Over at the National Review, Michael "King v. Burwell" Cannon of the CATO Institute and self-described Obamacare-slayer has penned a piece which tears into the ACA over the situation in Pinal County, Arizona, where, barring a last-minute development, several thousand residents are about to find themselves in a pretty unpleasant situation when it comes to finding a new healthcare policy for 2017. As I noted last week:
Pinal County won’t have a company offering marketplace health insurance plans next year following the nation’s third-largest health insurer’s decision to exit public exchanges in all but four states.
Aetna was the only insurer planning to offer Affordable Care Act plans in Pinal County for 2017. It currently only sells in Maricopa County but had planned to expand to Pinal County.
More than 75,000 Iowans will see their insurance premiums rise next year.
Iowa Insurance Commissioner Nick Gerhart has approved rate increases sought by four companies who provide health insurance in the state, Gerhart's agency announced Monday. The increases include plans covered by Wellmark Blue Cross & Blue Shield, the state's dominant health insurer.
However, the article was a little vague about some of the data, so I visited the IA DOI website and sure enough, they have separate entries for every one of the carriers (with one exception):
A week or so ago, I attempted to tally up the number of current ACA exchange enrollees who will have to shop around for a new policy this fall whether they want to or not, due to their current plan being discontinued. As a reminder, there are three main reasons for this: a) the carrier is pulling out of the exchange in their county/state (Aetna, Humana, UnitedHealthcare); b) the carrier is going out of business entirely (4 co-ops); or c) the carrier will still have policies available but is dropping the one they're enrolled in (mainly PPOs).
In addition to the 1.69 million estimate from Aetna, UnitedHealthcare, Humana and the 4 Co-Ops which are shutting down in CT, OH, IL and OR, we can also add the following (thanks to Louise Norris for the assist on some of these):
Two weeks ago, on August 14th, I officially concluded my requested 2017 rate hike project. I've since gone back and made some adjustments to various states where carriers have either pulled out of the individual market or resubmitted revised rate hike requests, but I had enough preliminary data from all 50 states (+DC) to come to some initial conclusions.
I sorted out the states by three different criteria, looking for any noteworthy patterns: Federal vs. State-Based Exchanges; Transitional Policies allowed vs. NO Transitional Policies; and whether or not the state has expanded Medicaid under the ACA (whether "standard" Medicaid or via a custom waiver version, like Arkansas, Indiana and New Hampshire did).
My conclusion at the time was that there wasn't enough of a distinction in either of the first two criteria to draw any conclusions...but as for Medicaid expansion, I said:
Over at Politico, Rachana Pradhan and Paul Demko have an interesting article speculating on the potential for the ACA-as-a-GOP-campaign-issue to spring back to life again due to the one-two punch of major carriers dropping out of the exchanges and significant rate hikes being imposed for the 2017 Open Enrollment period. The fact that #OE4 kicks off (November 1st) just 1 week before election day (November 8th) adds some fuel to this thinking:
The potential sticker shock — coupled with the likelihood many consumers will have fewer choices next year after major insurers scale back their exchange participation — creates a potential political opening for Republican candidates, especially since the next Obamacare enrollment season starts one week before Election Day.
Here's a peek under the hood of what a royal pain in the ass it is to keep track of all this stuff, here's a comment exchange I had with several site regulars a couple of days ago:
Charles Gaba: Actually, I did find *one* useful item...it looks like quite a few of the carriers *resubmitted* their filings later in the summer (my data is currently based on the requests from April/May).
So, we still don't have *approved* rates but the *requests* can be updated...
Some of it is odd---Aetna said they're *staying* on the exchange in Virginia...but it shows up here as being *new* to the exchange, even though they're a) already listed for 2016 over atData.HC.gov and b) I already have an exchange-based filing for them with over 13,000 current enrollees and a 13% requested hike. Huh.
joe: Aetna's 2016 plans are sold under Innovation Health Insurance Company. They were going to introduce new Aetna Leap plans in 2017.
Believe it or not, Indiana's individual market situation is actually among the brighter spots this year. While three carriers are dropping off of of the ACA exchange market (and Physicians Health Plan is dropping off-exchange policies as well), they're also seeing the addition of a new carrier (Golden Rule), and one major carrier, Celtic, actually requested and received an average reduction in their monthly premiums, which is pretty rare this go around.
Unfortunately, the overall average approved statewide increase, while still lower than most of the other states so far, is actually slightly higher than the requested average. Every carrier got what they asked for with the exception of Indiana University, which asked for a 9.9% hike but was approved for a 14.9% increase. This bumped the statewide average up from 17.7% to 18.5%:
The average premiums range from an increase of 29 percent by Indianapolis-based Anthem Inc. to a decrease of 5.3 percent by Chicago-based Celtic Insurance Co.
Usually when state regulators publicize their approved rate changes for carriers on the independent market, they list the various carriers and the approved average rate changes for each. I then simply plug these into my existing spreadsheet and get a before/after comparison against how much the carriers actually requested.
In the case of illinois, it's a little trickier. Unless I'm missing something, the only official notice the IL DOI has released is this PDF, which--while including lots of useful info about rating areas and so forth--doesn't actually list the overall statewide average approved rate increases by carrier.
