Tomorrow, HHS Secretary Azar will join Governor Haslam in Nashville, Tennessee to deliver remarks at an event hosted by the Nashville Health Care Council.
Secretary Azar will share news regarding the Affordable Care Act marketplace and reflect on lessons for healthcare reform.
In advance of tomorrow, here are a few excerpts of Secretary Azar’s remarks (as prepared for delivery):
“The previous administration’s major healthcare achievement, the Affordable Care Act, was an attempt to use more government regulation and intervention to improve American healthcare.
“As we all know, the results were disastrous, with skyrocketing costs and disappearing choices.
“But today, I am here to share with you some good news.
Later Wednesday, [Democratic Governor Gina] Raimondo held her own news conference to sign an executive order that, among other steps, directs the state to seek to codify in state law protections for people with preexisting conditions, dependents up to age 26, prescription drug benefits and maternity coverage in case federal action is taken to weaken the Affordable Care Act.
Rhode Island has one of the highest insured rates in the country, and Raimondo said she was defending "Rhode Islanders' access to high-quality, affordable health coverage."
I'm not quite sure what an executive order has to do with codifying ACA protections into law, since that's really up to the state legislature to do, but I guess it at least kicks their butts into gear?
This is also refreshing to hear from a Republican challenger:
A few minutes ago I posted about North Dakota'sapproved 2019 rate hikes, which are coming in at a mere 3.2% on average (but which would likely be dropping nearly 20 points without both last and this year's #ACASabotage factors).
As I noted last month when I first analyzed the requested 2019 rates for North Dakota insurers, ND was somewhat unique last year in that it was one of only two states (the other was Vermont) which didn't tack on any extra premium increases for 2018 to account for the lost Cost Sharing Reduction reimbursement revenue after Donald Trump cut off those payments last October.
This led to one of North Dakota's three carriers, Medica, dropping off the ACA exchange altogether, though they still ended up enrolling a few hundred people directly via the off-exchange market.
A few years back I posted an entry which breaks out the income eligibility thresholds for Medicaid and CHIP in every state. I've reposted an updated version below, which also takes into account Basic Health Plan (BHP) eligibility in Minnesota and New York. This comes directly from the Centers for Medicare & Medicaid. Note the footnotes at the bottom. The pink cells on the right indicate that the state has not yet expanded Medicaid under the ACA (Maine and Virginia have passed but note implemented doing so, while Medicaid expansion is on the ballot in Idaho, Nebraska and Utah this November).
As a reminder, here's the 2018 Federal Poverty Level income chart for every state except Alaska and Hawaii (Alaska is 25% higher, Hawaii is 15% higher):
The state is exploring whether a Montana-run reinsurance program would help lower the premiums people pay when buying their health insurance on the federal marketplace, in some cases by 10-20 percent.
Yes. Yes, it would.
...Montana Gov. Steve Bullock and Department of Administration Director John Lewis are creating a 13-person working group to explore how a state-run reinsurance program might work in Montana. The group will use information from a recent study commissioned by the Montana Healthcare Foundation looking at what reinsurance could mean for the state.
The study shows reinsurance could lower premiums that have risen by double digits in recent years. Those rates could drop anywhere from 9.6 percent to nearly 30 percent on extreme ends of the spectrum, according to the study.
As I noted back in July, in addition to the Trump Administration's Centers for Medicare & Medicaid (CMS) chopping down the marketing budget for HealthCare.Gov by 90% last year, they also slashed the navigator/personal outreach budget by over 40% as well, from $63 million down to $36 million...and this year have cut it by another $26 million, to just $10 million across all 34 states which rely on HealthCare.Gov to host their ACA exchange open enrollment functionality (there are 5 more states which are hosted by HC.gov, but which I believe operate their own exchange and navigator budget: Oregon, New Mexico, Nevada, Kentucky and Arkansas). Combined, that makes an 84% reduction in navigator funding over a 2 year period.
BREAKING: Governor @JerryBrownGov today signed several #Care4AllCA bills that protects patients and places greater accountability on health insurers now on Gov's desk:#SB910 & #SB1375 to ban/limit "junk" insurance;#AB2499 on MLR; and#AB2472 on a public option study.
Open enrollment for 2019 coverage will begin October 15, 2018 in California, and continue until January 15, 2019
Nationwide, open enrollment for 2019 coverage is scheduled to run from November 1, 2018 to December 15, 2018 — the same schedule that was followed in late 2017 for 2018 coverage. But Covered California was one of only three state-run exchanges that opted in 2017 to keep open enrollment at three months in duration for 2018 coverage (the others were New York and DC).
