Alaska is also a sparsely populated state with only two carriers on their individual market and four on their small group market. Alaska's insurance department website is useless when it comes to getting rate filings or enrollment data; I had to use the federal Rate Review site to even get the requested rate changes.
Fortunately, Premera Blue Cross includes a summary which lists their enrollment numbers, and with Moda being the only other carrier on the market, I was able to estimate a weighted average (assuming Moda only has around 2,200 enrollees, which seems about right given Alaska's total on-exchange enrollment of roughly 23,000 people).
Average rate change for unsubsidized enrollees in 2022 will be an ugly 18.7% on the individual market...underscoring how vitally important it is that the American Rescue Plan subsidies be extended (preferably permanently).
On the small group market, the unweighted average increase is 4.8%.
North Carolina has posted their preliminary 2023 individual and small group market rate filings. For the most part there's nothing terribly interesting or unusual that catches my eye, although I am a bit curious about Bright Health Co. and Friday Health Plans on the small group market. Both of them supposedly just entered the North Carolina sm. group market in 2022 and both are supposedly dropping out of it in 2023...or at least neither one of them is listed on the 2023 filing summary. Huh.
It's also worth noting that the enrollment totals for each carrier are projected for 2023, not current, though I'd imagine the relative market share is roughly the same, which would mean the weighted average rate increase would be around the same statewide as well.
It's worth noting that each market has a new entrant for 2022: UnitedHealthcare is joining the individual market while National Health Insurance is jumping into the off-exchange Small Group market.
UPDATE 11/03/22: Now that the 2023 Open Enrollment Period has officially launched, the Missouri Insurance Dept. has finally posted the final/approved rate changes. They've made some very minor tweaks to a few of the individual market filings, but that just brings the weighted average down around 0.1 points to 11% even.
The small group market filings were approved as is.
The Department of Insurance receives preliminary health plan information for the following year from insurance carriers by June 1 and reviews the proposed plan documents and rates for compliance with Idaho and federal regulations.The Department of Insurance does not have the authority to set or establish insurance rates, but it does have the authority to deem rate increases submitted by insurance companies as reasonable or unreasonable. After the review and negotiation process, the carriers submit their final rate increase information.The public is invited to provide comments on the rate changes. Please send any comments to Idaho Department of Insurance.
via the Centers for Medicare & Medicaid Services (CMS), by email:
Today, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for more millions of Americans.
Medicare
As of April 2022, 64,449,451 people are enrolled in Medicare. This is an increase of 88,177 since the last report.
34,879,219 are enrolled in Original Medicare.
29,570,232 are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.
50,011,957 are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage.
Over 12 million individuals are dually eligible for Medicare and Medicaid, so are counted in the enrollment figures for both programs.
Today, following President Biden’s Executive Order on ensuring access to reproductive health care, the U.S. Department of Health and Human Services (HHS), alongside the Departments of Labor and of the Treasury (Departments), took action to clarify protections for birth control coverage under the Affordable Care Act (ACA). Under the ACA, most private health plans are required to provide birth control and family planning counseling at no additional cost.
The Georgia Access model would eliminate the use of HealthCare.gov, transitioning consumers to decentralized enrollment through private web-brokers and insurers. The state would establish its own subsidy structure to allow for 1) the subsidization of plans that do not comply with all the ACA’s requirements; and 2) enrollment caps if subsidy costs exceed federal and state funds.
There's not a single part of the paragraph above which shouldn't be setting off major alarms:
On the last episode of "Who Wants to Try and Appease Joe Manchin?," the entire Democratic Senate caucus, as well as President Biden, had basically given up on trying to get West Virginia Senator Joe Manchin to be reasonable after spending a solid year listening to him come up with one excuse after another not to pass an ever-shrinking domestic "soft infrastructure" agenda.
In the end, they accepted that the $3.5 trillion "Build Back Better" package, which was later slashed to around $1.6 trillion by the time it passed the House of Representatives last fall, wasn't going to happen.
Instead, they were going to have to accept a shadow of its former self: A roughly $300 billion healthcare-only package which would primarily accomplish only two of the major provisions of the original pacakge (and only part of those):
For years, consumer advocates and some legislators have been battling to rein in escalating health care costs. Now the state has created a new agency to limit future growth in health care costs — and it will have the power to enforce that mandate.