Instead, it lists the averages based on metal level, and even then doesn't list all of the plans, just selected ones: Lowest-price Bronze, Lowest and 2nd Lowest-price Silver, and Lowest-price Gold, like so:
Virginia was the very first state which I ran an estimated 2017 average requested rate hike for, way back in mid-April.
Since then, aside from Humana pulling out (leaving just 1,800 current enrollees to find a new policy), Virginia's ACA exchange market has actually been remarkably calm; the state somehow managed to escape the wrath of both UnitedHealthcare and Aetna relatively intact, with both carriers still participating in the state's exchange next year as of this writing.
There have, however, been a few other changes to some of the rate filings here and there, found via this updated PDF on the VA DOI website as of July 19th. The overall average requested hikes don't really change much, but do nudge a bit higher than I had previously estimated, from 17.5% to 18.4%:
Physicians Health Plan of Northern Indiana announced Tuesday that it will quit selling individual insurance coverage next year through the federal Affordable Care Act.
The nonprofit PHP becomes the second insurer to announce it is leaving the HealthCare.gov insurance marketplace that serves residents of northeast Indiana. UnitedHealthcare said last spring it would drop out of the exchange in most states, including Indiana.
Four other insurers offered individual policies through HealthCare.gov this year in the Fort Wayne area and apparently will continue to do so in 2017. Insurers had until Tuesday to notify the state of their plans, and all four are among federal marketplace filings the Indiana Department of Insurance submitted Tuesday to the Department of Health and Human Services.
Fort Wayne-based PHP said it is paying $1.20 in medical expenses for every dollar it receives in premium payments from HealthCare.gov customers and has lost millions of dollars on the policies.
Following announcements by for-profit commercial carriers Humana and United Healthcare, nonprofits Health Alliance Plan and Priority Health are notifying agents they are pulling all PPO plans for 2017 from the Michigan health insurance exchange, Crain's has learned.
HAP has already announced it is pulling eight Personal Alliance individual preferred provider plans for individuals from the exchange and four PPO plans in the open market next year. HAP will continue to offer HMO individual plans on and off the exchange.
"We believe that these (PPO) plans do not represent the best value for the consumer," said Mary Ann Tournoux, HAP's senior vice president and chief marketing officer, in a statement. "At this time of cost-consciousness, we believe our remaining plans are the most cost-effective and offer our members and consumers greater value for their hard-earned insurance dollar."
About a month ago, when I first plugged in the average requested 2017 rate hikes for Georgia's ACA-compliant independent market, I came up with an overall weighted average of around 27.7%. However, there was one major gap in the data: I had trouble finding Ambetter/Peach State's enrollment numbers or even their average rate hike request, so I reluctantly left them out of the calculation completely.
When Aetna announced that they were dropping out of the Georgia exchange-based independent market, I went back and removed them from the mix. Since Aetna's request had been 15.5% on a substantial share of the market, this meant that the rest of the statewide average shot up to 32.0%.
Today I was able to track down the missing Ambetter/Peach State data--both the average requested rate hike (around 8.0%) as well as the number of current enrollees impacted...around 73,000:
With the growing concerns over expected large premium rate hikes next year, combined with the Big Announcements that major exchange players like UnitedHealthcare, Humana and Aetna are dropping out of most of the ACA exchange markets they're currently participating in, the HHS Dept. has obviously been under quite a bit of pressure to reassure exchange enrollees (both current and potential) to stay the course and not panic.
Thus, it's not surprising at all that an hour or so ago they released a new report which reminds people that nearly 4/5 of current ACA exchange enrollees will still be able to find an exchange-based Qualified Health Plan for $100 or less per month (and 3/4 could find one for $75 or less per month) after applying APTC assistance in the event of an across-the-board 25% premium rate increase in 2017:
OK. Last week I wrote up a post speculating about the potential impact to the state- and national-level average rate hike requests of Aetna dropping out of the ACA exchanges in 11 states. My conclusion was that the average will increase in some states...but may actually drop in others, since Aetna would otherwise have asked for rate hikes higher than the average requested by the other carriers in that state. Of course, this isn't really a positive development, since their current enrollees are still losing their plans entirely, and since a 50% hike from Aetna could still end up costing less than a 10% hike from one of the other carriers...but as always, this is the best I can do here.
According to a release from the company on Tuesday, the firm will no longer offer individual market plans through the Affordable Care Act in Dallas, Texas, and New Jersey.
..."We hope to return to these markets as we carry on with our mission to change healthcare in the US."
The "we hope to return" part suggests that Oscar will continue to be available off the exchange in New Jersey, since completely pulling out of a state means a carrier has to wait at least 5 years before re-entering. So...there's that, anyway.
...Oscar currently covers 7,000 people in Dallas and 26,000 in New Jersey.
As noted a couple of weeks ago, all three of the major insurance carriers participating in Tennessee's individual market ACA exchange asked for massive rate hikes this year, ranging from 44-62%. Blue Cross Blue Shield asked for 62% in the first place; Cigna and Humana resubmitted their original requests for higher ones.
