Health insurers are boosting individual market premiums by an average of 50 percent or more next year, increases that regulators say are necessary to save a market that otherwise was on the verge of collapse.
The increases were announced Friday by the state Commerce Department, and show premiums will jump even higher than proposed rates that were made public on Sept. 1.
At that point, carriers sought increases ranging from 36 percent to 67 percent. But the final average increases will range form 50 percent to 67 percent, depending on the insurer.
Here's how it actually plays out by the hard numbers:
As the dust settles on the Affordable Care Act, New Hampshire is feeling tremors from shifts occurring nationally, although the state’s health care landscape is more stable than the rest of the country.
About a quarter of the nation, geographically, and around 17 percent, demographically, only have one insurer on the exchange, meaning less competition on rates, and therefore higher costs. Over the past year, UnitedHealthcare, Aetna and Humana have pulled out of the markets in most states, not getting the healthy populations they expected.
It's a good article, full of stats, figures, context and quotes. THere's even a nifty pie chart showing the relative market share of the carriers and so on.
Arise Health Plan, a subsidiary of WPS Health Solutions, said Thursday that it will not sell health plans on the marketplaces set up through the Affordable Care Act next year, becoming the latest company to abandon the market.
Arise and WPS Health Insurance also will sell only high-deductible health plans for individuals and their families off the marketplace, and those plans will be available only in a limited number of counties.
...For now, the marketplace for Milwaukee County next year will have four companies offering health plans: Molina Healthcare; Network Health Plan, owned by Ascension Wisconsin and Froedtert Health; Common Ground Healthcare Cooperative; and Children’s Community Health Plan.
Waukesha County tentatively will have those companies as well as Anthem Blue Cross and Blue Shield in Wisconsin and Dean Health Plan.
...Arise Health Plan has a relatively small share of the market in southeastern Wisconsin.
77% of Americans say prescription drug costs are unreasonable in light of the Epi-Pen scandal, up from 72% a year ago
Approval/Disapproval of the ACA is split almost evenly, as usual (44% favorable, 47% unfavorable...which is actually better than I expected given all the bad news about rate hikes and carrier drop-outs in recent weeks)
The biggest healthcare-related concerns are (in order of decreasing importance): The future of the ACA in general; insurance premiums; insurance deductibles; drug prices; the uninsured; the opioid epidemic; and the Zika virus
There's a whole bunch of other interesting stuff, mostly about prescription drug issues, but there's one which made me feel like sticking my head in the oven (which wouldn't be very effective anyway, since ours is electric; I'd just end up burning my face):
There's been story after story over the past few months about insurance carriers large and small either dropping out of the ACA exchanges or (in the case of 4 co-ops) going belly-up altogether. Along the way, there have also been a few stories about other carriers expanding into new states or additional counties in states they're already participating in.
Residents in more West Virginia counties will have additional health plan options when the open enrollment period on the Mountain State’s insurance exchange, created in the Affordable Care Act, opens on Nov. 1.
In its 2nd year in West Virginia, CareSource, a nonprofit managed care provider based in Dayton, Ohio, is expanding its coverage area to include 32 counties.
...In 2016, CareSource is providing health insurance coverage to more than 1,300 West Virginia residents in ten counties: Brooke, Cabell, Hancock, Kanawha, Lincoln, Marshall, Mason, Ohio, Putnam, Wayne.
Two bits of news out of the DC exchange today: First, they announced that the uninsured rate has been slashed in half over the past 3 years thanks in no small part to the Affordable Care Act. Not a huge shocker given the recent surveys/studies released by the CDC, Gallup, Kaiser and so on of late, but still good to see:
Washington, DC – A new survey by the Center for the Study of Services conducted for the DC Health Benefit Exchange Authority (DCHBX) concludes that the District of Columbia made huge gains during the most recent open enrollment period to provide access to health insurance coverage to people who were previously uninsured. Results from this survey show that more than 25,500 people, who were not previously covered in 2015, gained access to health insurance coverage in 2016 through DC Health Link, the District’s online health insurance marketplace.
UnitedHealth Group Inc., the biggest U.S. health insurer, is scaling back its experiment in Obamacare markets as its Harken Health Insurance Co. startup withdraws from the two exchanges where it was selling plans.
Harken will not offer individual plans through Obamacare exchanges in Georgia and Chicago in 2017, the company said Thursday in an e-mailed statement. It will continue to offer individual plans off the exchange, Harken said.
As commenter ME notes, there are currently around 22,800 Harken enrollees in Illinois and another 10,500 in Georgia. I have no idea what the on/off exchange ratio is, however, so the number of people who will actually have to shop around will be up to 33,300; assuming, say, 2/3 are on the exchange, that would be roughly 22,000 people.