...In California and nationally, the most cited reason for people being uninsured or underinsured is cost. Even those with robust insurance sometimes struggle to afford hospital bills and their medication. Some take extreme measures, such as rationing their dosages or traveling south of the border for more affordable care. Half of Californians skipped or postponed medical care in 2021 because of costs, according to a California Health Care Foundation report.
...The recently approved state budget includes $30 million to create the office, whose key responsibility will be to set and enforce limits on cost growth for the industry, including hospitals, health insurers and physician groups.
ACA RATE CHANGES FOR ALABAMA POLICIES IN THE INDIVIDUAL MARKET
The Affordable Care Act (ACA) requires that insurers planning to increase plan premiums submit their rates to the Alabama Department of Insurance for review.
The rate review process is designed to improve insurer accountability and transparency. It ensures that experts evaluate whether the proposed rate increases are based on reasonable cost assumptions and solid evidence. The ACA also requires that a summary of rate review justifications and results be accessible to the public in an easily understandable format. The Federal HealthCare.gov Rate Review website is designed to meet that mandate. For more information, see here.
The information is provided in the tables below. Also attached are links to the redacted actuarial memorandum, which support these changes. The rate changes are being proposed and reviewed by the Alabama Department of insurance (ALDOI). As soon as they are final, they may be purchased on the Federal Exchange or through private agents and brokers. The programs will be effective beginning on January 1, 2023.
Awards to 36 grantees support President Biden’s Executive Orders on Strengthening Medicaid and the Affordable Care Act, and represent the largest outreach and enrollment investment ever made through Connecting Kids to Coverage program.
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today awarded $49 million to organizations on the frontlines of reducing uninsured rates and connecting more children, parents, and families to health care coverage. In support of President Biden’s Executive Orders on Strengthening Medicaid and the Affordable Care Act, and HHS Secretary Xavier Becerra’s priority of expanding access to affordable, quality health care, these awards represent the largest investment CMS has ever made in outreach and enrollment through the Connecting Kids to Coverage program.
Governor Tom Wolf today announced that Pennsylvania’s state-based health insurance marketplace, known as Pennie, has added a new qualifying life event to allow low-income Pennsylvanians the ability to enroll in health insurance throughout the year.
“Since taking office, a top priority of mine has been to expand access to quality, affordable health insurance to all Pennsylvanians,” said Gov. Wolf. “I strongly believe that access to health care is a fundamental right, but it’s also good for Pennsylvania’s economy. This additional qualifying event will make health insurance accessible to some of Pennsylvania’s most vulnerable citizens, providing them the security of knowing they can receive medical care without the astronomical costs associated with seeking care without health insurance.
As depressing as it may be to see President Biden's original $3.5 trillion American Families Plan (that was the actual name of the "soft" infrastructure portion of the Build Back Better agenda; since then the "hard" infrastructure portion which passed has been rebranded as the "Bipartisan Infrastructure Bill" while the American Families Plan was rebranded as...Build Back Better) get whittled down to less than $300 billion, the good news (such as it is) is that it looks like at least that much is finally going to happen...probably:
It’s official. Democrats’ Manchin-ified health-care reconciliation bill is moving forward.
Covered California Announces 2023 Plan Rates: Lower Than National Average Amid Uncertain Future of American Rescue Plan Benefits
California’s individual market will see a preliminary rate increase of 6 percent in 2023, due in part to the return of normal medical trends that existed prior to the COVID-19 pandemic and the uncertain future of the American Rescue Plan.
Despite the uncertainty, the rate change is below the national average thanks to Covered California’s 1.7 million enrollees and the state’s healthy consumer pool, which remains among the best in the nation.
Covered California also announced that a 13th carrier would join the marketplace, and an existing carrier would expand to become the second one to offer statewide coverage.
All Californians will have two or more choice of carriers, 93 percent will be able to choose from three or more, and 81 percent will have four or more choices.
The Georgia Access model would eliminate the use of HealthCare.gov, transitioning consumers to decentralized enrollment through private web-brokers and insurers. The state would establish its own subsidy structure to allow for 1) the subsidization of plans that do not comply with all the ACA’s requirements; and 2) enrollment caps if subsidy costs exceed federal and state funds.