Tennessee's insurance regulator approved hefty rate increases for the three carriers on the Obamacare exchange in an attempt to stabilize the already-limited number of insurers in the state.
...BlueCross BlueShield of Tennessee is the only insurer to sell statewide and there was the possibility that Cigna and Humana would reduce their footprints or leave the market altogether.
This was a double headache: First, because the actual enrollment numbers were only available for 3 out of 11 carriers via the filings; I had to get the rest from the MA exchange's monthly dashboard report. Secondly, even with the dashboard report, I had to merge together 2 different enrollment numbers for each carrier due to MA's unique "ConnectorCare" program.
There are a few states which have technically expanded Medicaid under the ACA, but have done so using an approved waiver which allows them to actually enroll expansion-eligible residents in private Qualified Health Policies (QHPs)...using public Medicaid funding to do so. To be honest, this has always struck me as being essentially no different than someone simply receiving 99.9% APTC/CSR subsidies for enrolling in an exchange policy anyway; it's just a question of which pool of federal funds the subsidies come from. The two states which I know for a fact do it this way are Arkansas and New Hampshire, with Arkansas calling their "Private Medicaid Option" program the "Health Care Independence Program".
In any event, AR "Private Option" enrollees may be categorized as "Medicaid expansion" in the official reports, but for purposes of estimating the risk pool, they're included in with every other ACA-compliant private individual policies, whether on or off the ACA exchange.
Amidst my Aetna Postapalooza yesterday, there's one important point which other outlets have brought up which I haven't addressed yet: Pinal County, Arizona.
Since participation in the ACA exchanges has always been voluntary for carriers selling ACA-compliant individual policies (except for the District of Columbia (and until recently, Vermont), where carriers are legally required to only sell individual policies via the exchange), there's always been the danger that sooner or later there might be a situation where no carriers are selling on the exchange. Not "a few", not "only one"...zilch.
In my mind, I've always thought of this problem in statewide terms; it wasn't until 2015 that I even realized that many carriers only sell policies in some of the counties in a given state, not all of them. That makes the list of 300+ exchange carriers nationwide a bit misleading; some of the carriers listed for a given state might only be selling in a few or just a single county, making the scenario above far more likely to happen.
You may have noticed that I recently set up a GoFundMe account as an alternate method of letting people help keep ACASignups.net going as we enter the 4th Open Enrollment Period.
Until now I've exclusively used PayPal for donations, but decided to add GoFundMe as well to see how that works out.
In addition to my general gratitude, I should also note that anyone who makes a donation is added to the official ACA Signups mailing list. Once a week* I send out a weekly digest including a wrap-up of the past week, along with special bulletins when there's a major ACA-related development.
*(well, nearly every week...occasionally I'm a bit late...)
Under the “third party” arrangements, nonprofit organizations work as a front for medical care providers trying to win higher payments from private insurers that pay more than government programs like Medicaid, insurers say. For example, UnitedHealth Group last month sued a dialysis chain, American Renal Associates, alleging fraud. In its suit, UnitedHealth said American Renal hooked patients up with a charitable organization that helped patients pay their premiums, according to media reports.
When I ran Kentucky's average requested rate hike numbers for the individual market back in May, I came up with a weighted average of 23.8%, but also cautioned that the weighting was likely based on less than 50% of the total ACA-compliant individual market state-wide.
Since then, it looks like a couple of the carriers resubmitted their filings with slightly different average requests, although nothing major. In fact, even Aetna dropping off the exchange doesn't change much, since it looks like they only have around 400 enrollees there anyway (plus, Aetna says they're sticking around the off-exchange market in "most" of the regions they're bailing on next year). Finally, as far as I can tell, Kentucky is among the states that Humana is not abandoning (though they might be reducing their footprint there?).
Anyway, just moments ago, according to SHADAC, the Kentucky DOI has posted their approved rates for the individual market:
Yesterday, in light of the Aetna announcement (coming on top of similar bombshells from UnitedHealthcare and Humana earlier this year), I took a stab at trying to calculate just how many current exchange-based enrollees will lose whatever plan they're currently enrolled in whether they want to switch to a different one or not. My conclusion is that up to 2 million of the 11 million or so will not, in fact, be able to "keep their plan if they like it" due to either the carrier going belly-up (4 more co-ops), the carrier pulling out of their county/state (UHC, Humana, Aetna) or the carrier dropping certain types of plans (BCBS of Minnesota). The number might be a few hundred thousand higher than that, actually, since there are other, smaller carriers here and there making changes to their plan offerings and/or participation levels.
This, of course, once again brings up President Obama's infamous "If You Like Your Policy, You Can Keep It!" promise, which he made a whole bunch of times throughout the contentious battle to get the ACA passed back in 2009-2010.
UPDATE: Wesley Sanders (via Twitter) pointed out that technically speaking, the headline above isn't quite accurate: In some cases, the enrollees in question will be automatically "mapped" to a different plan if they fail to actively shop around and pick a new policy themselves. So I suppose a more accurate headline would be "How many people will NOT have the same policy as of January 1st no matter what?"
