Vice President Pence said Thursday that Republicans plan to give another try to repealing and replacing ObamaCare if they do well enough in November’s elections.
Pence made the remarks to reporters while in Wisconsin to campaign for GOP Senate candidate Leah Vukmir, saying that if she wins, it would help Republicans with their goal of eventually repealing the health-care law.
“We made an effort to fully repeal and replace ObamaCare and we'll continue, with Leah Vukmir in the Senate, we'll continue to go back to that,” Pence told reporters.
Back in April, I started an ambitious project which set out to track every legislative or regulatory measure taken by every state to counter, cancel out or mitigate sabotage of the Affordable Care Act by the Trump Administration and Congressional Republicans. It resulted in this color-coded spreadsheet, which lists dozens of bills, proposals, amendments and so on at various stages of completion.
The bad news is that project has proven to be too large for me to keep up with--there's simply too many bills, too many stages and too much other stuff going on for me to keep track of it all.
Last year, Virginia residents experienced massive amounts of heartburn and ulcers as two major insurance carriers, Optima (Sentara Health) and Anthem (HealthKeepers) played musical chairs with both their 2018 rate filings and which areas of the state they offered plans on.
In May 2017, things didn't look too bad: Both Anthem and Optima were available in fairly large chunks of the state, and while Anthem wanted to raise rates an ugly 38% on average, Optima was only looking to increase rates by around 10-11%.
DOI Completes Review of Individual and Small-Group Health Insurance Rate Filings
The Kentucky Department of Insurance (DOI) announced today that it has completed its review of the individual and small-group insurance rates filed in the Kentucky market. The rates will be used to calculate insurance premiums in the 2019 benefit year.
Kentuckians in the individual market will once again experience changes in premiums and plan offerings. The rates that will be used reflect an average rate increase of 4.3 percent for Anthem Health Plans of Kentucky (Anthem) and 19.4 percent for CareSource. Since the actual premium charged will vary by individual and the plan level selected, some individuals may see a decrease in rates.
The judge overseeing the high-profile case over the constitutionality of the Affordable Care Act, which could potentially land at the Supreme Court, is slated to attend a Federalist Society event featuring Supreme Court Justice Clarence Thomas -- and several members of the federal circuit court of appeals that would review the case before it landed at the high court. A key ethic professor suggests the Texas' judge's appearance at the event does not cross any lines.
Judge Reed O'Connor is also slated to monitor a panel entitled “Trump, Sessions and the States,” during the Texas Chapter meeting on Sept. 8, just days after the Sept. 5 arguments in the federal Texas court are scheduled.
Inside Health Policy asked ethics experts whether O'Connor's appearance pushed the envelope on judicial ethics, and those that responded generally suggested his appearance at the event is not an issue.
A Lancaster County District judge has dismissed a challenge to the Medicaid expansion petition initiative, allowing the initiative to be placed on the November ballot.
The lawsuit was brought by former state Sen. Mark Christensen and Sen. Lydia Brasch. They alleged the initiative was an unconstitutional delegation of legislative authority, contained more than one subject, which the state Constitution prohibits, and that it failed to identify Nebraska Appleseed as a sworn sponsor.
Last week, Secretary of State John Gale confirmed that enough signatures were gathered by petition circulators to put the question of whether to expand Medicaid to about 90,000 uninsured adult Nebraskans on the Nov. 6 ballot.
...The campaign has said Medicaid expansion will create and sustain 10,000 new jobs, reduce medical bankruptcies, bring $1.1 billion of Nebraskans’ tax dollars back from Washington, D.C., and produce savings by reducing uncompensated care for those who lack health coverage.
This just in from the Florida Office of Insurance Regulation...
OIR Announces 2019 PPACA Individual Market Health Insurance Plan Rates
TALLAHASSEE, Fla. – The Florida Office of Insurance Regulation (OIR) 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 5.2 percent beginning January 1, 2019. Per federal guidelines, a total of nine health insurance companies submitted rate filings for OIR’s review in June with final rate determinations due by August 22, 2018.
Following OIR’s rate filing review, the average approved rate changes on the Exchange range from a low of -1.5 percent to a high of 9.8 percent. This information can be located in the Individual PPACA Market Monthly Premiums for Plan Year 2019 document available here.
