NOTE: This post re. North Carolina's 2020 individual market premium rate change is incomplete because it only includes one of the three carriers participating in NC's market (Blue Cross Blue Shield of NC). The rate change requests for Cigna and Centene haven't been released yet.
Normally I'd wait until I had data for the other two as well, but BCBSNC held around 95% of the state's Individual Market share last year, with Cigna holding the other 5% (Centene was a new entry to the market, so they didn't have any of it). I don't know how much the relative share has changed this year, but I'm assuming that BCBSNC still holds the lion's share of the total.
Blue Cross NC is decreasing 2020 Affordable Care Act (ACA) rates by an average of 5.2 percent for plans offered to individuals and an average of 3.3 percent for plans offered to small businesses with one to 50 employees. With this reduction, we take 238 million steps towards more affordable care in North Carolina.
The good news about the Ohio Insurnace Dept. is that they make it easy to find out which insurance carriers are participating on the ACA market and what the overall, weighted premium change is statewide.
The bad news is that they don't break out that statewide average by carrier rate changes, nor do they make it easy to find out the actual enrollment in the individual carriers...even on the SERFF database, they don't post the relevant filing forms until much later in the year, and tend to redact the critical data.
Still, the big number in the Buckeye State is a 7.0% average premium decrease year over year for 2020:
Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Pennsylvania Insurance Department for review and approval before plans can be sold to consumers. The Department reviews rates to ensure that the plans are priced appropriately -- that is, they are neither excessive (too high) nor inadequate (too low) -- and are not unfairly discriminatory.
Rates reflect estimates of future costs, including medical and prescription drug costs and administrative expenses, and are based on historical data and forecasts of trends in the upcoming year. In its review, the Department considers these factors, as well as factors such as the insurer's revenues, actual and projected profits, past rate changes, and the effect the change will have on Pennsylvania consumers. For more information on this process, watch our How Are Health Insurance Rates Decided?Opens In A New Window video.
Harris’s rollout Monday was met with swift criticism from both the Biden camp, which called it “A Bernie Sanders-lite Medicare for All,” and the Sanders camp, which insists Harris “can’t call [her] plan Medicare for All.”
In saying this, the Sanders campaign is effectively trying to lay a copyright claim to Medicare-for-all, as if it, and only it, can define what it means. The reality is far less clear — and depending on your perspective, it could be Harris’s proposal that is more justified in claiming the Medicare-for-all branding.
I'm not going to overquote my own piece, but this has led to some backlash against me, so for the record:
Maine’s three providers of individual health insurance on the Affordable Care Act marketplace have revised their rate requests for 2020, significantly lowering their projected rates.
Previously, the insurers had sought modest average rate increases of 1 percent to 8 percent. Under the revised filings, two of the three insurers are now requesting decreases for individual plans, and the other is seeking an increase of less than 1 percent.
The Arkansas Insurance Dept. just posted their preliminary 2020 individual and small group market premium rate change requests. For the most part it's pretty straightforward: Individual market premiums are increasing about 2.3% statewide, while small group plans are going up 6.5% overall.
However, there's two interesting things to note about Arkansas' individual market: First, unlike most states where over 70% of enrollees do so through the ACA exchange, in Arkansas it's more like 20%, with nearly 80% are enrolled off-exchange. The main reason for this is the state's unique "Private Option" Medicaid expansion waiver, in which around 252,000 residents who would otherwise be enrolled in Medicaid itself are instead enrolled in enhanced ACA individual market policies...with the state paying for their premiums.
(IMPORTANT: As my friend Shawn Pierce keeps pointing out, the phrase "Medicare for All" has two very different meanings...one is the brand "Medicare for All", which simply refers to any healthcare plan which ensures 100% universal, comprehensive healthcare coverage for everyone; the other is the specific bills introduced by Sen. Bernie Sanders and/or Rep. Pramila Jayapal, which would indeed completely eliminate private major medical insurance for 100% of the population as well as completely eliminating all out-of-pocket costs in favor of 100% federal public funding).
For months now, California Senator and Presidential candidate Kamala Harris has repeatedly struggled with how to address her support of Bernie Sanders' 100% mandatory, $0 out-of-pocket-cost, 100% comprehensive "pure" single payer "Medicare for All" healthcare bill.
