that's kind of the core concept of any single payer system, and he specifically says that "all you need to do" is go to the doctor with your insurance card. The "premiums" are, of course, listed as a 6.2% employer premium and a special 2.2% income tax paid by households.
UnitedHealth Group Inc. plans to exit a third state Obamacare market as the insurer works to stem losses from its struggling Affordable Care Act business.
The insurer won’t sell policies through Michigan’s ACA exchange for next year, according to Andrea Miller, a spokeswoman for the state’s Department of Insurance and Financial Services. Georgia and Arkansas said last week that UnitedHealth will quit their exchanges for 2017.
...Fifteen insurers sold policies in the state for this year, U.S. data show.
Grandfathered Policies: These are non-ACA compliant policies which people were already enrolled in prior to March 2010, when the ACA was signed into law. Anyone enrolled in one of these can keep renewing them until the day they die if they wish (as long as they keep paying the premiums), or until the carrier chooses to (voluntarily) discontinue the policy.
Transitional (or "Grandmothered") Policies: These are non-ACA compliant policies which people enrolled in between March 2010 and October 2013. This category was created by President Obama and the HHS Dept. in November 2013 during the ugly "If You Like Your Plan You Can Keep It!" backlash. Basically, the ACA originally would have required that these policies be terminated as of 12/31/13. However, after a bunch of people received cancellation notices from their carrier, there was a massive backlash, leading Obama to announce an extension program.
The short version is that there were several extensions allowed, ultimately allowing insurance companies to keep these non-compliant "transitional" policies effective until as late as December 31st, 2017...depending on whether the state they operate in allowed the extensions, and if so, through what date. As a result, instead of all 5-6 million of these policies being cut off on 12/31/13, the cut-off date varies by state, by carrier and even by plan. Some states kept to the original 12/31/13 deadline; others bumped it out through the end of 2014, 2015, 2016 or took the full extension through 2017.
Don't ask me why, but I was thinking about the movie "A Few Good Men" this morning, and something has always bothered me about it.
As you'll recall, the reason Private First Class William Santiago was given the Code Red in the first place is because a) he broke the chain of command by begging everyone in the world to transfer him out of Guantanamo Bay, and b) he offered to squeal about the "fenceline incident" in return for the transfer.
OK, fair enough. But the scene which bothers me is this one, which is also the introduction to Col. Jessup:
Here's my problem: As Jessup clearly states, PFC Santiago was, by all accounts, just a shitty Marine. He simply couldn't keep up with the training. Regardless of whether it was because of a legitimate medical condition or due to him "not being properly motivated", he couldn't hack it, end of story. Furthermore, no one liked him anyway.
As you can see, while the requested rate increases stayed consistent throughout the various updates, the number of enrollees changed dramatically depending on which filing source I used. Case in point: Anthem/HealthKeepers Inc.
The first filing I found for Anthem HealthKeepers made it pretty clear that they're asking for a 15.8% average rate hike next year which is expected to potentially impact up to 122,581 policy holders:
Pretty cut & dry, right? Note that according to the filing that number covers current Anthem HealthKeepers enrollees both on and off the exchange, so it should cover all ACA-compliant policies.
In both cases, I've been criticized either here or via Twitter about the twin problems of high deductibles/co-pays and narrow networks. In response to the first story, people noted that the "actual" number who are uninsured is "a lot more" than 29 million because many people still can't afford the deductibles/co-pays or can't find a doctor/hospital in their network. In response to the second story, people claimed that I'm "hiding" the truth about how much policies cost for the same reasons.
In light of today's confirmation that the average 2016 premium rate increase ended up only being appx. 8% nationally on the individual market (as opposed to the headlines screaming about 40%, 50%, 60%+ rate hikes being "typical"), I've decided to get a jump on the 2017 rate changes. Someone gave me a heads up that Virginia appears to be first out of the gate this year, with requested 2017 rate filings having already been submitted by at least 8 carriers.
Now, for 2016 there are actually 13 carriers offering individual policies in Virginia (although some of these are available off-exchange only). I'm don't know if the 5 missing carriers have decided to drop out of the VA market or if they simply haven't submitted their 2017 filings yet (it looks like in Virginia the carriers technically have until July 15th to get their requests to the HHS Dept. in states which have their own rate review process, but the state itself presumably has an earlier deadline). It's also possible that some additional carriers might join the exchange and/or start offering policies in the state which don't this year.
In any event, here's what I've found so far for Virginia:
The 2016 rate-increase hysteria has already started. Before you freak out, here are four things to remember about premium-hike proposals.
May 15 officially marked the start of the 2016 rate review season. What that means for Americans is that over the next month or so, newspapers and web sites across the country will start running stories with scary-sounding headlines like this:
Some Oregonians could face major insurance rate hikes next year
Health plans request double-digit premium increases
...The articles will throw a bunch of numbers around, saying that the “average” premium rate increase for a given state is expected to be X percent, followed by examples of the highest and lowest increases. There may even be a few “Company Y will actually be reducing their rates!” thrown in.