BATON ROUGE — The number of people who have signed up for Louisiana's Medicaid expansion program continues to grow, surpassing 300,000.
The Louisiana Department of Health released the latest figures Monday, saying more than 304,000 people are enrolled for the coverage that began July 1.
The department says nearly 12,000 Medicaid expansion enrollees have received preventive services through the government-finance insurance program so far, like cancer screenings, colonoscopies, and mammograms.
The maximum number of Louisianans eligible for Medicaid expansion in the state is supposedly around 375,000. Enrollment began in June (though the program didn't actually go into effect until July), so that's 81% of the total enrolled within just 3 1/2 months.
A few weeks back, the CDC released the results of the latest National Health Interview Survey, considered the gold standard for measuring U.S. insured/uninsured rates; it concluded, unsurprisingly, that thanks to the ACA, the uninsured rate in the United States has plummeted from 16% in 2010 to it's lowest level in pretty much forever, just 8.6%.
NHIS's methodology is more comprehensive than that of, say, the Gallup-Healthways quarterly surveys, which doesn't include children, so the numbers are understandably a bit different, but the results are unquestionable: For whatever other flaws it may have, the Affordable Care Act has dramatically lowered the uninsured rate in the United States.
Normally I post screenshots from the revised/updated SERFF filings and/or updates at RateReview.HealthCare.Gov, but it takes forever and I think I've more than established my credibility on this sort of thing, so forgive me for not doing so here. Besides, #OE4 is approaching so rapidly now that this entire project will become moot soon enough, as people start actually shopping around and finding out just what their premium changes will be for 2017.
The other reason I'm not too concerned about documenting the latest batch of updates/additional data is because in the end none of it is making much of a difference to the larger national average anyway; no matter how the individual carrier rates jump around in various states, the overall, national weighted average still seems to hover right around the 25% level.
Still, for the record, here's the latest...in four states (Iowa, Indiana, Maine & Tennessee) I've just updated the requested and/or approved average increases. In the other four (Massachusetts, Montana, North & South Dakota) I've added the approved rate hikes as well.
I've written a lot in the past about off-season exchange enrollments, otherwise known as SEPs (Special Enrollment Periods). For the most part, SEPs refer to people who enroll in individual policies after the official Open Enrollment period. They're allowed to do so for a variety of reasons: If they move outside of their rating area; if they get married or divorced; if they give birth or adopt a child; if they get out of prison; if they're discharged from the military; or, in most cases, if they lose whatever current healthcare coverage they have due to losing a job, etc.
Over the past 3 years I've estimated that somewhere between 7,000 - 9,000 people sign up for ACA exchange coverage via SEPs every day during the off season, and I've been proven pretty much dead on target on the rare occasions that hard data has been released. Now, that may have dropped somewhat this year since CMS has cracked down on verifying SEP eligibility, but that's still an uknown. Every time someone selects a QHP via one of the ACA exchanges, the official 12.7 million tally for 2016 continues to go up.
At the same time, there has obviously been a lot of of attrition as people drop their policies throughout the year. The official effectuated enrollee number as of March 31st was down to 11.1 million people...a 13% drop from the 12.7 million who had selected QHPs as of the end of January.
Wellmark Blue Cross and Blue Shield announced Tuesday that it will narrow its choices for individual Affordable Care Act plans in Iowa and will eliminate ACA individual plans in South Dakota altogether in 2017.
First, some clarification: Wellmark isn't on the exchange to begin with, and wasn't planning on joining it in SD next year, so this is a rare case of a carrier dropping their off-exchange individual market offerings. Since all of Wellmark's indy enrollees in South Dakota are paying full price, this one can't be blamed on APTC enrollees being sicker than average, etc.
As for Iowa, it's more of a mixed bag...Wellmark is basically swapping out higher end PPO plans for lower end HMO, which is pretty much the trend everywhere:
Every month I post an entry about the official CMS Medicaid enrollment report, 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.
An important reminder from an anonymous tipster for any Illinois resident who was enrolled in a policy via the now-defunct "Land of Lincoln" Co-Op:
Hey hey. Just wanted to pass some info to you in case you can get it out there. As of last week (not sure the date - either the 15th or the week after) only 34% of LOLH members had taken advantage of the SEP. Spoke with legislators yesterday to get the word out, but since the deadline is Friday, we are trying to get the word out for people to get enrolled.
Yesterday I hobbled together the weighted average rate hikes (either requested or approved) for the ACA-compliant small group markets across 15 states. In 4 of these states, I hadn't yet tallied the weighted average, so I temporarily used the median increase for each. In the case of Pennsylvania, the range was from a 3.8% decrease to a 33% increase, with a midpoint of around 14.6%.