With the deadline for submitting 2019 rate filings having passed a week or so ago, the approved rates from the various state insurance regulators have been popping up left and right. Today I took a look at the Arkansas Insurance Dept. website and sure enough, they've posted the approved filings for all 4 carriers on the individual market (as well as the small group market).
On the one hand, the statewide average rate increase hasn't changed much from the preliminary average; it dropped 0.4 points from 4.5% to 4.1%...and some of that change is simply because I had misestimated the actual enrollment/market share for a couple of the carriers.
On the other hand, in Arkansas, at least, it appears that the carriers don't think the repeal of the individual mandate and/or the Trump Administration's expansion of short-term and association health plans will have nearly as big of an adverse selection impact as other estimates/projections have...including my own.
Ensure that young adults can continue to remain on their parents’ health insurance plans until age 26
Prohibit insurers from using applicants’ gender to set premiums
Prohibit insurers from rejecting an application based on an applicant’s medical history, or imposing coverage exclusions based on pre-existing conditions.
Today, however, there were major developments regarding #ShortAssPlan restrictions (and a few other important patient protection bills) in three states: Two positive, one negative.
Many of the findings were things which I had been either predicting or documenting all year:
Enrollment through Healthcare.gov Was 5 Percent Lower in 2018 than 2017
Stakeholders Reported That Plan Affordability Likely Played a Major Role in Enrollment
HHS Reduced Consumer Outreach for 2018 and Used Problematic Data to Allocate Navigator Funding
HHS Did Not Set Numeric Enrollment Targets for 2018, and Instead Focused on Enhancing Certain Aspects of Consumers’ Experiences
We identified a list of factors that may have affected 2018 healthcare.gov enrollment based on a review of Department of Health and Human Services information, interviews with health policy experts, and review of recent publications by these experts related to 2018 exchange enrollment.
With the idiotic #TexasFoldEm lawsuit coming up for oral arguments in just two weeks and the midterms in just ten, Senate Republicans appear to be in a bit of a panic over how to deal with the massive negative fallout if they win their court case (technically it was brought by 20 GOP attorneys general, not the Senators themselves, but they've spent the past 8 years trying to accomplish the same goal).
As a quick reminder: The #TexasFoldEm case uses the World's Flimsiest Excuse to try and eliminate the Affordable Care Act's critical health insurance coverage protections for the 130 million Americans who have pre-existing conditions.
In response, Republican Senators Tillis, Alexander, Grassley, Ernst, Murkowski, Cassidy, Wicker, Graham, Heller and Barrasso have introduced a new bill which they claim would ensure pre-existing coverage protections. Unfortunately, it...doesn't.
Busy day today! State insurance regulators around the country appear to have decided to start posting approved 2019 ACA rate filings all at once; within the past week, Vermont, Ohio, Delaware and North Carolina have posted theirs...and now you can add Georgia to the list:
The Obamacare rates for next year are in, and it’s a first: Rates are going down.
Following years of steep price hikes, two of the four companies that offer plans on the Affordable Care Act exchange in Georgia, also known as Obamacare, have proposed to lower their rates next year from what they charged in 2018.
According to figures for the individual insurance market released Thursday by the state Department of Insurance, Blue Cross Blue Shield of Georgia is proposing a tiny decrease in premiums for next year, with 2019 premium prices that are on average 0.3 percent lower than 2018’s premiums. Alliant Health Plans is decreasing its premiums by 10 percent.
North Carolina has three insurance carriers offering individual market policies next year: Blue Cross Blue Shield, which holds a whopping 96% of the individual market; Cigna, which holds the remaining 4%, and newcomer Ambetter (aka Centene).
BLUE CROSS NC FILES TO LOWER ACA RATES BY AVERAGE OF 4.1 PERCENT
Durham, N.C. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced today it requested an overall average rate decrease of 4.1 percent for 2019 Affordable Care Act (ACA) plans offered to individuals. The reduction marks the first rate decrease in the history of Blue Cross NC since entering the current individual market more than 25 years ago.
...Many factors went into the Blue Cross NC’s rate filing:
It's been a year and a half since my last exclusive piece for healthinsurance.org, but I'm back, baby!
In my latest story for them, I explain that while the "ACA Sabotage!" card which Democrats have been playing against the GOP all year is very much real, it's also harder to explain to people in light of seemingly modest premium rate changes for 2019.
To understand both the reality and the difficulty in conveying it, read on!