There's not a single part of the paragraph above which shouldn't be setting off major alarms:
As I (and many others) have been noting for many months now, the official end of the federal Public Health Emergency (PHE), whenever it happens, will presumably bring with it reason to celebrate...but will also likely create a new disaster at the same time:
What goes up usually goes back down eventually, and that's likely to be the case with Medicaid enrollment as soon as the public health crisis formally ends...whenever that may be.
Well, yesterday Ryan Levi and Dan Gorenstein of of the Tradeoffs healthcare policy podcast posted a new episode which attempts to dig into just when that might be, how many people could be kicked off of the program once that time comes and how to mitigate the fallout (I should note that they actually reference my own estimate in the program notes):
TRENTON — Building on the Murphy Administration’s efforts to expand access to affordable health coverage, Governor Murphy signed legislation (A-674/S-1646) on June 30 creating the New Jersey Easy Enrollment Health Insurance Program to make it easier for residents to obtain health insurance through Get Covered New Jersey, the State's official health insurance marketplace.
“New Jersey has made great strides in ensuring more residents have access to affordable health insurance. More than 324,000 New Jerseyans signed up for health coverage through Get Covered New Jersey during the Affordable Care Act Open Enrollment Period—a record high in New Jersey,” said Department of Banking and Insurance Commissioner Marlene Caride. “I want to thank Governor Murphy for signing the New Jersey Easy Enrollment Health Insurance Program into law—this is another step forward that reduces barriers to health coverage. Enrolling more residents in health plans will lead to better health outcomes for New Jersey families.”
ALBANY, N.Y. (July 11, 2022) – NY State of Health, the state’s official health plan Marketplace, today released Health Insurance Coverage Update: Impact of ARPA Subsidies. The enrollment report, which compares data from March 2020 to May 2022, describes how millions of New Yorkers have benefitted from access to affordable, comprehensive coverage through the Marketplace thanks to flexibilities permitted during the Federal COVID-19 Public Health Emergency (PHE) and ARPA premium subsidies. Currently, federal enhanced subsidies do not extend into 2023 and New York’s uninsured rate is expected to rise, reversing the progress in insurance coverage made since the start of the pandemic.
Action on climate change and clean energy remains more urgent than ever.
So let me be clear: If the Senate will not move to tackle the climate crisis and strengthen our domestic clean energy industry, I will take strong executive action to meet this moment. My actions will create jobs, improve our energy security, bolster domestic manufacturing and supply chains, protect us from oil and gas price hikes in the future, and address climate change. I will not back down: The opportunity to create jobs and build a clean energy future is too important to relent.
I go by county residents who have received the 2nd COVID-19 shot only (or 1st in the case of the J&J vaccine).
I base my percentages on the total population via the 2020 U.S. Census including all ages (i.e., it includes kids under 12).
For most states + DC I use the daily data from the Centers for Disease Control, but there are some where the CDC is either missing county-level data entirely or where the CDC data is less than 90% complete at the county level. Therefore:
WASHINGTON — Sen. Joe Manchin, D-W.Va., and his staff told Democratic leadership on Thursday that he's not willing to support major climate and tax provisions in a sweeping Biden agenda bill, according to a Democrat briefed on the conversations.
Instead, Manchin, a key centrist who holds the swing vote in the 50-50 Senate, said he is willing to back only a filibuster-proof economic bill with drug pricing and a two-year extension of funding under the Affordable Care Act, the source said.
Manchin's move upends lengthy negotiations with Senate Majority Leader Chuck Schumer, D-N.Y., most likely forcing the party to scrap climate change policies and new taxes and delivering a major blow to some of President Joe Biden's priorities heading into an already challenging midterm election landscape for Democrats this fall.
With Congress scheduled to recess at the end of July, and health insurance marketplaces finalizing their rates for the 2023 coverage year, timely action to decide on the future of the American Rescue Plan’s benefits is critical.
The law, which provides increased and expanded federal financial assistance and helped millions of Americans sign up for health insurance through the Affordable Care Act, is set to expire at the end of this year.
An estimated 220,000 Californians could become uninsured, with premiums doubling for 1 million low-income consumers.
Middle-income consumers would lose all federal financial help, and their premiums would increase by an average of $272 per month if Congress does not act to extend the law.