Today, however, I've actually plugged in the enrollment numbers for each sm. group carrier in Pennsylvania based on their 2017 rate request filings, and have come up with a weighted average of just 7.9%:
(sigh) I thought that last Friday was the deadline for carriers to decide whether they were in or out of the exchange for 2017, but between today's news out of Tennessee and now this, apparently that deadline only applies to those who will be participating in the 4th Open Enrollment Period:
IU Health Plans said Monday afternoon it had “restructured its product offerings for 2017” and no longer will be offering individual plans on the exchange. It said the change was necessary “to adapt to new market dynamics” as well as uncertainty created by withdrawals of several other insurers.
Things are looking pretty good for the ACA exchanges in states like Rhode Island, North Dakota and Massachusetts, where they're looking at single-digit rate hikes next year. However, they're looking pretty dire in states like Arizona, Montana and Oklahoma, where the average hikes are likely to be around 50% or higher for many people.
The HHS Dept. is very much aware that they have got to get more millennials enrolled in ACA-compliant individual healthcare policies this season; the exchange risk pool has been hovering at around 28% 18-34 year olds for three years running, when the conventional wisdom among those who know more about such things is that they need that number to be somewhere closer to 40% to stabilize the market.
Now, there's a lot of reasons why more young people aren't signing up, including affordability, which of course is the main reason HHS is trying to get more of them to sign up in the first place, creating a bit of a Catch-22. In addition the very "19-25 year olds allowed to stay on their parents plan" provision of the ACA is itself cannibalizing several million potential ACA exchange enrollees, creating some additional irony, since most of those "sub26ers" are presumably enrolled in the employer policies of their parents. Some of these reasons are completely outside of HHS's control
UPDATE 10/26/16: In light of yesterday's official confirmation by the HHS Dept. that my estimate of ~25% weighted avg unsubsidized rate hikes on the individual market was dead-on target, I thought it was important to pin this entry to the front of the website again.
Remember that big pie chart I posted last March which broke out the entire U.S. population by type of healthcare coverage? Well, here's a modified version, showing which people will and won't be impacted by the "25% average" figure being argued about today:
A few people have asked whether or not the "25% average hikes" I've estimated which have been cited by pretty much every outlet under the sun also apply to job-based coverage.
NO! Absolutely not!
That 25% weighted national average only applies to the roughly 18 million people enrolled in ACA-compliant individual policies...and even then, roughly half of those folks are mostly protected from the hikes thanks to the federal tax credits. So we're really talking about roughly 9 million people who have to pay the full 25% average increases.
When I decided to once again launch my Annual Rate Hike Estimate project this summer, I knew that this year, the rate increases for the individual market were likely to be significantly higher than in years past. Coming as they are in an election year, as a Democrat and ACA supporter, I obviously took no joy in reporting this truth.
However, a) The data is the data; it would be dishonest of me to try and ignore reality; and b) I knew that if I didn't report the rate increases as accurately as possible, Donald Trump and his Republican Party would flat-out lie about them.
Thanks to the heads up from Louise Norris, however, I now have hard numbers from the Maryland Dept. of Insurance. I was close, but the actual weighted average is slightly higher. In addition, they've provided the small group averages as well:
The Maryland Insurance Administration Approves Premium Rates for 2017 Small Group and Individual Markets
Open Enrollment Begins Nov. 1 in the individual market; Consumers Encouraged to Shop Rates
Today (Friday, Sept. 23) happens to be the deadline for insurance carriers to sign agreements with the federal government for participating in the exchange this Open Enrollment period (I'm not sure if today's deadline also applies to the state-based exchanges or not; they might be different). Until today, it looked as though there were going to be 3 carriers offering individual policies on the Nebraska exchange:
The figures compared 2016 and 2017 rates for Blue Cross Blue Shield of Nebraska, Aetna Health Inc. and Medica, the three companies that will offer policies to Nebraskans on the exchange when open enrollment starts Nov. 1.
However, as commenter M E noted, it looks like BCBSNE decided to wait until literally the last minute (last hour, anyway) to change their minds:
A couple of days ago, I noted that the latest development in House v. Burwell (the lawsuit brought by former Republican House Speaker John Boehner on behalf of the GOP caucus in the House of Representatives) could, in a worst-case scenario, end up resulting in millions of exchange-based policies being terminated with little notice. Basically, the HHS Dept. has included an "escape hatch" for exchange carriers in the event that the Supreme Court eventually rules in favor of the GOP House when it comes to Cost Sharing Reduction (CSR) financial assistance, although a final ruling wouldn't be likely to happen for at least another year or so.