As I noted back in June, the Ohio Insurance Dept. doesn't seem to like providing a whole lot of detail about their insurance rate filings on their website; at the time, they only stated the following regarding the preliminary 2019 individual market rate filings:
In 2018, 8 companies sold health insurance products on the exchange in Ohio and 42 counties had just one insurer with an additional 20 counties having only two.
For 2019, 10 companies have filed rates and forms for the Department to review and all 88 counties will have at least one insurer. Preliminary filings show 16 counties with just one insurer and 33 counties with two.
CMS Administrator Seema Verma is difficult to get a read on. On the one hand, she glories in trashing the ACA every chance she gets while happily endorsing nearly every effort to undermine or sabotage it, including repeal of the individual mandate, slashing the marketing and outreach budgets and so forth. Last year she was even busted trying to (effectively) blackmail the insurance carriers at large by offering to push through CSR reimbursement payment in return for them supporting the GOP's Obamacare repeal bill.
Supreme Court nominee Brett Kavanaugh's Senate confirmation hearings will start on Sept. 4 and last between three and four days, Judiciary Chairman Chuck Grassley (R-Iowa) announced on Friday.
That scheduling tees up the GOP to meet its goal of getting President Donald Trump's pick seated on the high court by the time its term begins in early October, barring unforeseen obstacles or a breakthrough by Democrats who are pushing to derail Kavanaugh's confirmation.
The Supreme Court battle so far has focused on documents related to Kavanaugh's five years in the George W. Bush White House. Democrats have excoriated the GOP for declining to seek records from the nominee's time as Bush's staff secretary and condemned the Republican decision to rely on a Bush-driven review process for the early round of vetting, while the majority party hails the vast scope of documents that are set for release.
I read with great interest your Op-Ed piece in yesterday's Washington Post extolling the virtues of "Short-Term, Limited Duration" plans and how awesome it is that the Trump Administration is hoping to flood the individual health insurance market with them. I figured you might appreciate a bit of fact-checking.
Obamacare forgot about you. But Trump didn’t.
For all the discussion of Obamacare since its passage, it is too rarely known that the law effectively split the United States’ individual insurance market in two.
Yes and no. What split the market in two was the fact that premiums have increased faster than expected. Those earning more than 400% of the Federal Poverty Level (FPL)--around $48,000/year for a single adult or $98,000/year for a family of four--don't qualify for financial assistance and have to pay full price.
Note: Much of this entry is a repeat of yesterday's, but I felt it was worth a separate entry.
This metaphor will take a bit, but bear with me.
On March 16, 1981, CBS aired the 17th episode of Season 9 of M*A*S*H. For those of you too young to remember, M*A*S*H, set at a U.S. Army medical camp in Korea during the Korean War, was one of the most successful TV shows in history, running 11 seasons. I believe the series finale remains the most highly-viewed broadcast in history. While M*A*S*H started out primarily as a sitcom, it evolved over the years into more of a drama with comedic moments.
Anyway, in S9 Ep17, "Bless You, Hawkeye", the main character, Dr. Benjamin Franklin "Hawkeye" Pierce (played by Alan Alda) finds himself stricken with a sudden, unexplained and violent allergic reaction to something. He spends much of the episode trying standard medical solutions, but his fits of sneezing and coughing become so bad that eventually a recurring character, psychiatrist Dr. Sydney Freedman, is brought in to see if there might be a psychological cause.
Vermont's situation is unusual compared to most other states for a couple of reasons. First of all, VT is one of only two states (Massachusetts is the other one) which has merged their Individual and Small Group market risk pools into one to help stabilize both markets. This is something I wish every state would do, frankly, although it's probably a lot easier to do in deep blue states (and Vermont having such a small population probably made it easier as well).
A few weeks ago, I posted about New Jersey's preliminary 2019 ACA-compliant individual market rate filings. At the time, the official New Jersey Dept. of Banking & Insurance specifically stated that:
Because Congressional Republicans repealed the ACA's Individual Mandate Penalty, carriers were planning on increasing 2019 premiums by 12.6% on average, in part to account for the adverse selection which was expected to happen next year.
However, thanks to the Democratically-controlled New Jersey state legislature and Governor swiftly reinstating the ACA individual mandate, actual 2019 rate filings are only expected to increase rates an average of 5.8%, saving the average unsubsidized indy market enrollee around $470 apiece next year.