Colorado lost their Co-Op...and CO is also one of only two states (Oregon is the other one) to drop their "transitional" policies as of the end of 2015. As a result, Colorado has a lot of people who could still potentially enroll by the end of February thanks to the 60-day Loss of Coverage Special Enrollment Period provision.
Louise Norris noted that there were around 39,000 ex-Co-Op members in Colorado (along with some others) who could still potentially enroll during February via the SEP option; I spitballed anywhere from 10,000 - 20,000 more Coloradoans might yet be added. There are also the normal SEPs for things like getting married, giving birth and so forth.
I get a lot of ACA and healthcare-related email, as you might imagine. Sometimes it's a hot tip about some breaking news story or wonky report being released. Sometimes it's a clarification or correction of something I just posted from an industry insider wanting to clear the record. Sometimes it's a borderline illiterate Ted Cruz supporter complaining about how Cruz is shaking supporters down for cash or trash-talking his opponents. Sometimes it's an anti-ACA advocate arguing a point with me. Sometimes it's a scam artist trying to hustle me.
ALBANY, N.Y. (AP) — The state's health exchange expects to enroll more than 470,000 New Yorkers in its new low-cost option for coverage this year.
Testifying at an Assembly hearing this week, exchange Executive Director Donna Frescatore said New York chose to participate with the Essential Plan. The plan is an option under the federal Affordable Care Act starting in 2016.
It's aimed at adults who don't qualify for Medicaid but have been unable to afford private coverage.
The Essential Plan has no annual deductible before insurance begins paying medical bills.
Premiums are free for those with incomes at or below 150 percent of the federal poverty level.
With that in mind, I wanted to highlight an important point. For some time now, Bernie Sanders has been pointing out repeatedly that around 29 million people remain uninsured despite the Affordable Care Act. This has become one of his core bullet point arguments in favor of his Single Payer healthcare plan which, if enacted, would supposedly cover everyone in the country (more efficiently, with more comprehensive coverage, lower overhead, etc etc).
NOTE: To clarify, I'm not saying that Bernie is the one blaming the law for the 29 million, but I keep hearing a lot of other people doing so. I only mentioned him because instead of touting the 20 million people who the law has helped gain coverage, he focuses almost exclusively on the 29 million that it hasn't. A little balanced perspective is what I'm talking about.
I've stated many, many times that in spite of how unimpressed I am with Sanders's plan itself, in the long term I do think that something like it is our best option. However, for the moment I wanted to take a closer look at the breakout of those 29 million people:
Uninsured - Medicaid Eligible: 5.0 million
Uninsured - CHIP Eligible: 3.0 million
Uninsured - Medicaid Gap: 2.8 million
Uninsured - Undocumented Immigrants: 4.7 million
Eligible for ACA Tax Credits: 6.5 million
Ineligible for ACA Tax Credits: 7.0 million
Now, if you want to complain that the ACA is too complicated, pads the insurance carriers's pockets, doesn't keep costs down enough and so forth, those are reasonable arguments.
However, if you're arguing that the ACA is "failing" because it has "only" cut the uninsured rate by about 40% since 2013 instead of down to 0%, that's an absurdly unfair attack for two reasons. First, the ACA itself was never intended to get the U.S. to 100% coverage...nor did anyone ever claim that it would.
UnitedHealth Group will stop offering plans on Arkansas' health insurance exchange next year, a spokesman for the Arkansas Insurance Department said Thursday.
The Minnetonka, Minn.-based insurer offered plans this year for the first time, but it didn't submit plans to the department for 2017, department spokesman Ryan James said.
The deadline for insurers to submit such plans was April 1, he said.
This is hardly unexpected news for a couple of reasons. First, UHC made huge waves last November by making a big, dramatic announcement that they might very well drop out of the ACA exchanges altogether next year after taking large losses on exchange enrollees in 2015. As you may recall, this was a very oddly-timed announcement given that they had issued a glowing quarterly report just a month earlier which made it sound like everything was hunky-dory.
I was flattered to have my U.S. Healthcare Coverage Breakout chart receive the top spot in this week's Health Wonk Review over at Jaan Sidorov's appropriately-titled Population Health Blog:
Charles Gaba of ACASignups has been tracking the progress of the Affordable Care Act. This ongoing labor of love led him to comb through too-numerous-to-count public domain sources to provide an original-sourced summary (with links galore) of the health insurance status for the entire U.S. population in one chart. He calls it "ambitious." The PHB calls it gloriously detailed, credible and superb. KHN, you've met your match.
OK, I think that last line is a bit over the top (KHN refers to Kaiser Health News), but I appreciate the sentiment.
Check out the whole thing for some other fantastic Health Wonk writing!
I know I haven't posted much of anything for the past week or so. I'm playing catch-up with my day job and my kid is on spring break this week, so I haven't had much time to devote to the site. Furthermore, we're spending today at the Michigan Science Center, so I can't really do a proper post today either.