Today, Michael Cannon of the Cato Institute has posted his own entry about the HvB "escape hatch" development, and while it obviously has an extremely anti-ACA spin, his conclusion is pretty much the same as mine (he assumes all 11 million enrollees would be kicked off their plans, while various state/federal laws could mean a much smaller percentage...but it would be pretty devastating no matter what).
Back in March, Bruce Japsen and Andrew Sprung noted that regardless of the financial woes many carriers are having on the individual market under the ACA, many of those same carriers are raking in big bucks in other divisions...particularly managed Medicare and Medicaid:
A snapshot of health insurers’ Medicaid windfall under the ACA could be seen in the earnings reports of Wellcare Health Plans (WCG) and Centene CNC +0.20% (CNC), which both beat Wall Street’s fourth quarter 2015 earnings expectations. These companies are an important measure of whether health insurers can find financial success providing Medicaid coverage to poor Americans under the health law President Obama signed six years ago even as the other key part of the legislation has growing pains.
Larger plans like Aetna AET +1.51% (AET), Anthem ANTM +1.31% (ANTM) and UnitedHealth Group UNH +1.08% (UNH) are also doing well in the Medicaid business, but their overall profit margins have been somewhat negatively impacted due to the private coverage on the exchanges.
For the two carriers that are expected to participate in the exchange in 2017, the proposed average rate hikes for 2017 are:
Blue Cross Blue Shield of North Carolina: 18.8 percent 24.3 percent (new rates were filed in late August)
Cigna: 7 percent (based on current off-exchange plans) 15 percent (new rates were filed)
Aetna had proposed an average rate increase of 24.5 percent, but that is no longer applicable for exchange enrollees, as Aetna’s plans will not be available in the North Carolina exchange in 2017.
First, it sounds like ConnectCare (the largest carrier on the CT exchange) is jumping on the "standardized plan" bandwagon, by offering what they call "Passage" exchange plans:
HMO-style, $5 co-pay for Primary Care Physician (PCP) visits (pre-deductible)
The Silver "Passage" plan would have a flat $50specialist co-pay
High-quality PC network included
Simple/easy to understand standardized plans
also offering "Passage" plans to small group / Medicare enrollees
--Standardized plans help but not enough; still lots of confusion about process, what's included/not included, etc; launching 4 retail "ConnectiCare Centers" to help people shop, enroll, member services, billing/payment issues, health/wellness assessments, education/outreach events
--CliniSanitas: Multicultural health delivery for hispanic/etc. members (3 centers; 100% bilingual services)
The final rate approvals for the Idaho indy market are either positive or negative, depending on your POV. On the one hand, the statewide weighted average is roughly 24%. On the other hand, this is 4 points lower than the 28% requested average from the carriers. As I noted in June, Idaho is among the only states which also posts exactly how much each carrier earned in premiums and paid out in claims for both last year and this year to date, giving some insight into which carriers are making a profit or taking a loss on the indy market:
Over at Investor's Business Daily, Jed Graham has crunched some IRS numbers to determine just how many people ended up paying the ACA's dreaded "Shared Responsibility" mandate penalty this year. It's a pretty negative piece, as you'd expect, but I'm mostly interested in the actual numbers, of course:
Yet the IRS Taxpayer Advocate Service included some preliminary statistics on 2016 ObamaCare mandate payments, officially called the Individual Shared Responsibility Payment, when it issued its below-the-radar annual tax season review on July 7. As of April 30, 5.6 million tax returns included mandate payments averaging $442 per return, compared with 6.6 million tax forms including average payments of $190 at the same point in 2015.
More recent data from the IRS wrapping the past tax year show that the final tally for 2015 ObamaCare Mandate fines included payments on 8.1 million tax returns averaging $210 for a total of $1.7 billion.
In addition to the ACA providing "APTC" tax credits to those who qualify, the ACA also provides "CSR" (Cost Sharing Reduction) assistance to those who a) are under 250% FPL and b) enroll in Silver exchange plans.
The CSR payments don't actually go directly to the enrollee; instead the insurance carriers cover the appropriate chunk of deductibles/co-pays, with the CSR funds going to reimburse the carriers.
Former House Speaker, Republican John Boehner, sued the HHS Dept. and the Obama administration over CSR appropriations, claiming that since Congress never specifically appropriated funding for CSR payments, it's illegal for the HHS Dept. to reimburse the carriers.
