Regular readers know that I used to regularly post an entry about the official CMS Medicaid enrollment reports every month, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.
As of November 2015, there had been a net increase of 14.1 million people added to the Medicaid rolls since October 2013 (the month when ACA expansion enrollment began), plus another 950,000 people who had already been quietly transferred over to Medicaid from existing, state-funded programs prior to 2013 via other ACA provisions.
There's been numerous mentions this week at the Democratic National Convention about Hillary Clinton's role in creating the Children's Health Insurance Program (CHIP), and with good reason.
The number which keeps getting thrown around is "over 8 million" (which is true), while the official CHIP website lists it as 8.1 million (which was true for 2014).
However, out of curiousity, I took a look to see what the 2015 data is, and sure enough, it was up to 8.4 million last year.
Here's a table showing, state by state, how many children were enrolled in the CHIP program last year (as well as the number in Medicaid, which, surprisingly, is actually more than 4x higher). In fact, well over half of all Medicaid enrollees are children.
NOTE: "Ever Enrolled" is confusing; it makes it sound like this is cumulative since the 1990's. It actually means "ever enrolled during that year", since there's a lot of churn with children moving into or out of the program as their family situation changes over time:
(Note: I've had to re-work some of this entry thanks to clarifications from Adam Cancryn about the RBC rule; too many little edits to document each one).
Last week I posted about the latest ugly Co-Op meltdown, this time Land of Lincoln Health (LoL) of Illinois.
As pointed out in my follow-up entry, given the precarious financial state LoL was already in last year, it made little sense that they only asked for fairly nominal rate hikes:
Now, since LoL went belly-up mid-year regardless, obviously even those massive rate hikes weren't enough to save them, so the question is, what would have happened if LoL had gotten their nominal increases as requested?
The most recent ACA/healthcare news out of Illinois was the ugly announcement that Land of Lincoln Health is the latest ACA-created Co-Op to go belly-up, leaving 49,000 people (39,000 on individual plans and 10,000 in the small group market) having to scramble to find new coverage in the middle of the year. This was on top of recent news that UnitedHealthcare is pulling out of dozens of states including Illinois (Humana is also dropping out of a bunch of states, but I don't think Illinois is among them).
Well, nature (and the market) abhors a vacuum, so guess what?
One of the nation's largest health insurance companies plans to enter the Obamacare marketplace in the Chicago area for the first time, bringing new competition as other insurers exit or go out of business.
My posts have been pretty light of late; between being on vacation, a big work backlog when I got back, and getting wrapped up in the RNC and DNC craziness, I've been a bit off-track. I'm hoping to catch up a bit over the next week or so.
As of 6/12, MNsure had 95,637 QHP selections, so this is an additional 1,286, or 34/day over the past 38 days. This is down substantially from the June report, when it averaged a whopping 179/day.
For the entire off-season period, MNsure has added 11,533 QHP selections, or an average of 68 per day. Extrapolated out nationally, that would be about 10,300 per day nationally, although in prior years off-season SEPs have averaged between 7,000 - 9,000 per day.
Avik Roy is a well-known conservative, anti-ACA healthcare pundit, writer and advisor. As the article I link to below describes him:
Avik Roy is a Republican’s Republican. A health care wonk and editor at Forbes, he has worked for three Republican presidential hopefuls — Mitt Romney, Rick Perry, and Marco Rubio. Much of his adult life has been dedicated to advancing the Republican Party and conservative ideals.
Regular readers know that he and I have butted heads several times in the past:
This is a quick post...to be honest, it's mainly here just to remind myself to refer to the link again for a later project. But I just wanted to remind everyone that in addition to the exchange-based Qualified Health Plan listings at HealthCare.Gov (which cover 38 states) and the rate review database where you can search through the proposed (and, eventually, approved) rate hikes for every ACA-compliant individual or small group policy by carrier, there's also a third HC.gov database: The Plan Finder.
This Plan Finder website is provided by the federal government to help you find private health plans available outside the Health Insurance Marketplace. We want you to find health insurance that best fits your budget and meets your needs.
Getting subsidies for Affordable Care Act health plans is about to become easier.
Additional verification of eligibility will only be required if the difference between stated income and Internal Revenue Service or Social Security data is at least 25 percent, or $6,000, underguidance from the Department of Health and Human Services.
Currently, additional verification is required if the discrepancy is only 10 percent or greater.
The change, which is for the 2017 plan year, “will reduce the number of consumers who have to follow-up and submit documentation to verify their household income while maintaining important program integrity controls,” the Centers for Medicare & Medicaid Services said in the guidance.