The HHS guidelines indicate that an exchange cannot map enrollees to a plan offered by a different carrier. So if your health insurance carrier is exiting the exchange or pulling out of the individual market altogether – as is the case with 12 CO-OPs in November and December – the exchange generally won’t automatically re-enroll you in a similar plan from a different carrier. (New York State of Health made an exception for CO-OP members who lost coverage at the end of November.)
If your carrier is pulling out of the exchange but continuing to offer off-exchange coverage in your area, state regulations on guaranteed renewability will apply; the carrier may be able to auto-renew your coverage outside the exchange (which means you’d lose any premium subsidies and/or cost-sharing subsidies you were receiving in the exchange), or you may be directed to select a new plan during open enrollment.
That last paragraph is actually really important in the case of Aetna, who says that they plan on sticking around off-exchange in most of the areas that they're dropping on-exchange policies...if those enrollees aren't careful, they could end up "keeping their plans" after all...except that they'd suddenly go from paying, say, 20% of the full price to 100%.
UPDATE x2: OK, I've been informed by a source at the HHS Dept. that the above policies are NOT quite accurate after all:
"if an issuer no longer offers a particular plan, we work with states to enroll the consumer in as similar a plan, as best possible. Under some circumstances, this could be with a different issuer. (Of course, consumers still have the option to go back to HealthCare.gov and select a new plan during open enrollment.)
"Highlight #2 is not true."
I apologize for the confusion on this issue; it sounds like this policy may have changed for 2017. Louise assures me that she's updating her primer now.
Every year, both the HHS Dept. as well as myself make a point of strongly encouraging people to shop around, shop around, shop around when enrolling in ACA exchange policies, since doing so can usually result in a better deal being available. This remains the case this year: EVERYONE should shop around and see what's available, even if they end up sticking with the same plan in the end. You never know what you'll find.
However, there's a flip side to this advice: Every year, a substantial portion of current enrollees have no choice but to shop around, for a variety of reasons:
In 2013, a couple million people's policies were cancelled for not being ACA-compliant (about 5 million more were given a "transitional" period of up to three years, depending on the state).
In 2014, a million or so of those extended "transitional" policies expired. In addition, enrollees in Massachusetts, Maryland, Oregon and Nevada had to manually re-enroll whether they kept the same policy or not as those states switched to brand-new tech platforms.
In 2015, a dozen or so ACA-created Co-Ops failed, forcing around 800,000 people to have to shop around for a new carrier. Moda pulled out of a couple of states, Blue Cross dropped out of New Mexico and so on.
In 2016, 4 more co-ops have failed, plus the big drop-out announcements from UnitedHealthcare, Humana and Aetna.
In addition, throughout all 3 years, various carriers have dropped some types of policies in given states while retaining others...usually dropping PPOs but keeping HMOs, as Blue Cross did in Texas this year and is doing in Minnesota next year. In these cases, the enrollees may or may not have to switch carriers, but they will have to choose a different plan one way or the other.
Ever since the big Aetna news the other day, several people have asked me for my estimate of just how many people will have to shop around next year. Here's my best attempt to tally them up:
(Updated to add Jeffrey Young to the headline/body...I missed his name on the byline originally, apologies to him!)
Ever since Aetna dropped the bombshell 10 days ago that they were abandoning their previously-announced intention of expanding into additional state ACA exchanges next year and instead might even drop out of some of the states they're already participating in, plenty of people have smelled something fishy about the timing of the 180º turn, given that the original expansion announcement came in mid-May, followed by the Dept. of Justice annoucing that they were suing Aetna to prevent them from merging with Humana in July.
I noted this morning that several of the news stories about Aetna's announcement that they're pulling out of the ACA exchange in 11 states next year included this clarification:
In most areas it’s exiting, Aetna will offer individual coverage outside of the program’s exchanges.
At the time, I only mentioned it in terms of making it tricky to calculate how many current Aetna enrollees would be losing their policies and how much it might impact the average rate hikes for the individual market in that state. After all, if there are 10,000 exchange-based Aetna enrollees and 90,000 off-exchange in a given state, it makes a huge difference whether Aetna is dropping both on & off-exchange plans or on-exchange only.
Health insurer Aetna Inc. will stop selling individual Obamacare plans next year in 11 of the 15 states where it had been participating in the program, joining other major insurers who’ve pulled out of the government-run markets in the face of mounting losses.
Here's the full list of states Aetna is pulling up stakes in:
Arizona, Florida, Georgia, Illinois, Kentucky, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina and Texas
Here's the 4 states where Aetna will still be selling exchange-based policies:
Health Insurer Aetna Inc on Wednesday said it plans to continue its Obamacare health insurance business next year in the 15 states where it now participates, and may expand to a few additional states.
"We have submitted rates in all 15 states where we are participating and have no plans at this point to withdraw from any of them," said company spokesman Walt Cherniak. But he noted that a final determination would hinge on binding agreements being signed with the states in September.
Aetna sells the individual coverage on exchanges created by the Affordable Care Act, also called Obamacare. By also filing proposed rates in several other states, Aetna said it had preserved its options to participate in them as well next year. It declined to identify the potential new markets.