So far, the federal judge in the case has sided with the House Republicans, although the case is still winding it's way up the ladder, presumably to eventually end up at, yes...the Supreme Court of the United States (which has to be sick to death of being dragged into the middle of Obamacare yet again)
For the moment, the CSR assistance/reimbursements continue to flow...but if they were to be cut off, the insurance carriers would still be legally required to keep paying out CSR assistance, even though they wouldn't be reimbursed by the HHS Dept.
This would result in the carriers either a) filing potentially millions of lawsuits to get legally-mandated reimbursements for each individual CSR claim, which would clog up the courts, or, more likely, b) it would result in the carriers basically saying "screw this, I'm just gonna jack up rates by $1,000 a pop to cover my CSR losses".
However, due to a quirk in how the metal levels and CSR rules work, only Silver plans (the ones with CSR) would have their rates increase...meaning that Gold plans could end up costing less than Silver, which would just confuse the hell out of everyone.
Every once in awhile I remember what I actually do for a living (I'm a website developer, for those who don't know). That's actually a major reason I started this project in the first place...the techical meltdown of HealthCare.Gov and many of the state-based exchange sites in October 2013 fascinated me, leading me to start trying to assess just how many people were actually enrolling in the plans using the messy websites, and it spread from there.
Since then, of course, most of the exchange sites have been vastly improved. HealthCare.Gov is literally 100,000x better than it was in 2013 (while also now being considered among the most secure major consumer websites in the world), and has completely overhauled and streamlined their user interface and workflow process (cutting the number of screens for creating an account from around 80 down to 16). They've also added some nifty features like their Expected Total Cost, Network and Formulary tools.
Well, today the Colorado Dept. of Insurance released their approved rate hikes for both the individual and small group markets. Unfortunately, I don't see an actual carrier-by-carrier breakout, but they do provide weighted averages by other criteria such as metal level, on exchange vs. off exchange and so on:
While it would be nice to have the averages weighted by carrier, the on/off breakout is kind of interesting because it also lets me know what the relative numbers are between the two. For the individual market, note that the on exchange weighted average is 20.9% vs. the off-exchange's 19.9%.
Insuring people through Obamacare — which was crafted in part to cover people who can't get health insurance through their jobs — may be costing less money than if they had employer-based coverage, a new study suggests.
The study, by the Urban Institute, comes as premium rates for 2017 Obamacare plans are being finalized. Those premiums are expected to rise more sharply, on average, than in recent years.
But the report found that certain key Obamacare plans, on average, cost 10 percent less in premiums than average employer-based coverage, when adjusting for how much the plans cover for medical services, as well as for adjustments for health-care usage and age distribution.
Blue Cross Blue Shield of Texas will be the sole player in the ACA marketplace here, making Tarrant County the largest metro area in the state down to one participant.
Four of the previous insurers in the county — Aetna, Scott & White, Cigna and UnitedHealth — each confirmed they have pulled out of the ACA marketplace throughout the state.
According to my original estimates from back in May, Cigna only has around 19,000 people enrolled in individual market plans to begin with: 14,000 via Cigna Health & Life Insurance, 5,000 via Cigna Healthcare of Texas. However...
...Cigna also will continue to offer individual plans off the marketplace, according to spokesman Joe Mondy.
A week or so ago, the Washington Insurance Commissioner announced that the weighted average rate hike for 46 plans certified by the state insurance dept. regulators is 13.1%. However, there was a major caveat: There were another 52 plans which still had to be certified by the board. Without knowing the average rate hike for the other half of the plans, there's no way of knowing what the final approved average increase will be.
In addition, I also don't know what the relative market share of any of the plans (certified vs. uncertified) is, so there's no way of weighting the average across the full market. For all I know, 90% of enrollees might be among the first 46 (in which case any variances mong the other 52 plans would barely move the needle). Alternately, 90% could be among the missing 52 plans, or anywhere in between.
Maricopa County residents could have a new health insurer on the Affordable Care Act exchange next year, but it might not be the insurer that many local observers thought it would be.
Last month I noted (well, after Louise Norris called my attention to it) that after 2 years of restricting all individual market enrollments to their still-buggy ACA exchange, the state of Vermont actually reversed this policy for 2016 by allowing individuals to enroll in ACA-compliant policies directly through the carriers after all.
This actually goes against the recommendations I just wrote about yesterday, leaving the District of Columbia as the only other exchange to require all indy plans to run through it), but given how many technical problems Vermont seems to still be having with their platform, I can understand them allowing direct enrollment for the time being. I stand by my recommendation that every state should eventually move everything onto the exchange in the future, however.
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.
Earlier today, the U.S. Senate Committee on Homeland Security and Governmental Affairs (not sure why those two are lumped into a single committee, but whatever) held hearings on The State of Health Insurance Marketplaces.