Rep. Josh Gottheimer (D-N.J.) is gauging support among House centrists for a counteroffer to the emerging Senate reconciliation package, with one big clause: No new taxes.
Why it matters: Any attempt to modify a deal that Senate Majority Leader Chuck Schumer may reach with Sen. Joe Manchin (D-W.Va.) could scuttle the entire package. That could deprive President Biden — and vulnerable lawmakers — of a pre-election win at a time of real weakness.
Gottheimer's discussions target a small group that includes Reps. Carolyn Bourdeaux (D-Ga.), Ed Case (D-Hawaii), Tom Suozzi (D-N.Y.), Susie Lee (D-Nev.) Dean Phillips (D-Minn.) and Mikie Sherrill (D-N.J.).
...Gottheimer's formula would leave $177 billion for deficit reduction — a step toward Manchin but a long way from his roughly $500 billion target.
...After declaring Biden’s original $2.2 trillion social spending and climate package dead last December, Manchin revived talks with Schumer on a much smaller deal this spring, and the two sides are continuing their negotiations.
...O’Connor also rules that the U.S. Preventive Services Task Force (PSFT) violates the Appointments Clause because he finds the members are officers of the United States not appointed properly.
...O’Connor rejects several other claims, as to Appointments Clause claims and as to the nondelegation doctrine.
Reinsurance continues to save Coloradans money on health care, while the Colorado Option Plan is included for the first time.
DENVER - The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has released preliminary information about the health insurance plans and premiums for 2023 -- for the individual market (meaning health insurance plans for people who don’t get their insurance from an employer) and the small group market (for small businesses with 2-100 employees).
The initial review by the DOI of the insurance companies’ filings for 2023, indicate that the overall average consumer impact on premiums in the individual market will be an 11.3% increase over 2022 premiums. These are the health insurance plans available to individuals on Connect for Health Colorado, the state’s health exchange made possible by the Affordable Care Act (ACA).
Tennessee has posted their preliminary 2023 individual & small group market health insurance rate filings. For the most part they're fairly straightforward: The individual market is looking at average rate increases of around 9%, assuming they're approved as is by state regulators, while the small group market averages around +2.9% overall.
Company Legal Name: Aetna Health, Inc.
State: DE HIOS
Issuer ID: 67190
Market: Individual
Effective Date: 01/01/2023
The development of the rates reflects the impact of the market forces and rating requirements associated with the Patient Protection and Affordable Care Act (PPACA) and subsequent regulation. These rates are for plans issued in Delaware beginning January 1, 2023. The rates comply with all rating guidelines under federal and state regulations. The filing covers plans that will be offered on and off the public Marketplace in Delaware.
Today, the U.S. Department of Health and Human Services (HHS) announced new guidance and communication to ensure all patients — including pregnant women and others experiencing pregnancy loss — have access to the full rights and protections for emergency medical care afforded under the law. This announcement follows President Biden’s executive order on reproductive health issued Friday.
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:
Section 1. Policy. Nearly 50 years ago, Roe v. Wade, 410 U.S. 113 (1973), articulated the United States Constitution’s protection of women’s fundamental right to make reproductive healthcare decisions. These deeply private decisions should not be subject to government interference. Yet today, fundamental rights — to privacy, autonomy, freedom, and equality — have been denied to millions of women across the country.
Anthem, 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. ConnectiCare Insurance Company, Inc. has filed rates for the individual market on the exchange.
Harvard Pilgrim Health Care and HPHC have decided to leave the CT market and will no longer offer new business small group health plans. They will only renew existing plans through the end of their appropriate plan years.
The 2023 rate proposals for the individual and small group market are on average higher than last year:
As I noted a couple of weeks ago, Sword of Damocles dangling over the. head of extending the enhanced premium subsidies temporarily included as part of the American Rescue Plan has been circling the runway in an on-again, off-again pattern for the past month or two.
I know I mangled several metaphors there, but the bottom line is that it's starting to look like Senate Democrats may end up bringing it in for a landing after all. Yesterday, via Benjy Sarlin & Sahil Kapur of NBC News:
Manchin weighs options for extending ACA funding to avert premium hikes
I'm about 1/3(update: make that 2/3) of the way through my Annual Individual & Small Group Market Rate Filing project, having analyzed & crunched the numbers for 18 36 states + DC. This seems like a good time to step back and see where things stand.