Finally, the NJ legislature also passed, and Governor Murphy signed into law, a robust reinsurance bill which, if approved by CMS, is expected to lower unsubsidized 2019 premiums by an additional 15 percentage points, for a final 2019 average premium reduction of around 9.2%.
It's also important to understand that New Jersey's portion of the funding for the proposed reinsurance program will be coming from the revenue generated by the reinstated mandate penalty itself.
(Note: I uploaded Livengood's video clip to YouTube because it's the only way I could embed it within the blog post)
VIDEO: Today, I attempted to pin down @SchuetteOnDuty today on whether he will keep @onetoughnerd’s expanded Medicaid program intact if he’s elected governor.
I think I’ll try again next week... pic.twitter.com/hu6ejM2vpt
Livengood: "Attorney General, if you're elected governor, are you gonna keep the Medicaid program that the governor's established, the Healthy Michigan plan?"
The Department of Health and Human Services is urging states to cooperate with the federal government, but instead, insurance commissioners are panning the new plans as "junk” insurance and state legislatures are putting restrictions on their sales.
State insurance officials argue that, despite being less expensive than ObamaCare plans, the short-term plans are bad for consumers and aren't an adequate substitute for comprehensive insurance.
“These policies are substandard, don’t cover essential health benefits, and consumers at a minimum don’t understand [what they’re buying], and at worse are misled,” California Insurance Commissioner Dave Jones (D) said.
Hot on the heels of Anthem's announcement that they're significantly expanding their ACA market coverage throughout Virginia comes another piece of welcome news:
Gov. Ralph Northam’s administration will convene a new work group on Monday to consider options to stabilize soaring premiums in Virginia’s health insurance market.
The Virginia Market Stability Group will consider a wide range of options to lower insurance premiums expected to average more than $833 a month next year, making coverage unaffordable to people who don’t qualify for federal subsidies for premiums or out-of-pocket expenses in the marketplace established by the Affordable Care Act.
...But one option could trump all others — a state budget plan to request a federal waiver for a “re-insurance” program in Virginia that would help defray the costs for the most expensive patients and relieve the expense for others by lowering the risk.
From the moment he took office, President Trump has used all aspects of his executive power to sabotage the Affordable Care Act. He has issued executive orders, directed agencies to come up with new rules and used the public platform of the presidency in a blatant attempt to undermine the law. Indeed, he has repeatedly bragged about doing so, making statements like, “Essentially, we are getting rid of Obamacare.”
Oral arguments have been scheduled for Sept. 10 in a Texas lawsuit seeking to strike down Obamacare as unconstitutional.
The case was filed in February by 20 Republican state attorneys general. They’re seeking a preliminary injunction halting enforcement of the federal health care law.
The Trump administration has partly sided with the plaintiffs in seeking to strike down the Affordable Care Act’s insurance protections, including the prohibition on denying coverage to individuals with pre-existing medical conditions.
Back in the early 1990's, Bill and Hillary Clinton attempted an ambitious overhaul of the entire U.S. healthcare coverage system. Hillary was put in charge of the effort.
The backlash from the health insurance lobby was swift and furious, most infamously encapsulated in the form of the "Harry & Louise" attack ads, two of which I've posted above.
SIDENOTE: There's a lot going on here, especially in the 2nd ad:
The good news was that average unsubsidized 2019 ACA individual market premiums were expected to drop by about 5.7% after years of double-digit rate hikes.
The bad news was that due specifically to various types of deliberate sabotage by the Trump Administration and Congressional Republicans (primarily repeal of the individual mandate and expansion of #ShortAssPlans), that 5.7% drop was still a good 12 points or so higher than it otherwise would have been.
The ugly news was that due specifically to the Trump Administration's utterly unnecessary decision to freeze Risk Adjustment fund transfers in response to a lawsuit out of New Mexico, 2019 premiums would be hundreds of dollars higher still than they should have been for Blue Cross Blue Shield of Tennessee's 113,000 enrollees:
UPDATE: As noted in the comments below, it looks like Anthem won't be expanding to cover the entire state after all. Even so, this is a major improvement in the situation.
Every year, Virginia is the first state out of the gate with their preliminary healthcare premium rate changes for the following year, posting the initial rate requests in early May. For 2019, it originally looked like the carriers were asking for a statewide average increase of 15.2%, but I later corrected this to 13.4%.