In my latest piece for healthinsurance.org, I list seven reasons why other states should follow the District of Columbia's lead by requiring that all individual market healthcare policies be sold on the ACA exchange exclusively...along with, I also admit, three issues which would have to be dealt with in doing so.
Alexander Bill Would Extend Subsidies to Off-Exchange Plans
Sen. Lamar Alexander is introducing a bill Wednesday that would extend Affordable Care Act subsidies to plans off of the exchanges for some eligible consumers.
I don't usually post a whole lot about the small group market (other than occasionally trying to track how many SHOP enrollees there are by state and nationally), but this seems like pretty good news given how chaotic the individual market continues to be...
Covered California for Small Business Announces Rate Change and Expanded Coverage Choices for 2017
Statewide weighted average rate increase is less than 6 percent.
Blue Shield of California expands to Full PPO network statewide.
Kaiser Permanente moves into Santa Cruz County.
SACRAMENTO, Calif. — Covered California announced today the rates and expansion plans for its small group health insurance exchange, Covered California for Small Business. The statewide weighted average rate increase is 5.9 percent, for employers and their employees beginning Jan. 1, 2017, which is down from the 7.2 percent increase in 2016.
Lindeen Finds Blue Cross Rate Increases Unreasonable
HELENA – Montana Commissioner of Securities and Insurance Monica Lindeen announced today that following an extensive rate review process, her office has found the rates filed for health insurance in the individual and small-group marketplaces by Health Care Services Corp. (doing business as Blue Cross Blue Shield of Montana) to be unreasonable. This is the first time that such a finding has been issued.
Over the past week or so there was a lot of tense negotiations and confusion about whether or not ConnectiCare, the 2nd largest carrier on Connecticut's exchange and the largest in CT's individual market overall, would bail on participating on AccessHealthCT next year. They bumped up their rate hike request not once but twice, from 14.3% to 17.4% to 27.1%, and when state regulators stuck with 17.4% and refused to budge any higher, they threatened to file a lawsuit and drop out of the exchange. As of last Friday, it looked like they were indeed pulling out.
Days after declaring it would leave the state’s health insurance exchange, ConnectiCare has decided not to drop out of the marketplace, much to the relief of many — including Gov. Dannel P. Malloy.
Lots of stuff happening fast & furious these days as #OE4 approaches. Instead of individual posts, I'm gonna cram 7 state updates into a single one...and am also cheating a bit by cribbing off of excellent work by Louise Norris over at healthinsurance.org (which is fair, since she also gets some of her data from me as well):
ALABAMA: Here's what my requested rate hike table looked like for Alabama on August 1st:
As noted by Nicholas Bagley, Richard Mayhew and myself several times over the past year, Marco Rubio's Risk Corridor Massacre, which cut the ACA's risk corridor program off at the knees back in December 2014, has caused a tremendous amount of damage to the country in the form of helping kick 800,000 people off their healthcare policies, putting several hundred people out of work and could potentially cost taxpayers several billion dollars more than it would have cost if the program hadn't been interfered with in the first place...for no reason whatsoever. Rubio can't even argue that it was worth it for his own personal gain, since his stunt didn't even gain him the Republican Presidential nomination.
I know, the headline is clickbait, but hear me out; lemme play Devil's Advocate for a moment here.
Last week, when writing about Phoenix Health Plans becoming the latest carrier to drop out of the Arizona exchange, I noted that...
Ironically, this may prove to have a silver lining, according to one expert:
If Cigna decides to stick with the exchange marketplace, it will have access to a solid mix of healthy and unhealthy patients, said Jim Hammond, publisher of the Hertel Report.
"The first question is, will Cigna stay in," Hammond said. "If Cigna bails, then we have a real problem and the state and federal officials are going to have to figure out what to do about it. They've made this mandate and there's no way for people to actually meet the mandate."
Once an insurance carrier gets a decent mix of healthy and unhealthy patients, and targets the unhealthy patients with special programs, then it should be fine, he said.
I didn't really make a big thing out of it, but thought it was an interesting perspective.
The Massachusetts Health Connector has posted their latest monthly enrollment report (through the end of August), 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.
In light of Hillary Clinton's "half of Trump supporters belong in the racist/bigot basket" brouhaha, I figured since I'm known as a data/numbers guy, let's do some quick math:
Taking Clinton's "half" literally (which is of course unbelieveably silly), that's 50% of his supporters, or around 32.2 million registered voters.
32.2 million / 324 million = appx. 10% of the total U.S. population.
In other words, if you take Hillary Clinton's statement literally, she's effectively saying that 10% of the U.S. population is racist.
This is hardly a controversial statement.