And the state enacted legislation (A.B.156) in late 2017 that codifies a three-month open enrollment period going forward — California will not be switching to the November 1 – December 15 open enrollment window that other states will be using.
This is a pretty minor update, but I'm trying to lock in all of the approved 2019 rate changes as they come in. Last month, South Dakota's two carriers, Avera and Sanford, posted requested rate increases which I thought were 2.6% and 10.0% at the time. I also estimated their relative enrollment at around 27,000 and 4,000 enrollees apiece for market share calculations, which gave a statewide average increase of around 3.5%.
I checked the South Dakota Insurance Division website again today, and it certainly looks like the filings have been approved by the state insurance regulators...however, when I double-checked the filings themselves, it looks like they were actually slightly lower than I thought: 2.5% and 9.7% respectively.
In addition, I was able to find the hard enrollment numbers for each...the total is pretty close to what I had it at (29,180 vs. 31,000), but the splut is quite different. Insetad of Avera still having an 87% market share, it looks ike the split is more like 63/37 this year. Since Sanford is requesting a significantly higher increase than Avera, that means the weighted statewide average is higher as well...around 5.2% instead of 3.5%.
I posted Montana's preliminary/requested 2019 ACA indiividual market rate change requests back in late June. At the time, they were seeking average rate increases of 6.0% statewide, and I estimated that the GOP's repeal of the ACA's individual mandate penalty, combined with the Trump Administration's expansion of #ShortAssPlans, accounted for about 9.9 percentage points of that.
More recently, the state insurance commissioner's website published approved 2019 rate changes. The average increases have been sliced down slightly (from 6.0% to 5.7% on average), and I've lowered my estimate of #ACASabotage impact from 9.9% to 6% based on the lack of either factor being prominently mentioned in the actual carrier rate filings. If accurate that means rates would have been flat year over year on average in 2019 if not for those factors.
Unsubsidized Montana enrollees are paying an average of $637/month this year, so that's roughly a $38/month difference, or around $460 for the full year.
When Maryland insurance carriers originally submitted their proposed 2019 premium changes back in May, it looked pretty grim...they were expected to average around 29.5% statewide for the ACA-compliant individual market., increasing from around $631/month on average to roughly $817/month for unsubsidized enrollees.
Thanks to swift, bipartisan action on the part of the Democratically-controlled Maryland state legislature and the Republican Governor, Maryland was able to pass several bills which partially negated or cancelled out Trump/Congressional Republican sabotage of the Affordable Care Act. In particular, they passed laws which locked in current restrictions on both short-term plans and association health plans (the types of "junk policies" which Trump is pushing hard to expand upon)...along with an extremely robust reinsurance program.
Just in case anyone thinks state insurance regulatory boards can't be hard-core badasses, consider the Optima Health situation in Virginia which I wrote about a couple of weeks ago:
By early September, it was clear that Trump would indeed be cutting off CSR funding. With just a few weeks left before the final deadline to sign 2018 ACA exchange contracts, Optima suddenly announced that they were not only jacking up rates a whopping 81%, they were also pulling out of a large chunk of the state, leaving large areas at risk of "going bare" without any ACA carriers whatsoever.
...Then, on September 14, with just days to spare and thanks to what I assume were some pretty intense backroom deals being made, Anthem suddenly announced that they were back in the game after all!
Back in July, I wrote about a lawsuit filed by twelve state Attorneys General against the Trump Administration over their attempt to vastly expand "Association Health Plans" as an alternative to ACA-compliant healthcare policies:
A group of 11 states and Washington, D.C., are suing the Trump administration in an attempt to roll back a regulation that allowed for the expansion of certain health plans that skirt ObamaCare regulations.
The lawsuit, led by New York Attorney General Barbara Underwood (D) and Massachusetts Attorney General Maura Healey (D), alleges that the Department of Labor violated the Administrative Procedures Act when it wrote a rule expanding access to association health plans.
Association health plans allow small businesses and other groups to band together to buy health insurance. The rule allows more groups to join together to form associations.
The move is part of a broader Trump administration effort to open up skimpier, cheaper plans as an alternative to ObamaCare plans.
Maryland files suit to protect health reform from Texas.
... the Maryland attorney general today filed a separate lawsuit in a Maryland district court. Among other things, he’s seeking an injunction requiring the continued enforcement of the law. Depending on how quickly the Maryland case moves, it’s possible we could see dueling injunctions—one ordering the Trump administration to stop enforcing the law, the other ordering it to keep enforcing.