However, these were just preliminary numbers. The requests still have to go through the rate review process, and the carriers often make other changes as well before the final deadlines pass.
As regular readers know, each year I analyze hundreds of insurance carrier rate filings for the following year, then crunch the numbers to get an estimate of how much average premiums will increase (or in a few cases, decrease!) statewide.
As they also know, last year and again this year I've expanded on this by breaking out the portion of the annual rate increase which can be tied directly to sabotage efforts by the Trump Administration and Congressional Republicans. For 2018, this boiled down to roughly 17 points of the total nationwide increase being sabotage-related. It varied greatly by state, carrier and plan, but nationally, I estimated that without last year's ACA sabotage efforts, average premiums would have gone up around 11% instead of around 28%.
Annnnnnnnd finally, the least-populated state of them all...which also happens to be suffering from the highest average monthly premiums for unsubsidized individual market enrollees: Wyoming.
There's only a single carrier in the Equality State (seriously...that's their motto; who knew?), Blue Cross Blue Shield. They're actually looking to lower rates by just a smidge (0.25% on average).
Assuming just 2/3 of that to play it safe, that still means that unsubsidized enrollees would have been looking at roughly a 12% drop in their 2019 premiums without those measures...a difference of over $120/month, or a whopping $1,400 more apiece next year. Ouch.
The most noteworthy thing about West Virginia's 2019 filings that I can see is that CareSource is expanding their state coverage from 10 counties to 35 counties, and the confirmation that West Virginia will remain one of the few states sticking with a Broad Load CSR strategy for reasons unknown next year (the state insurance commissioner might change their tune, however, now that CMS has done a complete 180 degree turn and has officially come out in favor of Silver Switching).
In any event, the statewide average premium hike appears to be around 14.9%...but once again, much of this is due to the ACA's individual mandate being repealed and Trump opening the floodgates on #ShortAssPlans.
At $843/month, West Virginia has one of the highest average monthly premiums in the country...and instead of only going up nominally next year, thanks to #ACASabotage, unsubsidized enrollees will likely have to pay a whopping $1,300 more apiece next year.
Utah has four carriers offering ACA-compliant individual market plans. Two of them (BridgeSpan and Regence BCBS) only offered their policies off-exchange this year; I'm not sure what the status is for either one in 2019. I can only find hard enrollment data for one of the four (Regence), so I'm estimating the other three based on a combination of last year's numbers and the total estimated individual market size in Utah from 2017. Because of this, consider the Utah estimates to be even rougher than some other states.
Having said that, there's one interesting extra sabotage factor to consider for the University of Utah rate filing: They note that they've added an extra 10.3% to their 2019 rates specifically tied to last year's Cost Sharing Reduction (CSR) cut-off. I presume they chose not to bake the CSR load into their rates this year, but I don't think Utah went the "mixed load" route so who knows?
In any event, as far as I can tell, this means around a 14-point #ACASabotage factor, between CSR load, mandate repeal and #ShortAssPlans.
South Dakota has two ACA indy market carriers, Avera and Sanford. The relative enrollment market shares are based on last year's numbers. The 14.4% #ACASabotage impact assumes 2/3 of the Urban Institute's projections to err on the side of caution.
THe average unsubsidized SD indy market enrollee pays $624/month this year; instead of that dropping by around $68/month, it's expected to increase by $22...for a total monthly difference of $90.
Assuming that's accurate, this means unsubsidized SD residents will be paying over $1,000 more apiece next year than they'd otherwise have to.
The only confusing thing about South Carolina's 2019 rate filings is that I'm not sure whether the "BlueChoice Health Plan" should be rolled in with the main Blue Cross Blue Shield of SC population. Carriers often have multiple listings in the same state for different policy lines, but they're generally listed under the same official corporate name. In this case, "BlueChoice" (which is clearly still part of BCBS) has a completely seaparate listing.
The BCBS filing clearly states the number of enrollees as around 203,000 people. The BlueChoice listing doesn't give a membership number, but appears to be roughly 6,800 people based on the full premium dollars they received in all of 2017 ($53.5 million divided by 12 months, divided by the statewide average of $654/month this year). This doesn't really make much difference, however, since BCBS still holds nearly 99% of the market anyway.
Assuming an 11.5% #ACASabotage factor (mandate repeal + shortassplans), this translates into unsubsidized enrollees having to pay an extra $900 than they'd otherwise have to (a 9.2% rate increase instead of a 2.3% rate drop).