I hereby admit that a) I don't know much about Medicare (remember, my major focus is on the ACA exchanges, Medicaid expansion, the individual/small group market and so forth) and b) I'm swamped at the moment so don't have time to do a real analysis/write-up on today's announcement, but it appears to be a Pretty Big Deal, so I'll just present the press release/statement for the moment:
U.S. Department of Health & Human Services • Monday, July 25, 2016 • News Release • 202-690-6343
Today, the Department of Health & Human Services proposed new models that continue the Administration’s progress to shift Medicare payments from quantity to quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.
CMS approves Arizona’s plan to re-open CHIP program
Today, the Centers for Medicare & Medicaid Services (CMS) announced that it has approved Arizona’s plan to allow new enrollment in the Children’s Health Insurance Program (CHIP) after enrollment was frozen for several years. Now all states provide CHIP coverage to eligible children.
“Today’s approval is a step forward for the health of Arizona children in low-income families,” said Vikki Wachino, CMS Deputy Administrator and Director of the Center for Medicaid and CHIP Services. “With Arizona’s decision, all states in the nation now provide CHIP coverage to any eligible child who applies. More children in Arizona will have access to coverage early in their lives, which helps kids grow into healthy adults and provides parents with the peace of mind that comes from their children having affordable coverage.”
Having coverage through CHIP improves children’s health and increases their ability to succeed in school. Recent research on Medicaid and CHIP shows that these gains are long lasting, with children who gained coverage experiencing better health, higher educational attainment, and higher earnings as adults.
Every year, Republicans insist that the ACA is guaranteed to cause a rate hike "death spiral" as increasing premiums cause healthier people to drop out of the individual exchange market, causing higher medical expenses, causing even higher premiums, causing more healthy people to drop out and so forth...and every year, for three years in a row so far, this has failed to be the case nationally. While premiums have obviously continued to increase for many people, the individual insurance market has grown each year, from around 11 million in 2013 to 15.6 million in 2014, around 17 million last year and up to 19-20 million or so today.
IMPORTANT: This is really just a placeholder for Georgia's 2017 average rate hike requests, because it's extremely spotty and partial so far. I'll update it once I'm able to actually track down the bulk of Georgia's individual market enrollment and rate hike request numbers.
UPDATE 7/25/16: I've managed to acquire the additional filings; see update below
Remember the Hobby Lobby and Little Sisters of the Poor Supreme Court cases, in which each protested the ACA's requirement that healthcare plans covered by employers include contraceptive coverage?
Well, guess what? It turns out there's another "Obamacare contraceptive requirement" case which chugging along through the federal court system, and a federal judge just ruled against the government again. This time, however, instead of an employer having a problem with providing contraception for "sincerely felt" religious reasons, it's the enrollee who's getting the vapors over the prospect of being required to receive the coverage.
Meanwhile, Humana just released their quarterly earnings report [correction: their 2017 Earnings Guidance Report]...and there's some big news buried in it.
Likely stupid question here, but if they were doing this bad financially that they couldn't even make it though all of 2016, then how come when requesting their 2016 rates last year they (apparently) asked for less than a 10% bump?
Land of Lincoln coverage will end Oct. 1 for individual enrollees
Land of Lincoln Health's insurance coverage for its individual enrollees will end Oct. 1, according to the Illinois Department of Insurance.
The agency posted the news on Land of Lincoln's website. A green banner now greets visitors to the website with the headline, "Important notice to all members" with a link taking them to information about the Chicago-based insurer's impending shutdown. The notice comes a week after the agency moved to seize control of the financially troubled Chicago-based insurer.
California’s health insurance exchange estimates that its Obamacare premiums may rise 8 percent on average next year, which would end two consecutive years of more modest 4 percent increases.
The projected rate increase in California, included in the exchange’s proposed annual budget, comes amid growing nationwide concern about insurers seeking double-digit premium hikes in the health law’s insurance marketplaces.
...Insurers in California have submitted initial rates for 2017, but the final figures won’t be known until July after state officials conduct private negotiations.
President Barack Obama has revived his endorsement of a government-run “public option” health insurance program that would compete with private plans on the Affordable Care Act’s exchange marketplaces.
(MOOP: Maximum Out-of-Pocket expense; please forgive my Seinfeld reference.)
When it comes to healthcare policy cost trends, my main focus has been on the average premium rate increases, which currently look (if approved as requested) like they'll go up around 22% on average next year on the individual market (perhaps half that for the small group market).