If you turn that around, the real reason Trump supporters are getting all bent out of shape this morning (hey, I thought they hated it when people are too "PC"!) isn't so much that Hillary said that a lot of Trump supporters are racist...it's because she (effectively) said that pretty much all racists are Trump supporters.
The cost of health insurance plans offered under the Affordable Care Act will jump 20 percent or more next year under rates to be announced Friday by Maryland regulators.
His remarks came as the Maryland Insurance Administration approved double-digit rate increases for the four companies that sell health plans through the state exchange, an online marketplace set up under the law for people who cannot buy coverage through their employer.
...CareFirst, which holds 68 percent of the market, received an average hike of 31.4 percent on its PPO plan and 23.7 percent on its HMO — the highest increases of any insurer.
...Rates in Maryland also have been typically lower than those nationally under the Affordable Care Act, so there could be some normalizing going on, said John Holahan, a fellow in the Urban Institute's Health Policy Center.
"Maryland rates have been lower than the rest of the nation so it seems some catching up should be expected," said Holahan.
Over the past few days I've been doing some serious number-crunching in an attempt to break out the entire individual market between exchange-based, ACA-compliant off-exchange, grandfathered and transitional plans. For the most part, I believe most of my data is pretty close...but there's still some pieces of the puzzle missing here and there.
For New Jersey, my current numbers (as of March 2016) are:
When I first ran the numbers for New Mexico back in May, the average requested rate hike for the indy market appeared to be about 24.9%. Since then, however, there have been three major changes: First, Presbyterian Health Plan decided to drop off the exchange (although they'll still be around off-exchange). Second, it looks like CHRISTUS bumped up their request from 12.3% to 15.78%; and third, Molina Healthcare, which had been requesting a refreshingly modest 3.8% hike, resubmitted their request at a much higher 24% average increase.
Three of the 5 carriers had their final requests approved exactly as is by state regulators. CHRISTUS and Molina have yet to be approved, but based on a lengthy online conversation with someone very much in the know about the New Mexico health insurance market, I'm highly inclined to believe that both of their final asks will be approved as is as well.
The Washington Insurance Commissioner just issued the following press release. On the surface, it looks straightforward: 13.5% avg. requested, 13.1% approved. However, it's more complicated than that, because that 13.1% figure only applies to fewer than half of the plans (46 out of 98). The other 52 are still being reviewed:
OLYMPIA, Wash. – The Office of the Insurance Commissioner (OIC) has approved 46 individual health plans from seven insurers who will offer them in the Exchange, Wahealthplanfinder (www.wahealthplanfinder.org), for sale in 2017. The Washington Health Benefit Exchange Board is scheduled to certify the approved insurers and their plans at its board meeting later today.
Regence Blueshield also filed 21 plans for sale in the Exchange and Bridgespan filed 31 plans. Both companies’ filings and rates are still under review. They must be approved by the OIC before they can be considered for certification by the Exchange.
WARNING: This is a pretty long, wonky, number-crunchy post...if you want to skip to the point of it about 2/3 down, click here.
Yesterday I posted an extensive entry in which I reiterated, with a substantial amount of hard data (h/t to Bob Laszewski & Steve Davis) to back me up, that the off exchange individual health insurance market is consdierably larger than many pundits, reporters, politicians and policy wonks seem willing to admit; in fact, it appears to make up around 36% of the ACA-compliant indy market if you include grandfathered/transitional plans, or around 40% if you don't include them.
Arizona’s Pinal County Gains Health-Law Exchange Insurer
Blue Cross Blue Shield of Arizona will offer plans on the Affordable Care Act exchange in Arizona’s Pinal County next year, resolving a situation that drew a national spotlight because it represented a major challenge to the mechanics of the health law.
When Aetna Inc. announced last month that it would withdraw from the exchange in Arizona, among other states, it left Pinal at risk of becoming the first U.S. county without a single insurer selling exchange plans. Aetna had been expected to sell exchange plans in Pinal County, where approximately 10,000 people had signed up for ACA plans.
Given all the ugly ACA-related news over the past month or so (carriers dropping out of markets, average rate hikes going up significantly), it's important to remember the positive impact of the law as well...and today's early release of the latest National Health Interview Survey is very, very good news indeed:
Whenever Gallup releases their quarterly survey re. uninsured rates, I always make sure to note that as accurate as their methods may be in other ways, one major flaw of Gallup's methodology is that they don't include children under 18 whatsoever. This is no small gap, either, since a) children make up about 1/4 of the total population and b) children have historically had a significantly lower uninsured rate than adults (thanks, in no small part, to the Children's Health Insurance Program, spearheaded by Hillary Clinton, I might add). The NHIS, however, includes everyone...and breaks the data out in a whole mess of different ways. Here's what they have to say; note that all data from this survey was as of January - March 2016, so any changes since then (like, say, Louisiana expanding Medicaid to over 278,000 people) is not reflected in it yet):
In the first 3 months of 2016, 27.3 million (8.6%) persons of all ages were uninsured at the time of interview—1.3 million fewer persons than in 2015 and 21.3 million fewer persons than in 2010.