Oklahoma is pretty clear cut: BCBSOK holds nearly all of the ACA-compliant market share, with CommunityCare HMO having a small number of off-exchange enrollees (the numbers are estimates based on last year's figures).
The Urban Institute projected an 18.4% rate increase due to #MandateRepeal and #ShortAssPlans. BCBSOK doesn't go into specifics about the impact, but does list both of these as significant factors. Knocking 1/3 off this projection gives around 12.4%.
Unsubsidized Oklahoma enrollees are paying an average of $694/month in 2018. Without ACA sabotage, they'd likely see this drop to around $595; instead, they're likely looking at paying roughly $681/month, or an additional $1,033 apiece.
In direct response to this, Medica Health Plans dropped out of the ND on-exchange individual market this year to avoid taking the CSR hit. They hung around the off-exchange market, however, and therefore still have about 600 enrollees in the state.
New Hampshire is perhaps the most striking example of both insurance carriers significantly overshooting the mark for 2018 premiums while also proving my point that just because premiums are dropping next year, #ACASabotage is still causing unsubsidized enrollees to pay a lot more than they'd have to otherwise.
All three of the carriers offering ACA policies on New Hampshire's individual market are reducing their 2019 premiums, by anywhere from 7.4% for Harvard Pilgrim to a whopping 15.2% in the case of Ambetter/Celtic.
THe enrollee market share numbers come from the monthly report from the New Hampshire insurance department (I'd love it if every state required one of these...it includes both on and off-exchange enrollees). The "PAP" column refers to NH residents enrolled in their "private option" Medicaid expansion program...but those are still part of the same risk pool as the other enrollees, so they still have to be factored into the market share formula.
Nebraska is about as simple as it gets--there's only one carrier offering ACA individual market plans. Unfortunately, they've redacted the combined average rate change request between their two plan entries, so all I can do is split the difference and assume around a 1% average increase.
The Urban Institute projected that Nebraska rates would see a whopping 20.4 percentage point increase due to #MandateRepeal and #ShortAssPlans, which are both referenced in Medica's filing. Since they don't get more specific than that, I'm assuming 2/3 of Urban's estimate, or a 13.6% increase.
Unsubsidized Nebraska enrollees are currently paying an average of $854/month, so if accurate, that's a difference of around $116/month or nearly $1,400 for the year. Ouch.
Mississippi is pretty easy: Only two carriers. I have no idea what their relative market share is (the enrollment data along with a lot of other stuff is redacted in their filings), but in this case it really doesn't matter because both of the carriers are requesting nearly identical rate changes anyway...which is to say, just about no change whatsoever.
The Urban Institute projected that #MandateRepeal and #ShortAssPlans would add a 17.2 percentage point rate hike factor in Mississippi. I generally knock 1/3 off of their estimates to err on the side of caution (11.4%), but given Ambetter specifically stating that they didn't add any increase to account for #ShortAssPlans (why?? interesting!), I'm shaving off a bit more and assuming a flat 10% impact.
This means that unsubsidized Mississippi enrollees would likely have saved a good $800 apiece next year without Trump/GOP efforts to undermine the ACA this year.
NOTE: The good news is that I don't have to worry about any sabotage impact for Massachusetts in 2019 (thanks to the state still having their pre-ACA individual mandate penalty in place and banning #ShortAssPlans outright). This obviously makes that part of my analysis very easy--I can just enter "0%" across the board in the "2018 sabotage factor" columns.
The bad news is that determining the market share for each carrier in Massachusetts is a royal pain in the ass. only two of the twelve carriers offering individual market plans actually state what their enrollment numbers are, and this is further confused by the fact that several of them (Fallon, Harvard Pilgrim and Tufts) have two or three different listings for different divisions of the company.
In addition, Massachusetts is one of just two states where the individual and small group market risk pools are merged, making it even more difficult to separate out the two for market share purposes.
Kansas is pretty frustrating. There's only three carriers offering ACA individual market policies, but two of the three have heavily redacted actuarial memos, so I don't know what their market share is...and the same two were new (or "semi-new") to the exchange this year so I can't even use last year's effectuated enrollment as a guideline. In light of that, I had to split the estimate right down the middle to get an estimated overall market share.