The 15 states where it currently participates are Arizona, Delaware, Florida, Georgia, Illinois, Iowa, Kentucky, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Texas and Virginia.
Now that the official ASPE Q1 2016 Effectuated Enrollment report is out, I can compare various state exchange reports against that to see how they're doing. In Washington State, 158,245 people were reported as being enrolled in active, effectuated exchange policies as of 3/31/16.
The WA HealthplanFinder has issued their July dashboard report, and their off-season retention numbers look pretty good: 168,958 people had paid their monthly premiums as of June...a 6.8% increase over the March figure. Even if this is off slightly due to methodology differences, it's still a good thing to see exchange enrollment up from earlier in the year, since overall enrollment is down at least 12.6% since the end of open enrollment due to non-payments, legal issues and so on.
The Massachusetts Health Connector has posted their latest monthly enrollment report (through the end of July), and the news is good. As I note every month:
Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.
The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day....yet their March report claims 208,000 effectuated enrollees as of February.
As I keep noting, the DC exchange insists on presenting their enrollment numbers as cumulative since October2013.
As a result, I have to subtract the prior numbers from the current ones to find out the net increase in QHP selections, Medicaid enrollments and SHOP enrollments.
As I've been noting for a few months now, Connect for Health Colorado's monthly enrollment reports are chock full of data and confusing as hell at the same time.
As a result, I've started simply presenting them without much commentary. Here's the July report:
I don't write about Idaho much, which is a bit surprising when you think about it because it's kind of a unique state when it comes to the ACA exchanges. Most states never set up their own exchange platform. A dozen or so set them up and are still using them. Two states (Massachusetts and Maryland) scrapped their original, failed platforms and completely overhauled them.
Three states started out with their own platform but gave up when they failed, moving home to the mothership (HealthCare.Gov). One state, New Mexico, was supposed to move off of HC.gov after the first couple of years, but changed their mind and is still hosted by the federal platform. Oh, and there's also Kentucky, which is scheduled to scrap their perfectly-functioning tech platform for absolutely no good reason other than the petty whim of their new Governor, Matt Bevin.
And then there's Idaho.
Idaho is unique for a couple of reasons: Not only is it the only state to start off hosted by HC.gov and then move off of the federal tech platform onto it's own system, it's also the only state running it's own full exchange which hasn't expanded Medicaid as well.
UPDATE 10/27/16: See below for FINAL update (for real!)
UPDATE 10/19/16: As you can see, I've locked in the approved weighted average rate hikes for 40 states plus DC, leaving 10 states to go. I do plan on filling in the remaining approved rate hikes as the data for those 10 states comes in, but at this point it's quite clear that 25% is the magic number. The weighted average has been hovering between the 23-26% range since the first few approvals started being publicized in mid-August, and has stabilized in the 24-25% range for the past month. Over 77% of the total U.S. population is represented by these 40 states (+DC); unless there's some dramatic final rate changes in the remaining 10 states, that national 25% average isn't likely to budge by more than a rounding error.
As proof of this, I assumed that the requested rate hikes are approved exactly as is for all 10 states.
Result? The national, weighted average rate hikes went from 25.25%...to 25.36%.
OK, make that four states in which at least one major carrier has submitted an updated rate filing request since I originally estimated the statewide average.
Shortly after that, however, HealthyCT became the latest ACA-created Co-Op to fail, meaning their 16,000 or so current enrollees will have to shop around for new coverage next year. I revised the numbers accordingly and the average request bumped up a bit to 22.2%...
BALTIMORE – Commissioner Al Redmer, Jr. will be conducting a second public hearing on Monday, August 15th from 11 am – 1 pm at the Maryland Insurance Administration located at 200 St. Paul Place, 24th floor Hearing Room, Baltimore, MD 21202 to receive public input on a revised filing made by CareFirst. On July 26, CareFirst refiled its 2017 proposed rates for the individual market and requested a 27.8% rate increase for HMO plans and a 36.6% rate increase for PPO plans. CareFirst previously requested a 12.0% and 15.3% rate increase, respectively.
I noted back in February that Vermont Health Connect, VT's ACA exchange, has remained essentially silent since last fall, issuing only 2 press releases since Open Enrollment started last November (one of which was about a new plan comparison tool, the other of which was about some sort of Medicaid-related dealine). In other words, they haven't publicized their 2016 enrollment numbers whatsoever...the only reason I have data for VT at all is thanks to the official ASPE reports from the HHS Dept. This is a stunning 180º turnaround from 2015, when they were issuing detailed reports on a regular basis.
Cigna and Humana would have to revise their requests up to 50% apiece in order for the statewide average to end up hitting the 60% threshold, but that's not exactly a vote of confidence when it's already in the 56% range to begin with.
In its latest filing, Cigna is proposing an average 46 percent increase — double its first 23 percent increase request.
Humana, which requested a 29 percent average increase in June, is requesting an average 44.3 percent increase, according to a filing with the state regulators.
Here's what that looks like on the weighted average table:
Rhode Island, in addition to being one of the smallest states, is also one of the first states I crunched the rate hike numbers for back in late May. It was actually pretty easy to run a weighted average hike request since there are only 2 carriers even operating on the individual market next year: Blue Cross Blue Shield of RI and Neighborhood Health Plan (UnitedHealthcare is dropping out of the RI indy market entirely, but only has about 1,400 people enrolled to begin with).