That’s an unholy mess just waiting to happen. Now, it may not come to that. My best guess is that the Texas lawsuit will fizzle: any injunction will likely be stayed pending appeal, either by the Fifth Circuit or the Supreme Court, and the case is going nowhere on the merits. The Maryland lawsuit will likely prove unnecessary.
I don't have much to add to this other than to note how much this case underscores just how much power and importance state attorneys general have.
As I just noted earlier this afternoon, Massachusetts is NOT expecting the repeal of the ACA's individual mandate to impact their 2019 individual market enrollment or premiums for a simple reason: The Bay State never formally repealed their own, pre-ACA mandate penalty. They basically mothballed it once the ACA's version went into effect, and are simply dusting it off for 2019 and beyond now that the federal mandate has been formally repealed.
However, the two mandate penalties don't work quite the same way. For the federal mandate, unless you qualify for an exemption (and there's a whole bunch of those), the penalty for not having ACA-compliant healthcare coverage is (or has been up until now) as follows:
Ready for Open Enrollment, Health Connector sets 2019 plans with lower premium increases, selects community organizations to provide in-person support to residents
Boston – September 13, 2018 – The Massachusetts Health Connector Board of Directors today approved 57 Qualified Health Plans from nine carriers for individuals and families, with new plan designs that create better value for members and premium increases that average under 5 percent from 2018.
Unfortunately, the press release doesn't specify what "under 5%" means, nor does it break that out by carrier/market share. I've put in a request for those details and will update this as soon as I hear back from them. They sent me the following chart, but this only includes enrollees earning between 300-400% of the Federal Poverty Level, which means the marketshare across the entire individual market is likely somewhat different. I'm assuming the 4.4% overall average applies to the entire market but could be wrong about that as well:
For months now, I've been trying to get people to understand that when it comes to sabotage of the Affordable Care Act, especially in terms of individual market premium increases, you have to include the impact of actions taken by Donald Trump and Congressional Republicans in BOTH 2017 and 2018, not just 2018 alone.
In 2017, the single largest factor in the ~28% average national unsubsidized premium increase for ACA plans was Donald Trump's cutting off of Cost Sharing Reduction (CSR) reimbursement payments to carriers. This alone accounted for fully half of the 2018 increase. However, there were other, smaller actions taken which added up to another 3% or so: Slashing the Open Enrollment Period in half, CMS slashing the marketing budget for the federal exchange down 90%, slashing the outreach/navigator budget down 40% and so on.
“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”
--Douglas Adams, The Hitchhiker's Guide to the Galaxy
Yesterday CMS Administrator Seema Verma posted this on Twitter...
I’m excited by the partnerships that Arkansas has fostered to connect Medicaid beneficiaries to work and educational opportunities, and I look forward to our continued collaboration as we thoroughly evaluate the results of their innovative reforms. #TransformingMedicaid
Iowa has only a single insurance carrier offering ACA-compliant individual market policies this year. Next year they'll have two, as Wellmark has decided to Hokey Pokey their way back onto the exchange again in 2019...but since they weren't around this year, there's no current policy premiums to measure any increase (or decrease) against.
Medica, the sole carrier now selling individual health insurance policies in Iowa, plans to raise its 2019 premiums by less than a tenth as much as it did for 2018.
Medica raised its Iowa health insurance premiums by a staggering average of 57 percent for 2018. It was the steepest such health insurance increase in Iowa history. Company leaders said last summer they needed the higher premiums to stay in the market. But this time around, the Minnesota-based carrier is planning to raise Iowa premiums by an average of less than 5.6 percent, state regulators disclosed Wednesday.
To enter the Fort Worth Courtroom of Judge Reed O’Connor on September 5, 2018, was to leave the real world. The Affordable Care Act was once again on trial. At stake was access to health care for the 20 million Americans who have gained coverage through the ACA, affordable coverage for 133 million Americans with preexisting conditions, and preventive services coverage for 44 million Medicare beneficiaries.
New Mexico was one of the earlier states to post their initial, requested 2019 ACA individual market premium hikes back in June. At the time, the five carriers asked for rate increases ranging from a slight drop (-0.4% for Molina) to as high as an 18.5% increase for Presbyterian Health, which is currently only offering off-exchange policies this year. Based on their preliminary filings, New Mexico was looking at a weighted average increase of around 10.0% next year, which would have been more like 4% if not for this years sabotage efforts by Trump and the GOP (mandate repeal & expansion of #ShortAssPlans):
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:
AP Exclusive: Modest premium hikes as 'Obamacare' stabilizes
Millions of people covered under the Affordable Care Act will see only modest premium increases next year, and some will get price cuts. That's the conclusion from an exclusive analysis of the besieged but resilient program, which still sparks deep divisions heading into this year's midterm elections.