In addition, Medica is the only one of the three to specifally mention mandate repeal and/or #ShortAssPlans as a contributing factor; that's also redacted in the filings for the other two. Therefore, instead of assuming 2/3 of the Urban Institute's sabotage projection, I'm being extra-cautious and assuming just half (9.6% instead of 19.2%). This gives a rough statewide average increase of around 6.1%, which would likely be closer to a 3.5% premium reduction without mandate repeal and short-term plan expansion.
Illinois has the same four ACA indy market carriers participating next year as they do this year. All four rate filings specificlaly call out Mandate Repeal and #ShortAssPlans as significant factors in their rate requests, but none of them break out the actual amount, so I'm relying on my standard assumption of 2/3 of the Urban Institute's projections.
In Illinois' case, that's 2/3 of 19.4%, or around a 12.9% #ACASabotage premium increase for unsubsidized enrollees.
I should also note that only one of the four carriers (Health Alliance) specifies just how many enrollees they have; for the other three I'm basing my estimates on last year's numbers for now. The two carriers with what I assume are still the largest market share (BCBS and Celtic) are basically keeping rates flat year over year, while the other two are 7.5% and 10% apiece, for an average rate increase of just 0.7% statewide.
Unsubsidized Illinois residents are currently paying $644/month on average, so a 12.9% sabotage effect means that each of them will have to pay nearly $1,000 extra next year. Ouch.
Gov. Cuomo just announced that he has directed Supt. Vullo to reject any individual market rate increase that included an increase to compensate for the repeal of the individual mandate
...Assuming that nothing else changes during the rate review process, this makes carriers that didn't associate a % of their rate request with the loss of the mandate big winners...and those who did, not so much.
Azar Says He Is Not Aware Of Discussions On Blocking ‘Silver-Loading’ in 2019
HHS Secretary Alex Azar said that he has not been involved in discussions about blocking ‘silver-loading’ plans in 2019 and is not aware of any agency discussions about ending the practice at the moment.
...In recent weeks, some stakeholders have speculated that the Trump administration could block silver-loading in 2019. Several pro-ACA experts say that even though the administration may have authority to stop silver-loading, it would be a self-destructive move, especially leading up to the November midterm elections.
CMS Administrator Seema Verma told reporters on Thursday (March 22) that she was “very concerned” about certain aspects of ‘silver loading’ plans, namely that it raises costs for unsubsidized consumers and the federal government. Verma did not commit to allowing or blocking the process for the 2019 plan year.
Idaho's insurance department website displays their annual rate filing summaries in a unique way--they don't publish the actual enrollment numbers, but they do post breakouts of the rate hikes for different metal levels (handy!) as well as the premiums brought in and claims paid out, which gives some refreshing insight into just how profitable (or not) some fo the carriers are (if I'm reading the screenshot correctly, it looks to me like BCBS and Mountain Health did just fine last year, but the other three carriers ended up in the hole (especially SelectHealth...ouch).
The state website also claims the overall weighted averge rate increase being requested in 8% even though my own spreadsheet brings it in at 9.4%. This could be due to my misestimating SelectHealth's enrollment number, or it could be because Regence Blue Shield cays they're raising rates 3.9% but the state claims it's 7% (although that should actually result in a higher average from the state, not lower...)
Delaware is pretty cut & dried: There's only one carrier, Highmark, offering ACA policies in the state. They're requesting a 13.0% average rate increase for 2019, and yes, they call out both the individual mandate being repealed and #ShortAssPlans being expanded by Trump and the GOP.
Unfortunately, they've redacted the specific percentages caused by those factors. The Urban Institute pegs it at 19.9%, but I err on the side of caution and only assume 2/3 of that amount, or right around...13%. If accurate, that means Highmark BCBSD would be keeping rates pretty much flat next year if those changes hadn't been made.
Arkansas has three carriers offering ACA individual market policies, but one of them is kind of/sort of split into two separate entities (QualChoice and QCA). Unfortunately, most of the key actuarial memo content has been redacted, so I'm missing data on market share for three of the four entries--Ambetter/Celtic is the only one which states outright their current enrollment number. For the other three I had to estimate based on last years data. For QCA and USAble (which is actually Blue Cross Blue Shield, for some reason), I had to sort of split the difference between the different entries to get the overall requested rate increases.