Anyway, BCBS was asking for a 9% increase, while Neighborhood is among the very few carriers to actually request a rate decrease...of around 5%. As a result, Rhode Island has the honor of having the lowest average rate hike request of all 50 states (+DC) next year...a mere 3.6% overall, which is awesome.
It's a whopping 64 pages long. Some of it is stuff like "how many people speaking Cambodian called the support lines?" (answer: 6) and the like, but there's also a whole bunch of handy data regarding actual healthcare policy/program enrollment in the Empire State. I don't mean to be ungrateful, as this is extremely comprehensive...but it would've been far more useful if the report had included data from the end of March (or even later), as opposed to cutting off at the end of the 2016 Open Enrollment period (January 31st). Due to attrition due to people who never pay their first premium, are denied policies for legal reasons (residency status, etc) and so on, only around 82% of the 272,000 people who selected QHPs in NY during OE3 were still actually enrolled as of two months later. A good 10-12% or so never paid in the first place and another 6-8% were kicked off involuntarily for one reason or another...none of which is reflected in this report.
Of course, as I (and others on both sides of the political spectrum) have written about many, many times, not everyone who selects a QHP (either on or off the exchanges) actually pays their first premium, and therefore is never actually enrolled in an active, effectuated policy. This amounted to roughly 12-13% of all QHP selections in 2014, but got a bit better over the next two years as people got used to how the system works and technical improvements were made. In addition, another chunk of QHP selections were scrapped by the HHS Dept. or state exchanges at later points thorughout 2014 for a variety of reasons ranging from legal residency issues to other data matching problems. Again, this percentage has been gradually whittled down as improvements to the system have been made.
With all the concern about the ACA exchange risk pool being sicker than expected as well as plenty of grumbling about how the ACA's Risk Adjustment program is working out in practice, earlier today Kevin Counihan, the CEO of the Health Insurance Marketplace (i.e., the guy in charge of HealthCare.Gov) posted a blog entry laying out some changes that CMS has in mind for the RA program going forward. It's interesting stuff for health insurance wonks, but to be honest, I was more interested in a different document also released today (referenced in the RA blog):
Changes in ACA Individual Market Costs from 2014-2015: Near-Zero Growth Suggests an Improving Risk Pool
(as whoever posted the commercial to YouTube noted, "Seriously, who struts down the sidewalk munching on a jar of peanut butter?")
I've written quite a few times before about how the small group insurance market is sort of the odd man out when it comes to the Affordable Care Act. The SHOP exchanges have turned out to be mostly a dud (to the point that the HHS Dept. has only stated once just how many people are even enrolled in SHOP policies (and even that was missing some states; my best guesstimate is arouns 150,000 nationally).
That's a net increase of 12,277 people in just 9 days, or over 1,300 per day.
There are an estimated 375,000 Louisianans eligible for ACA Medicaid expansion. If they can enroll another 700/day, they'll have maxed out by New Year's Eve.
What are the actual old and new dollar amounts that we’re talking about here?
Remember, until now we’ve been talking purely about percentages … but that can be very misleading. In our hypothetical example, Acme is a new player on the market. They priced aggressively last year in order to steal customers away from the more familiar brand names, and managed to get 5 percent of the market; not bad.
Unfortunately, those customers turned out to be loss leaders – it’s costing them more to care for their enrollees than they’re being paid, so they jacked up their rates 25 percent this year, while Blue Cross is only raising theirs 6 percent (weighted).
HOWEVER, when you look at the average premium dollar amounts of each company, look what happens:
MIT health economist Jonathan Gruber was the Republican Party's favorite stock villian during the absurd King v. Burwell (formerly Halbig v. Burwell) Supreme Court saga which raged throughout the first half of 2015, in large part because of his tendency to have a bad case of diarrhea of the mouth when speculating about the reason why certain sections of the ACA were written the way they were.
From a pure, cold economic perspective, the debate going on between the dueling studies above is about how much the first is being cancelled out by the second.
The debate which should be going on from a human perspective is about whether more or fewer people are better or worse off health-wise and economically thanks to/due to the ACA than they would otherwise be without it.
Unfortunately, when it comes to healthcare, this is a nearly impossible task to measure properly.
For instance, let's take someone with cancer. Under the ACA, they're allowed to enroll in a policy which will cover their treatments. If they have a low income, they'll receive heavy APTC assistance and possibly CSR assistance.
Without the ACA, they'd be utterly screwed and would very likely go bankrupt trying to pay the full price for treatment, or die without it, or the first followed by the second.
In an effort to prevent more insurers from abandoning the Obamacare exchange in Tennessee, the state's insurance regulator is allowing health insurers refile 2017 rate requests by Aug. 12 after Cigna and Humana said their previously requested premium hikes were too low.
As of last week, five companies in Arizona had announced plans to pull out or pull back: Health Choice, United Healthcare, Humana, Blue Cross Blue Shield of Arizona and Health Net.