The United States could have averted about 15,600 deaths if all 50 states expanded Medicaid under the Affordable Care Act, new research suggests.
...As of 2019, 36 states and the District of Columbia have adopted the Medicaid expansion, and 14 have not.
Four researchers — University of Michigan economist Sarah Miller, University of California, Los Angeles public health scholar Laura Wherry, National Institutes of Health’s Sean Altekruse and Norman Johnson with the US Census Bureau — used that difference to study what happened to people’s health outcomes in states that expanded the program compared to those that did not.A new working paper published by the National Bureau of Economic Research details their results.
UPDATE: My contract with CAP ended on Nov. 30th, 2020 (on a positive note--I knew going in it was a temporary arrangement and enjoyed working with them).
NOTE: This is not an in-depth analysis, for three reasons:
Third, I have a bit of a personal/household crisis to deal with this week (don't worry...no one's sick, dead or getting divorced, but our house is in need of some serious attention)
I wasn't expecting my analysis of Rhode Island's 2020 ACA premium changes to be of any particular interest; it's a small state with only two carriers offering individual market policies, after all, so there's not usually much to it.
A week or so ago I reported that Covered California had released their preliminary 2020 ACA individual market premium rate changes, with a record-low 0.8% average increase statewide. They detailed in the report how the combination of reinstating the ACA's individual mandate penalty and using that funding to provide additional financial subsidies to the enrollees lowered the average rate increases from 4.0% to 0.8%, saving unsubsidized enrollees around 3.2 points or $167/year on average.
Today, CoveredCA has posted more details about some of the specifics:
Covered California Releases Regional Data Behind Record-Low 0.8 Percent Rate Change for the Individual Market in 2020
I've gotten a lot of praise over the years for my "Psychedelic Donut®" depiction of the total healthcare coverage landscape nationally.
For comparison, here's a similar state-level pie chart from the Vermont Agency of Human Services. It doesn't start out too bad, breaking out the total statewide coverage along the lines of the Donut. As you'd expect, around half the state's 627,000 residents are covered via private insurance (45% via their employer, 5% via the ACA individual market, 1% via "Association Health Plans"), while the other half is mostly covered via Medicare or Medicaid. Vermont has only a 3% uninsured rate.
Back in March, I noted that a federal judge had shot down the Trump Administration's attempt to expand so-called "Association Health Plans", which are quasi-ACA compliant but which also have a long, ugly history of fraud and other abuses:
There is a long history of shady and inept operators of association health plans and related multiple employer welfare arrangements, with dozens of civil and criminal enforcement actions at the state and federal levels. The U.S. Government Accountability Office identified 144 "unauthorized or bogus" plans from 2000 to 2002, covering at least 15,000 employers and more than 200,000 policyholders, leaving $252 million in unpaid medical claims. Some were run as pyramid schemes, while others charged too little for premiums and became insolvent.
...Powerful words from DC District Court Judge John Bates in holding a Trump DOL rule unlawful: "The Final Rule was intended and designed to end run the requirements of the ACA, but it does so only by ignoring the language and purpose of both ERISA and the ACA."
At the time, I concluded that the weighted average change marketwide was a 1.95% reduction in premiums compared to 2019, for around 281,000 Michiganders on the Indy market. This would mean roughly a $10 average premium reduction per unsubsidized enrollee per month, or $116 per year:
Polis Administration Projects 18.2% Average Decrease in Premiums for Individual Health Insurance Plans in 2020
Reducing health care costs has been a top priority for Polis.
DENVER (July 16, 2019) – Today, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), announced that for the first time ever, Colorado health insurance companies that sell individual plans (for people who do not get their health insurance from an employer or government program) expect to reduce premiums by an average of 18.2 percent (-18.2%) over their 2019 premiums, provided the reinsurance program is approved by the federal government. These are the health insurance plans available on the Connect for Health Insurance Exchange, the state’s health exchange made possible by the Affordable Care Act (ACA).