The Associated Press and the consulting firm Avalere Health crunched available state data and found that "Obamacare's" health insurance marketplaces seem to be stabilizing after two years of sharp premium hikes. And the exodus of insurers from the program has halted, even reversed somewhat, with more consumer choices for 2019.
Normally at this point in the year I only do full rate hike write-ups for states when their approved rate changes are made public by insurance regulators. I'm making an exception for Texas, however, because my preliminary analysis of the statewide average premium changes back in June was missing a huge portion of the market--I only had around half the ACA individual market accounted for, and I repeatedly warned that the missing enrollment and rate change data could easily skew the statewide average higher or lower.
Well, it's early September now, and not only do I have access to pretty much all of the missing data now, some of the rate filings have changed significantly as well. At the time, I estimated Texas carriers as requesting average rate increases of just 1.5% overall, with them dropping around 10.6% if not for the ACA's individual mandate being repealed and Trump's expansion of #ShortAssPlans.
I received a tip about this early this morning...which, unfortunately, I was unable to scoop anyone with due to being bogged down/caught up with the #TexasFoldEm drama.
Montana insurer wins lawsuit against feds over unpaid cost-sharing reduction payments
Several health insurers have sued the U.S. government over its failure to make cost-sharing reduction payments that help lower healthcare costs for certain consumers. One just scored the first victory. The U.S. Court of Federal Claims ruled in favor of Montana Health Co-op, which sued the federal government for $5.3 million in unpaid cost-sharing reduction payments, finding that the government violated its obligation under the Affordable Care Act when it stopped paying the CSRs in October 2017."
The rest of the article is behind a paywall, but the gist of it is as follows:
U.S. District Court Judge Reed O'Connor, a George W. Bush appointee, vigorously questioned attorneys during the three-hour hearing but gave no indication when he would rule.
Lawyers for the Trump administration partially agreed with the red states' argument, concluding that the removal of Obamacare's individual mandate requires striking down the law's insurance provisions, including protections for people with preexisting medical conditions.
But the administration disagreed on the need for immediate action, arguing that any remedies should not be applied until next year.
In June 2018, President Trump’s administration announced – as part of a lawsuit known as Texas v. United States, brought by 20 Republican state attorneys general – it will no longer defend the ACA’s protections for people with pre-existing medical conditions.
Senate Democrats are preparing a long-shot procedural maneuver to reverse new Trump administration regulations that they say would sabotage the Affordable Care Act by expanding “junk” insurance that isn’t obligated to cover preexisting conditions.
Rhode Island is kind of an interesting state this year. The smallest state geographically and one of the smallest population-wise, they only have two carriers offering individual market coverage: Blue Cross Blue Shield and Neighborhood Health Plan. Way back in May both carriers submitted their preliminary 2019 ACA policy rate increase requests, averaging around 9.7% overall. What's most noteworthy is that unlike most other states, both carriers are mostly blowing off 2018 ACA sabotage factors like mandate repeal and #ShortAssPlans. Blue Cross isn't adding anything to account for the negative risk pool impact, while Neighborhood (which holds slightly more than half of the market share) is only tacking on about 2% in response.
OK, a little more self-serving news...until last week I hadn't been interviewed, quoted or cited by other media outlets for awhile, but with both the #TexasFoldEm lawsuit, the Brent Kavanaugh SCOTUS hearings and the 2019 Open Enrollment Period all coming up fast, I've had one of each of the above happen over the past week:
INTERVIEW: If you want to hear me flap my gums explaining the #TexasFoldEm lawsuit and the implications of it for 40 minutes or so, check out last week's special episode of Hopping Mad podcast with Arliss Bunny and Will McLeod:
The Big News this week is all about the #TexasFoldEm court case (which could potentially destroy the Affordable Care Act as soon as January 2019) and the Brent Kavanaugh SCOTUS confirmation hearings (which could potentially destroy both the Affordable Care Act and the rest of United States as soon as, oh, let's call it within a year or so).
I hope neither of these things happens, of course...but regardless of how things play out, I also hope to still be around to document, analyze and explain the latest healthcare policy drama as it happens for years to come.
ACASignups.net has been kept alive for nearly five years thanks to two main sources: Individual supporters who donate either once or monthly, and banner ads, which are usually generic. Today I'm honored to announce that the Robert Wood Johnson Foundation, one of the most respected sources for healthcare knowledge and education, has also agreed to advertise on this site.