Well, there you have it: Across all 50 states (+DC), taking a bunch of caveats into account (see below), as far as I can estimate, the average premium rate increases being requested by health insurance carriers sits at right around 23% overall.
Off-exchange policies are included whenever possible, but only if they're ACA-compliant (grandfathered/transitional plans are in a different risk pool anyway). The ACA-compliant individual market totals roughly 18-19 million people nationally (11 million on-exchange, another 7-8 million off-exchange). Grandfathered/Transitional plans likely total around 2-3 million more.
Only individual market policies are included (there's a few states where the small group market has been merged with the individual market risk-pool wise, but I only include indy enrollees for purposes of weighting). The small group market was around 13.5 million people, according to Mark Farrah Associates.
Some carriers are pulling out of either specific counties or entire states next year, or are dropping certain plans while keeping others. There's no way of estimating the "average rate increase" for anyone who's losing their existing plan altogether.
Well, I've managed to put together estimates (some very rough, some pretty specific) of the weighted average requested ACA-compliant individual market rate hikes for 49 out of 50 states, along with the District of Columbia. This leaves just one state left: Minnesota. For whatever reason, I've been informed that Minnesota's requested rate filings won't be available to the public until September 1st, which is too late for my purposes...because by that point, many of the other states will have started releasing their approved rates for next year (in fact 3 of them--Oregon, New York and Mississippi--have already done so). Minnesota's approved rates will be posted on October 1st. It's always been my intent to lock down the requested rates for every state before the approved numbers are posted in order to run a comparison between what was asked for and what the final approved rate changes are.
Mississippi remains one of only two states which still don't have their 2017 Rate Filings posted over at HC.gov's Rate Review database. In addition, while Mississippi does use the SERFF system for other types of insurance, major medical doesn't appear to be among them. Finally, while the MS Dept. of Insurance does include a special website specifically designed for searching/comparing rate changes for health insurance policies...it doesn't appear to have been updated in awhile (the only recently listings are for obscure carriers which seem to be mostly offering short-term plans and other "mini-med" types of policies, not full ACA-compliant plans.
Health Insurer Aetna Inc on Wednesday said it plans to continue its Obamacare health insurance business next year in the 15 states where it now participates, and may expand to a few additional states.
"We have submitted rates in all 15 states where we are participating and have no plans at this point to withdraw from any of them," said company spokesman Walt Cherniak. But he noted that a final determination would hinge on binding agreements being signed with the states in September.
Aetna sells the individual coverage on exchanges created by the Affordable Care Act, also called Obamacare. By also filing proposed rates in several other states, Aetna said it had preserved its options to participate in them as well next year. It declined to identify the potential new markets.
Massachusetts' total individual market was only around 72,000 people in 2014, but their ACA exchange had disastrous technical problems during the first ACA open enrollment period, causing tens of thousands of Baystaters to enter a sort of "limbo" status healthcare coverage-wise (the first version of the exchange couldn't properly confirm which enrollees qualified for APTC assistance, so only those paying full price were actually enrolled in exchange QHPs; those claiming APTC status were temporarily transferred over to state-based coverage until it could be sorted out, which took nearly a year in most cases). Fortunately, in 2015, the state got their act together and enrolled nearly 214,000 people in exchange-based policies this year.
New Hampshire has only 5 carriers offering individual market policies, all 5 of which will still be participating in the NH market next year as well. Two of the five (Community Health Options and Minuteman Health) are among the 7 surviving ACA-created Co-Ops.
Even so, NH is proving to be a very tricky state to estimate, because only one of the 5 carrier rate filings includes their actual current rate-impacted enrollment data. As a result, I've had to take my best shot at estimating the market share of the other four. The only way I could think of to do this was to look up the latest NH DOI 2016 QHP Monthly Membership Report. New Hampshire, to their credit, is one of the only states without their own state-based ACA exchange which still actually posts regular reports about how many residents are enrolled in ACA exchange policies. Furthermore, they even break these numbers out by metal level and carrier, making the relative market share easy to calculate.
North Dakota's total individual market was 49,000 people in 2014. Assuming a 25% increase since then, it should be roughly 61,000 today, some portion of which is composed of transitional/grandfathered enrollees. I'm going to assume (based on hard numbers from a few other states) that GF/TR enrollees make up perhaps 10% of the total, or 6,100. They enrolled 21,604 people in exchange plans this year, of whom 20,536 were still enrolled as of the end of March. Last year, Blue Cross Blue Shield of ND held roughly 29,000 enrollees total, with Medica making up another 4,800 or so.
All of the above numbers are important when attempting to estimate the weighted average rate hikes requested by ND carriers, because of the 3 operating on the individual market (BCBS, Medica and Sanford), only one of them, Medica, has provided their actual 2016 enrollment tally (7,329).
Billionaire businessman Donald Trump on Wednesday offered a glimpse into his presidential platform on healthcare, saying he would replace ObamaCare with “something terrific.”
“It’s gotta go,” Trump said of ObamaCare in an interview Wednesday with CNN. “Repeal and replace with something terrific."