Huh. Back in June, when I first ran the requested rate hike numbers for Nebraska, it looked as though there were only two real carriers offering individual plans, either on or off the exchange: Blue Cross Blue Shield and Medica. UnitedHealthcare announced they were leaving NE along with a bunch of other states, and Coventry (aka Aetna) didn't have any filings for 2017, so I assumed they were bailing as well. Finally, the less time spent talking about "Enterprise/Freedom Life" the better. So...it looked like BCBS and Medica were it. Here's what the table looked like:
For 2 1/2 years, dating back to around February 2014, I've been trying to hammer home the importance of the OFF-exchange individual market. Time and time again I've been stunned at the seeming blind spot that people who should know better (such as Avik Roy) have regarding the millions of people who are enrolled in fully ACA-compliant policies, but are doing so directly through the carriers themselves. There are a few reasons why people buying individual/family policies would do this, but the most obvious one is simple: If you earn more than 400% of the Federal Poverty Level (around 97,000/year for a family of 4), there's no reason to jump through the extra hoops of enrolling through HealthCare.Gov or the other various ACA exchanges...because you don't qualify for federal financial assistance anyway. For whatever reason, however, numerous reporters, pundits and even the HHS Dept. itself keep acting as though this market doesn't exist.
The Connecticut average requested rate hike has jumped around a lot over the summer. It started out at roughly 21.3% back in June, then increased to 22.2% after the HealthyCT Co-Op announced they were closing up shop. Then, several of the carriers submitted revised rate hike requests, bumping the average up further to around 26.8%.
Well, over the holiday weekend, the CT Mirror reports that the CT Dept. of Insurance released their response to the requests. There were also yet more last-minute filing changes. I've updated the spreadsheet with both the final requests as well as the approvals...but there are a copule of major blank spaces I still have to fill in:
Most Connecticut health insurance plans sold through individual and small group markets will undergo steep rate hikes next year, although in some cases, the prices will not go up by as much as carriers had sought.
When I last crunched the numbers for the 2017 individual market in Arizona, the average requested rate hike statewide was a whopping 68%. However, that was before Aetna dropped their bombshell about dropping out of the exchanges in 11 states (AZ included), leaving about 6,400 residents receiving ACA tax credits in Pinal County with no subsidized policy options whatsoever.
Since Aetna had intended on requesting a jaw-dropping 85.8% average rate hike if they had stuck around, this technically meant that the average requested hike for the other carriers would have dropped somewhat, although this would be limited by Aetna only having about 7% of the individual market in the state.
Since then there have been two major changes: First, Aetna, which had been planning on entering the Maine ACA exchange, infamously pulled a complete 180 and not only decided not to expand, but actually pulled out of the exchange in most of the states they're already in. This doesn't really impact Maine since they were only available off-exchange anyway. The second change does, however: Several of the carriers submitted revised requests, pushing the average up higher, to 23.9%.
Community Health Options, a Lewiston-based health insurance cooperative, has gotten approval to withdraw from the New Hampshire insurance market in 2017.
The plan was approved this week by the Maine Bureau of Insurance, which has been monitoring CHO’s finances as it tries to recover from a $31 million loss in 2015. The nonprofit cooperative has set aside more than $45 million in reserves to try to avoid another big loss this year.
I appear to have something of a semi-exclusive here, if only because the Florida DOI isn't formally posting these documents on their website until tomorrow due ot the holiday weekend:
Office Announces 2017 PPACA Individual Market Health Insurance Plan Rates to Increase 19% on Average
TALLAHASSEE, Fla. – The Florida Office of Insurance Regulation announced today that premiums for Florida individual major medical plans in compliance with the federal Patient Protection & Affordable Care Act (PPACA) will increase an average of 19% beginning January 1, 2017. Per federal guidelines, a total of 15 health insurance companies submitted rate filings for the Office’s review in May. These rate filings consisted of individual major medical plans to be sold both on and off the Exchange. Following the Office’s rate filing review, the average approved rate changes on the Exchange range from a low of -6% to a high of 65%. This information can be located in the attached “Individual PPACA Market Monthly Premiums for Plan Year 2017*” document.
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. I sort of forgot to post about the reports for awhile, but checked back in again for the May report, released back in July.