If I could only ask one question of the 20-odd candidates vying for the Democratic nomination for President at the next debate coming up right here in Detroit, Michigan, here's how I would word it. I've customized it for each of the five major candidates (apologies to the rest of them):
Preface to each of the candidates:
"Earlier this month, oral arguments were heard by the 5th Circuit Court of Appeals over a lawsuit against the Affordable Care Act filed by 20 Republican Attorneys General and fully supported by the Trump Administration.
"If the plaintiffs are successful and the ACA is struck down entirely, up to 20 million Americans would find themselves without healthcare coverage and tens of millions more with pre-existing conditions would lose critical protections, while states would lose hundreds of millions, or even billions of federal funding.
"Every Democratic candidate has come out in favor of significantly expanding publicly-funded healthcare coverage to some degree or another. Some want to build upon the Affordable Care Act. Some want to add a public option. Some want guaranteed universal coverage, and some are demanding universal single payer healthcare for everyone in the United States.
I promised to have a writeup about Joe Biden's just-rolled-out healthcare proposal yesterday, but I ended up stuck at the Apple Store for nearly six hours (don't ask).
On March 23, 2010, President Obama signed the Affordable Care Act into law, with Vice President Biden standing by his side, and made history. It was a victory 100 years in the making. It was the conclusion of a tough fight that required taking on Republicans, special interests, and the status quo to do what’s right. But the Obama-Biden Administration got it done.
Yes, I'm back from Netroots Nation 2019, and yes, I know that Joe Biden just rolled out his official healthcare policy proposal for the 2020 Presidential election.
I still have to read his plan through and will write up my thoughts about it later today, but before that, I have to take care of this:
A new set of proposals provide some of the strongest evidence yet that Obamacare -- once on the verge of collapse in Tennessee -- has stabilized.
The state’s largest insurance company, BlueCross BlueShield of Tennessee, plans to reenter the Affordable Care Act marketplace in Nashville, Memphis and surrounding counties next year, providing another option for residents on Obamacare. Additionally, two other insurance companies that already offer Obamacare in these cities, Cigna and Oscar Health, are planning to significantly reduce the cost of their coverage plans.
Although the proposals are not final, it appears Tennesseans will have more options and competitive prices in the coming year, said Kevin Walters, a spokesman for the Department of Commerce and Insurance.
The Connecticut Insurance Department has posted the initial proposed health insurance rate filings for the 2020 individual and small group markets. There are 14 filings made by 10 health insurers for plans that currently cover about 242,000 people.
Two carriers – Anthem and ConnectiCare Benefits Inc. (CBI) – have filed rates for both individual and small group plans that will be marketed through Access Health CT, the state-sponsored health insurance exchange.
The 2020 rate proposals for the individual market are on average lower than last year while the small group market is on average slightly higher than last year.
For the most part it went pretty well--we had a pretty full house and only went a bit over time, which is pretty impressive given that we were trying to cram about 10 hours' worth of wonky data about three different healthcare policies and a federal lawsuit into a single hour. The feedback I received from both those in attendance as well as comments on Twitter and Facebook from people who watched the livestream seemed extremely positive.
However, there was one incident which marred the event, and it was my fault.
The Minnesota Commerce Dept. just posted their preliminary 2020 Individual and Small Group rate changes. The actual rate changes are pretty straightforward...a mere 1.6% average rate increase on the ACA Individual Market, and a 5.5% increase on the Small Group market.
OK, it feels a bit surreal to post about California's 2020 ACA premiums--and especially mentioning the fact that they're reinstating the ACA individual mandate penalty at the state level--on the very same day that the entire ACA itself is on the brink of complete oblivion (again), due specifically TO the fact that Congressional Republicans repealed the federal mandate penalty..
They also attempted to calculate how much federal funding every state would lose each year if the ACA were to be repealed. Nationally, they concluded that the U.S uninsured rate would increase by nearly 20 million people, while the 50 states (+DC) would collectively lose out on nearly $135 billion in federal funding.
I'm happy to report that our panel did indeed make the final cut, and will be happening this Friday, July 12th:
FIX THE DAMN HEALTHCARE: SORTING OUT ACA 2.0, MFA, MED4AM AND MORE!