Just as I'm wrapping up calculating the weighted average rate hikes requested in all 50 states, New York just became the second state (after Oregon) to release their approved rates:
As of 2014, South Carolina's total individual market was roughly 201,000 people, including grandfathered & transitional enrollees. 205,000 people were enrolled in exchange policies as of the end of March 2016; when you add off-exchange enrollees, it's likely closer to 250K, of which I'd imagine 225K or so are ACA-compliant. The enrollment numbers below therefore should reflect roughly 70% of the ACA-compliant market.
To calculate the Blue Cross Blue Shield average percentage, I had to do a bit of guesswork as to the proportion of their 116,000 enrollees between the 3 different types of plans (BlueEssentials, Multistate and Catastrophic). BlueEssentials is the highest of the three (14.74%), but also likely holds the vast majority (I'd guess 95% or more); usually very few people select Catastrophic plans, and I don't think many go for Multistate either. Therefore, I'm eyeballing the overall average at around 14.4%.
Golf Carts vs. Ford Fiestas: No, "healthcare policy" premiums did NOT go up 49% due to the ACA
Yesterday I posted an entry which noted a story published by Avik Roy over at Forbes about an extensive study by the Manhattan Institute which compared the average insurance policy premiums last year vs. the average premiums this year, after the first ACA open enrollment period. Roy's piece breathlessly claims "Obamacare Increased 2014 Individual-Market Premiums By Average Of 49%"
I wrote a response piece which also included the HHS report about ACA subsidies covering an average of 76% of the premium cost for the Federal marketplace, but I didn't really have time to do a full analysis of the Forbes piece. However, I did note 4 major points which lept out at me right off the bat:
Patients burst into tears at this city’s glistening new charity hospital when they learned they could get Medicaid health insurance.
In Baton Rouge, state officials had to bring in extra workers to process the flood of applications for coverage.
And at the call center for one of Louisiana’s private Medicaid plans, operators recorded their busiest day on record.
The outpouring began in June, when Louisiana became the 31st state to offer expanded Medicaid coverage through the Affordable Care Act, effectively guaranteeing health insurance to its residents for the first time.
Now, as Republican presidential nominee Donald Trump promises to repeal the healthcare law, Louisiana is emerging as a powerful illustration of the huge pent-up demand for health insurance, particularly in red states where elected officials have fought the 2010 law.
Supreme Court grants emergency order to block transgender male student in Virginia from using boys' restroom
Last month I noted that while South Dakota hadn't posted their ACA-compliant 2017 rate filings yet, they had posted their grandfathered/transitional filings, and decided to take a look at those. While GF/TR plans are down to a pretty nominal number in most states (and about half the states don't have any transitionals at all at this point), SD still has a huge portion of their individual market enrolled in them (over 1/3, from what I can tell).
Only 4 carriers appear to be participating in the ACA-compliant individual market in South Dakota next year: Aetna, Sanfrod, SD State Medical and Welmark. I only have the enrollment numbers for 3 of the 4, but the requested rate hike for the fourth one (Sanford) is pretty close to the average of the other three anyway, so it shouldn't really impact the overall average by much:
As I noted Monday morning, I believe that August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.
Wisconsin's total individual market was around 260,000 people in 2014 and is likely up to around 300,000 today (not including grandfathered/transitional enrollees), with about 224,000 enrolled on ACA exchange policies as of March 2016, plus an unknown number off-exchange. That means that the table below is likely missing around 1/3 of the total ACA-compliant market.
As I noted Monday morning, I believe that August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.
I've written a number of times about the irritating tendency of media outlets (and even the original data source itself) posting graphs & charts which are presented in highly misleading ways...even if the data itself supports the larger headline. The usual target of my ire is Gallup itself, which keeps presenting their quarterly Uninsured Rate graphs like so:
By cutting off the first 10 percentage points, this makes the uninsured rate drop since the ACA was implemented seem far more impressive than it already is. I support the ACA, but still prefer the situation be presented as accurately as possible. As a result, I keep reformatting Gallup's data like so (I also add some additional data points for further context):
I'm bringing this up again today because Greg Dworkin took note of the opposite problem yesterday (h/t to Richard Mayhew for calling his tweet to my attention):
As I noted Monday morning, I believe that August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.
As I noted Monday morning, I believe that August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.
There are only two insurance carriers participating in Hawaii's individual market next year: The Hawaii Medical Service Association (HMSA) and the Kaiser Foundation Health Plan.
As I noted Monday, I believe August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.
In 2014, New Jersey's total individual market was estimated at around 261,000 people, including off-exchange, grandfathered and transitional enrollees. Assuming 25% growth, this should be around 325,000 today.
As I noted Monday, I believe August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.
Today is August 1st. I was hoping that most/all of the states still missing from my 2017 Requested Rate Hike project would finally make their rate filings public as of today, but apparently not (or at least, they aren't live as of 10am).
Health plans sold on Michigan's insurance exchange could see an average 17.3% increase next year, and if recent history is any guide, state regulators could approve the insurance companies' rate hike requests without many — if any — changes.
The rate increases would mean a financial hit for taxpayers in general and the 345,000 Michiganders who buy their health insurance on the Healthcare.gov exchange, created under the Affordable Care Act, also known as Obamacare.