In terms of #MandateRepeal & #ShortAssPlans, the Urban Institute projected an 18.8 percentage point impact. 2/3 of that is 12.5%, so I'm estimating that without those factors, average unsubsidized Arkansas rates would be dropping by around 8% next year.
Arizona has only three carriers offering individual market policies next year. Blue Cross Blue Shield of AZ has nearly 40,000 enrollees and is keeping rates virtually flat, but specifically states that yes, they baked in extra costs to account for Congressional Republicans repealing the ACA's Individual Mandate and due to Trump's expansion of #ShortAssPlans (see screenshot below).
Centene is dropping rates by over 5 points. I don't know their exact enrollment/market share, so I'm forced to assume it's similar to last year's 95,000. Again, they call out both #MandateRepeal and #ShortAssPlans, but don't include a specific percentage for either (they did, but it was redacted in the public filing).
Finally, Cigna is dropping their 2019 premiums by a whopping 18.2% even with sabotage factors, which again are referenced in the filing. I don't know their enrollment either, but amd assuming it's roughly 16,000 since Arizona's total ACA indy market is around 150,000 people.
Obamacare premiums to drop in Louisiana in 2019 after years of rate hikes
After seeing years of rate hikes, Louisiana residents getting health insurance through the Affordable Care Act’s individual exchange will see premiums drop in 2019 by an average of 6.4 percent.
The direction is an abrupt turnaround for the individual exchange, created under the ACA —commonly known as Obamacare — to offer insurance to people who don’t receive it through their jobs or other means. Until now, Louisiana’s individual market has weathered years of rising premiums, including a jump of 18.5 percent on average for 2018.
Alaska has only a single insurance carrier offering ACA-compliant individual market plans, so it should be a piece of cake to calculate their average premium change, since I don't have to calculate the relative market share.
Unfortunately, some carriers submit multiple filings for different lines of business even if they both use the same "Actuarial Memorandum" to justify the incresae...and often times the memo itself is redacted, with the critical data (covered lives, percent increases, dollar amounts, etc.) blocked out, making it kind of useless for my purposes. Such is the case with Premera Blue Cross Blue Shield, the sole ACA market carrier in Alaska. Thanks in large part to the state's successful reinsurance program, they'redropping rates by 7% on most of their policies, and by 10.3% on the rest...but I don't know the relative portion of each, so I can't be sure what the weighted average of the two is. The second listing is for Health Savings Account plans only, so I'm assuming the bulk of their enrollees have the first types of policies, which suggests roughly an 8% overall premium drop.
Last year Alabama had only a single insurance carrier, Blue Cross Blue Shield, offering individual market policies anywhere in the state. For 2018, a new carrier, Bright Health Insurance, jumped into the AL market. For 2019, both companies are lowering rates--BCBSAL is only dropping theirs slightly, but Bright clearly way overshot the mark out of the gate and is lowering their prices by 15.5% overall next year.
Unfortunately, neither of the filings clarifies just how many enrollees either has, so I don't know what the relative market share is; I'm going to assume that BCBS held onto about 90% of the total given their monopoly hold last year and the fact that Bright is a new/unknown player in the market (not to mention the fact that Bright seems to have overpriced their first year). Obviously I'll have to change this if I receive hard numbers to the contrary.
It took me four full months for me to analyse the 2019 ACA rate filings for the first 30 states, but the remaining 20 should come fast & furious starting today, because it looks like they were all finally uploaded to the official RateReview.HealthCare.Gov website earlier this afternoon.
Case in point: Hawaii. There's four carrier listings at RR.HC.gov, but this is misleading; two of them are basically double-listed (Hawaii Medical Service Association separated out their PPOs and HMOs into separate listings, but the filing itself merges both; the same is true of Kaiser Foundation Health Plan, whish has On and Off-Exchange policies listed separately in the database but again merges them into the same filing). In reality, Hawaii only has two carriers on the Individual Market as they have for years.
The Missouri Insurance Dept. has released preliminary 2019 rate filings for the individual and small group markets. Interestingly, in addition to the ACA compliant rate changes, they also posted transitional policy rate changes as well, which is unusual.
Missouri's situation is pretty straightforward: Three existing ACA market carriers are sticking around, and a fourth one is jumping in (Medica). Since Medica is new to the market, they don't have any actual rate changes to speak of. The other three are requesting rate increases of 3.7%, 7.3% and -8.6% respectively; Celtic is dropping rates next year.