However, the other major cause of hand-wringing when it comes to healthcare costs these days are deductibles and co-pays...the out-of-pocket expenses which people may have to pay in addition to their premiums. Again, co-pays are a flat fee (usually $30-$50) which you have to pay for many doctor visits, while deductibles are the amount which you may have to pay towards various healthcare treatments/services before the insurance carrier actually starts to chip in their 60-90% of the bill. I don't think co-pays have really changed much over the years, but a whole lot of people feel that deductibles have shot up a lot since the ACA went into effect.
This is actually the second time this has happened. The first was over a year ago, when CATO Institute ACA Attack Dog Michael Cannon used my work to testify before a U.S. Senate committee how many millions of people would be screwed over by a plaintiff win in King v. Burwell. This was kind of interesting, considering that he was using that fact to support a plaintiff win in King v. Burwell; from his perspective, over 6 million people losing their APTC assistance would have actually been a positive thing. Conservatives are strange like that. Thankfully, the Supreme Court ruled against the plaintiffs, which made the whole thing moot, but whatever.
Testimony of Joel C. White, President, Council for Affordable Health Coverage
Committee on Ways and Means Hearing on Rising Health Insurance Premiums Under the Affordable Care Act • July 12, 2016
Over the weekend, Hillary Clinton rolled out her official campaign healthcare platform. Much fuss is being made over the fact that it includes support for a Public Option, although as I noted at the time, that's hardly news...since she's consistently supported one since at least 2008.
As for the rest of the proposal, there's a whole lot to like...even if your name is Bernie Sanders.
Almost exactly 1 year ago, both Andrew Sprung and I realized that due to an overlap in two provisions of the ACA, a significant chunk of exchange enrollees would actually be eligible for Medicaid instead of a private QHP...if the remaining Republican holdout states were to stop being jackasses and expand the program already.
Why? Because while ACA Medicaid expansion covers people up to 138% of the Federal Poverty Line, QHP financial assistance applies to those with incomes between 100-400% of the FPL. In other words, anyone enrolled in a private exchange policy between 100-138% FPL in a NON-expansion state would automatically become eligible for Medicaid instead the moment that state expanded their Medicaid program via the ACA.
Unfortunately, there was no way of knowing exactly how many people this applied to, because until now, the HHS Dept. only broke out exchange enrollee income brackets into 50% chunks (ie, they listed 100-150% FPL, but not 100-138%).
OK, this is a nice early Christmas present to data geeks like myself (which is ironic, considering that I'm Jewish). Shortly after releasing the 2016 First Quarter Effectuated Enrollment Report, the CMS division of the HHS Dept. has released that data in Excel spreadsheet format...along with the previous 6 quarterly reports. This is nice, but not that huge since this data was already available.
As I do every three months, I'm reformatting their data in a more relevant format, since Gallup seems to be determined not to show the full Y-axis on their graphs (see bottom of entry for original). In addition, I've added some other key data points: Q1 2010 (when the ACA was actually signed into law) and Q3 2013 (when the ACA exchanges and Medicaid Expansion programs launched). Finally, I've added 3 color-coded sections, showing three major categories of the uninsured: Adults who are already eligible for Medicaid but haven't actually enrolled in the program yet; undocumented immigrants who aren't eligible for any taxpayer-funded coverage (or even for full-price exchange-based policies); and the 2.8 million people still caught in the "Medicaid Gap" across 19 states which haven't expanded the program yet. Note that the Medicaid Gap has shrunk from around 5 million in 2014 as a half-dozen or so states have come around; the other two groups may have gone up or down since 2014.
LAS VEGAS (AP) — Health insurance costs for about 240,000 Nevadans who buy individual or small-group plans are expected to rise next year, and state officials want consumers to offer feedback before the proposed rates are locked in in coming weeks.
Emails released last week by the State Department that were found on Mrs. Clinton’s private server show that she was keenly interested in the administration’s push to win passage of the health care law.
...The email messages show that throughout the fall of 2009, as the health care push entered a decisive phase, Mrs. Clinton lobbied some members of Congress for votes and even debated sometimes-esoteric policy proposals with aides, some of whom had worked with her in the White House when she was first lady, after her own failed attempt to push a national health care overhaul.
...Congressional officials who worked on the Affordable Care Act said that Mrs. Clinton was an important and effective advocate.
FIRST THINGS FIRST: My deepest sympathies to the families, friends and co-workers of the 5 police officers murdered in Dallas last night (as well as Alton Sterling, Philando Castile and all other victims of gun violence)...and my wishes for a full and speedy recovery to the other seven officers who were shot.