So far, I've compiled the preliminary unsubsidized average premium rate filings for both the ACA-compliant individual and small group markes in Akransas, Colorado, Connecticut, Delaware, DC, Georgia, Hawaii, Indiana, Kentucky, Maine, Maryland, Michigan, Minnesota, New York, Oregon, Rhode Island, Tennessee, Vermont and Washington State. It's important to remember that these are preliminary filings only--many of the carriers will have their final 2023 rate changes reduced, although in most cases they tend to be approved as is, and in some cases they're even increased beyond what the carrier originally requested.
It's also important to note that these 18 states + DC only represent around 30% of the total U.S. population...aside from New York, the other big states (California, Florida, Texas, Pennsylvania, etc.) haven't posted their 2023 filings yet.
Georgia's health department doesn't publish their annual rate filings publicly, but they don't hide them either; I was able to acquire pretty much everything via a simple FOIA request which was responded to within an hour of my asking.
There's one significant development apiece in Georgia's individual & small group markets:
INDIVIDUAL: A few years ago, Georgia's GOP Governor, Brian Kemp, put in a request to the Centers for Medicare & Medicaid Services (CMS) for what's known as a Section 1332 State Innovation Waiver. If approved, these waivers allow individual states to modify how the ACA operates in their state as long as they can prove that the changes would a) cover at least as many residents b) at least as comprehensively without c) increasing federal spending in the process.
Arkansas is a problematic state for many reasons, but I have to give their insurance dept. website high praise for posting their annual rate filings in a clear, simple & comprehensive fashion (which is to say, not only do they post the avg. premium changes for each carrier, they also post the number of covered lives for each, which is often difficult for me to dig up). Better yet, they also include direct links to the filing summaries and include the SERFF tracking number for each in case I need to look up more detailed info.
Hawaii only has two health insurance carriers serving the individual market, Hawaii Medical Service Assocation and Kaiser Foundation Health Plan. Both of them have submitted their proposed premium rate filings for 2023, and unlike most states so far this year, their initial requests are quite reasonable: Just a 2% average hike apiece.
Unfortunately, things are much spottier for Hawaii's small group market: I can only find the rate change & current enrollment filings for one of the 5 carriers offering small business plans, at 5.7%. This doesn't mean much without the data from the other carriers, however:
UPDATE 10/19/22: Both of Hawaii's individual market carrier filings have been approved as is, so that's a 2% average rate increase. On the small group market there's still some missing data but I was able to fill in some fields for both the preliminary and final rate filings:
The projected population consists of expected retention of existing policies and new sales. The sources of new entrants include the previously uninsured population, grandfathered and transitional policies voluntarily migrating to ACA-compliant plans, and previously insured populations from other markets or carriers. The morbidity adjustment reflects projected Anthem and market changes in morbidity, including changes driven by economic conditions and from the expiration of the enhanced ACA premium tax credits available under The American Rescue Plan Act (ARP) as of December 31, 2022. Membership projections reflect contraction similar to pre-ARP population in 2021. Exhibit E shows the morbidity factor.
Maine Health Insurers File Proposed Rates for 2023 Plan Year
Health insurance carriers in Maine's Individual and Small Group markets have filed proposed rates with the Maine Bureau of Insurance (the Bureau) for the 2023 plan year. June 27, 2022 was the deadline for the initial filing of plans and rates, but insurers may revise their filings through July 20, 2022.
The bad news is they don't include the number of enrollees for each carrier, and even the SERFF database filings don't include that information...yet. Fortunately, MNsure does provide a carrier breakout of the individual market...but this only includes on-exchange enrollment, which means PreferredOne (which only offers ACA plans off-exchange) isn't listed, nor are any off-exchange enrollees for the other five exchange carriers.
As for the small group market, the most recent hard enrollment data I have for that is from 2021, which means it's likely not terribly accurate anymore (especially since PreferredOne appears to be dropping out of the MN small group market entirely next year). In addition, UnitedHealthcare scrapped all of their sm. group offerings last year and replaced them with new ones, so I have no clue how many enrollees they have at the moment.