Friday, Jul. 12 4:30 PM, Room: 118C
The healthcare landscape is confusing and exciting in 2019. Reining in Big Pharma, strengthening the ACA, adding public options, “Medicare for America” or “Medicare for All”… the alphabet soup of plans can be confusing. Can improvements be implemented before 2021 at the federal level or is it all up to the states? And what about the latest lawsuit looming over everything? We’ll go beyond the slogans and into the details: How are the proposals similar and different, and what do patients, caregivers and other invested parties think.
Over the past few years I've had a somewhat contentious relationship with some die-hard single payer/"Medicare for All" activists over the feasibility, logistical practicality, fiscal and political realities and so forth of transitioning to a "pure" universal single payer healthcare system versus other healthcare expansion/improvement measures.
However, I've also developed great relationships with a few M4All activists, including friendships.
Dover, DE -- Highmark Blue Cross Blue Shield of Delaware (Highmark BCBS) has submitted its required annual rate filing to the Delaware Department of Insurance. After years of substantial increases, Delaware’s Marketplace has stabilized and premiums have decreased. Highmark BCBS, the only insurer continuing to offer insurance coverage in Delaware’s individual market, has proposed a 5.8% decrease for 2020. The proposed 2020 rate decrease will affect over 20,000 Delawareans.
The decrease comes after last year’s 3% rate increase and the Department’s decision to silver load. By applying the rate increase to silver level plans only, a practice known as ‘silver-loading,’ Delaware’s Marketplace received more federal subsidies, helping to assist in stabilizing the market and lowering premiums.
The Justice Department nonetheless thinks that neither the House of Representatives nor the blue states have standing. And if the Fifth Circuit dismisses the appeal, the Department says that O'Connor's opinion should *not* be vacated.
Significantly, the Justice Department now says that it will continue to enforce the ACA "pending a final judicial determination of the constitutionality of the individual mandate as well as the severability of the ACA's other provisions."
Republican attorneys general suing to strike down the Affordable Care Act asked the 5th U.S. Circuit Court of Appeals to delay oral arguments in the case, which are set to take place on July 9.
The Republican states said they need more time to file a supplemental brief on whether the U.S. House of Representatives and the Democratic states that are defending the landmark healthcare law have standing to intervene in the case and if not, what that means for the appeal. The Republican attorneys general asked to extend the July 3 deadline to file the brief by 20 days and reschedule oral arguments for after that date.
...The Democratic states and the House urged the court to deny the request, arguing that moving ahead with the case would reduce uncertainty in the healthcare sector.
D.C. residents are among tens of thousands of Americans left uninsured by a health insurance scam that collected more than $100 million in premiums for junk plans.
A special enrollment period from now through Aug. 30, via the DC Health Benefits Exchange Authority, has been earmarked for residents who bought the junk plans from a Florida-based operation that was recently shut down by a federal court.
The overall average rate increase for 2020 Indiana individual marketplace plans is 9.0%. CareSource and Celtic (MHS/Ambetter) have filed to participate in the 2020 Indiana Individual Marketplace. The Department of Insurance anticipates that all 92 counties in Indiana will be covered by both CareSource and Celtic (MHS/Ambetter).
Anthem has filed to offer a 2020 Off-Marketplace plan in Indiana. This plan is a catastrophic plan and is offered only in Benton, Jasper, Newton, Warren and White Counties.
Filing a rate does not guarantee it will be approved for use on the Marketplace, nor does the filed rate guarantee to be the final rate. Therefore, the Department of Insurance is not able to ascertain the amount of any final rates at this time. The state has until September 24, 2019 to review and submit dispositions to U.S. Department of Health and Human Services.
Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Montana State Auditor’s Department of Insurance for review and before plans can be sold to consumers.
What is rate review?
The rate review process, established by the Montana Legislature in 2013, does not give the Commissioner the authority to disapprove rates or prevent them from taking affect. It does give the commissioner the chance to review the factors insurance companies use in setting rates.
If the commissioner finds a rate increase to be excessive or unjustified, the insurer can voluntarily lower the rate increase. If the insurer decides to use the rate anyway, the commissioner will issue a public finding announcing that the rate is unjustified.