This is a pretty grim topic, but given how much misinformation is flying around out there, including a lot of statistics and numbers, it's important to get this stuff right.
Last October, I wrote an entry which focused on an interesting chart posted by National Review Online regarding the downward trend of gun homicides vs. the upward trend of gun sales over the past couple of decades. My conclusion was that NRO's main claim was accurate...but that they had massively exaggerated the degree to which it was true.
Earlier this evening, someone on Twitter posted the following graphic, which has been retweeted over a thousand times as of this writing:
ACCESS HEALTH CT PROVIDES TRANSITIONAL MEDICAL ASSISTANCE ENROLLMENT UPDATE
2,846 individuals have enrolled in a new healthcare plan
Hartford, Conn. (July 8, 2016) - Access Health CT (AHCT) CEO Jim Wadleigh provided an update today on enrollment of approximately 13,811 parents and caregivers who will lose their Transitional Medical Assistance (TMA) on July 31st when they no longer meet the HUSKY A eligibility requirements due to a change in legislation last year. As of July 7, 2016, 2,846 individuals have enrolled in a new healthcare plan via the exchange. Of those, 1,966 applications have been re-determined eligible for coverage in a HUSKY program through the integrated eligibility system with the Department of Social Services, and 880 have enrolled in a Qualified Health Plan (QHP) with AHCT.
Oy vey iz mir. Last fall, half of the two dozen Co-Ops created by the ACA were wiped out, falling like dominos over about a two month period, for a variety of reasons including the Risk Corridor Massacre. The other half managed to survive The Purge, many of them just barely doing so.
This year, it looks very much like the Risk Adjustment debacle has decided to try and finish off the job.
Montana's entire individual market was around 70,000 people back in 2014, and has likely grown to around 87,000 today, so it looks like pretty much everyone is accounted for above (the remaining 9,000 or so are presumably enrolled in grandfathered policies; Montana is among the few red states which didn't allow transitional plans).
As for the actual requested rate hikes...ouch. BCBS is seeking a whopping 62% average increase, and since they own 70% of the individual market, that means a statewide weighted average of right around 50% even. Things aren't as ugly on the small group market, but that 27.5% average is still pretty ugly.
Earlier this week I noted that one of the remaining co-ops, HealthyCT of Connecticut, is the latest to go belly-up...due in large part to a different program, "Risk Adjustment". The irony in both cases is that both programs were supposed to be designed specifically to help ensure that "little guy startups" such as the co-ops would be protected from dissolution during the unstable first few years of the ACA exchanges. Instead, developments in both programs have served to help destroy them.
As I noted the other day, the Risk Adjustment program seems to be backfiring:
OK, regular readers know that I almost never write directly about Medicare-related issues (unless it's in relation to trying to figure out the total uninsured rate and so forth), and I've only even mentioned Medigap before 3 times in the history of this website. I honestly don't know much about the program except that it's basically supplemental insurance which covers treatment/services not already covered by Medicare.
However, this seems like a significant development for my home state:
Seniors can expect to pay an additional $48 to $177 per month on BCBS Medigap plans.
Nearly 200,000 seniors can expect to pay more for their Medigap supplemental health insurance plans next year -- for some older individuals, more than twice their current amount -- when Blue Cross Blue Shield of Michigan goes forward with a long-awaited rate increase that does away with what the insurer says are below-market rates.
Blue Cross today proposed the new Medigap rates that would take effect on Jan. 1, following a five-year rate freeze for its Legacy Medigap plan.
So here it is...Super Tuesday. Unless the GOP base suddenly decides that they don't want a xenophobic, misogynistic, hate-mongering, con-artist moron to be their standard-bearer, it's looking very likely that by the time midnight rolls around, Donald Drumpf will indeed be almost unstoppable as the Republican Presidential Nominee for 2016.
Which means, aside from the GOP establishment being on collective suicide watch, Mr. Drumpf will have to think about who his running mate will be for the general election.
...OK, so here's who this person has to be:
NATURAL BORN U.S. CITIZEN
35 YEARS OLD
YOUNG
PHOTOGENIC
FEMALE
JEWISH
TRUSTED IMPLICITLY
Which is why I present to you the only possible 2016 Republican nominee for Vice President of the United States....Ivanka Drumpf.
For years now, various healthcare writers, myself included, have noted that prior to the ACA exchange policies being implemented in January 2014, individual market insurance policy rates were typically increasing by an average of around 10-12% per year. This was based on several different sources, including studies like these:
The DC exchange has this frustrating habit where they do issue regular, easy-to-read enrollment reports...but they keep using cumulative numbers since 2013 in those reports. I honestly have no idea why they do it this way; since people are constantly moving on and off of different types of coverage, and even those who keep the same policy have to renew those policies every year anyway, so reporting the multi-year cumulative number of enrollments makes about as much sense to me as Ford reporting how many cars they've sold since 1903.
However, by simply comparing the cumulative numbers against older cumulative numbers, I can use the difference to see how things are going during the off season, like so:
More Than 225,000 People Enrolled in Health Coverage Through DC Health Link from October 1, 2013 to June 10, 2016
OK, this blows. Last year, you'll recall that about a dozen of two dozen ACA-created Co-Ops melted down, one after another, throughout August, September and October. There were a lot of reasons behind their failure, but one of the biggest ones had to do with the infamous Risk Corridor Massacre brouhaha.
As I noted last fall, "Risk Corridors" were one of three programs put into place by the federal government which are intended to smooth the way for the insurance carriers as they try to navigate the rocky, uncertain terrain of the new health insurance landscape under the ACA. Two of the programs--Risk Corridors and Reinsurance--were never intended to last more than the first 3 years of the exchanges anyway (that is, they've always been scheduled to be discontinued at the end of 2016). Unfortunately, due to the GOP yanking the rug out from under the Risk Corridor program, only 13% of the money which was supposed to be paid out to the eligible carriers ever was last year, causing several co-ops (and at least one private carrier) to go belly-up...and leaving many of the remaining co-ops on very shaky financial ground.
The third program, "Risk Adjustment", is permanent. Risk Corridors were set up to shift funds from carriers which lost more than a certain amount of money from carriers which earned more than a certain amount of money. Risk Adjustment, on the other hand, is designed to shift funds from carriers which happened to enroll lower-risk enrollees to those which enrolled higher-risk enrollees. This may sound similar on the surface, and I'm assuming there's quite a bit of overlap between the two in practice, but that's an important distinction.
It's been nearly 2 weeks since the last update to my 2017 Requested Rate Hike project. While I've locked down the requested increases for 35 states and the District of Columbia, the remaining 15 states seem to be pretty quiet about their 2017 rate filings. Today, however, I'm able to fill in at least half of the puzzle for one state: South Dakota.
To the best of my knowledge, there are only 6 carriers offering policies on the SD indy market: Avera, DakotaCare (off-exchange only), Sanford, SD State Medical, Celtic and Wellmark BCBS. It's worth noting that DakotaCare is in the process of being bought out by Avera, but I'm not sure whether they'll be submitting separate filings or not.
It turns out there were actually two ACA-related federal cases ruled on today...and the second one went against the Obama administration. This one has to do with "Fixed Indemnity plans". I admit to not knowing much about these, so here's an explainer courtesy of healthinsurance.org:
DEFINITION: A fixed-dollar indemnity plan is a type of medical insurance that pays a pre-determined amount on a per-period or per-incident basis, regardless of the total charges incurred. Plans might pay $200 upon hospital admission, for example, or $100 per day while a person is hospitalized.
Last night I wrote a pretty extensive post about the Q1 2016 ACA Exchange Effectuated Enrollment Report, which breaks out the effectuated enrollment numbers as of the end of March. This is a follow-up post with some additional oddball items of interest. I'll probably add some things, so check back later for updates.
First up: While the national net attrition rate from the end of open enrollment through the end of March was around 12.6% (11.08 million vs. 12.68 million), the drop-off rate ranged widely state to state. Here's a table breaking this out. The net attrition is over 20% in 5 states and DC and between 15-20% in 5 more states, but is under 10% in 14 states. In fact, Rhode Island saw a net increase in effectuated enrollees from January through the end of March.
With all of the lawsuits against the ACA flying around over the years, there are some which I haven't even heard about. One of them just came to my attention this morning (thanks to Nicholas Bagley for the heads' up): The State of West Virginia vs. the HHS Dept:
Elbert Lin, Solicitor General, Office of the Attorney General for the State of West Virginia, argued the cause for appellant. With him on the briefs were Patrick J. Morrisey, Attorney General, and Julie Marie Blake, Assistant Attorney General.
Lindsey Powell, Attorney, U.S. Department of Justice, argued the cause for appellee. With her on the brief were Benjamin C. Mizer, Principal Deputy Assistant Attorney General, and Alisa B. Klein and Mark B. Stern, Attorneys.
Before: KAVANAUGH and WILKINS, Circuit Judges, and SILBERMAN, Senior Circuit Judge.
Opinion for the Court filed by Senior Circuit Judge SILBERMAN.
