Charles Gaba's blog

As I'm sure some readers have noticed, I haven't posted any updates since Friday, which is highly unusual for me, especially with open enrollment rapidly approaching. I'm afraid that due to an unfortunate coincidence of timing, I have an outside personal commitment which will be eating up a lot of my time for the next 4 weeks; as a result, expect posts to be lighter than usual.

Anyway, Hawaii's official 2017 approved rates came out the other day (thanks to commenter "M E" for the heads up):

Kaiser's 25.9% request was approved as is; HMSA's 43.3% was shot down originally; they later resubmitted it at 35%, which was then approved.

You may also notice that I've started making sure to include UNSUBSIDIZED in the headlines for all of these rate hikes. This is vitally important to remember, even if it's only relevant to around 50% of individual market enrollees.

Last year, the average full-price rate hikes approved by state regulators tended to be several percentage points lower overall than the increases requested by carriers. This year, there's been very little of that; in most case so far, the regulators have pretty much authorized the premium rate increases as requested by carriers...and in many cases have approved higher increases than requested. As a result, the overall national averages approved have been pretty close to the requests (around 24-25% nationally).

However, Nevada is an exception to this trend. Back in early June, the weighted average increases requested were just over 15% state-wide (this was confirmed by the NV DOI a month later). Yesterday, however, the DOI released the approved rate hikes, and I'm happy to report that they lopped about 1/3 off the average hikes:

I originally looked at the requested rate hikes in Kansas back in June; at the time, the weighted statewide average was roughly 35%.

While I haven't seen any press releases or news stories about it, when I looked at HealthCare.Gov's rate review database this morning, I saw that they have fianl (approved) rate increases listed for all of the Kansas listings. In most cases the requests were approved as is; in Coventry's off-exchange plans, however, are being increased more than requested, giving the following.

I should also note that according to Louise Norris, Medica is also entering the Kansas exchange for the first time, which means there's no "increase" to list since there's no current rates to compare them to.

I'm a little late on this, but the MNsure BOD held their monthly meeting on September 21st and provided some updated 2016 enrollment data.

To me the most noteworthy slide is the last one, which shows the effectuated exchange QHP enrollees for each month. While effectuated enrollment is likely down around 20% from the 12.7 million who had selected QHPs as of 2/01/16, Minnesota is showing a less dramatic drop-off (off around 16% from the 83,507 QHP selections as of 2/01).

My original estimate for the average unsubsidized rate hikes for Delaware's individual market back in June was 30.6%. Today the DE Dept. of Insurance issued their final approved rates, including the small group market:

Insurance Commissioner Karen Weldin Stewart today released Delaware’s Qualified Health Plan average rates for Plan Year 2017.

The Commissioner recommended approval of a 32.5 % average rate increase in the individual market for Highmark Blue Cross Blue Shield of Delaware. The approved average rate increase for the small group market for Highmark’s plans is 2.74%.

Aetna Life Insurance Company received an average of 22.8 % increase in the individual market and Aetna Health Insurance Company received an average increase of 23.6 %. In the small group market, Aetna Life received an average increase of 15.2 % and Aetna Health received an average increase of 19.7 %.

I mentioned a couple of weeks ago that Blue Cross Blue Shield of Oklahoma, which had originally asked for an already-ugly 51% average rate hike, had bumped that up to a jaw-dropping 76% ask. Well, earlier this week, they got it:

Obamacare premiums will raise a staggering 76 percent on average for Oklahoma residents, and the state's top insurance regulator says the state's insurance exchange set up by the law is on "life support."

Oklahoma's Insurance Department said on Tuesday that increases in individual marketplace plans will range from 58 percent to 96 percent.

"These jaw-dropping increases make it clear that Oklahoma's exchange is on life support," said Insurance Commissioner John Doak, in a statement. "Health insurers are losing massive amounts of money. If they don't raise rates they'll go out of business. This system has been doomed from the beginning."

Huh. OK, it looks like three of the ACA state-based exchanges have already launched their 2017 window shopping tools: Idaho, Maryland and California!

The other two announced that their 2017 offerings were open for business via press releases, but it looks like CoveredCA just quietly opened the doors without any fanfare. I stumbled across this by simply visiting the CoveredCA site and clicking the "Shop & Compare" link at the top, which now lists 2017 as the default Coverage Year (you can still choose 2016 if you need to enroll for the rest of this year via SEP). Plugging in some dummy info confirms that the plans are indeed set to start on 01/01/17.

On Monday, I thought that Your Health Idaho was first out of the gate with bringing their 2017 Window Shopping tool online. However, it looks like Maryland launched their all-new 2017 system the same day:

With less than one month until open enrollment begins, we want you to be armed with the knowledge you need to sign up or choose a new plan for 2017. You can now browse and compare prices online at MarylandHealthConnection.gov or on your phone or tablet through our new mobile app, Enroll MHC. Find the free app in the Play Store for Android or Apple’s App Store.
Here’s how to get started:

The ACA's Medical Loss Ratio rule requires insurance carriers to spend at least 80% of all individual market premiums on actual healthcare, as opposed to CEO bonuses, exotic junkets to Tahiti, marble columns in their corporate headquarters and the like. The way it works is pretty simple: If an insurance carrier ends up spending less than 80% of the premiums paid by their enrollees on actual healthcare claims in a given year, they have to pay the difference back to their customers in the form of a rebate check the following year. You can thank Senator Al Franken for this provision, and it's a good one..so good that nationally, carriers have had to return over $2.4 billion in excessive premiums to their enrollees over the past 4 years.

Unfortunately, as I noted two years ago:

So, the last day or so my email inbox & Twitter feed have been filling up with references to Bill Clinton's "Crazy System!" comments regarding the Affordable Care Act. I live in Michigan, but unfortunately couldn't make his Flint speech on Monday due to it being Rosh Hashanah.

Anyway, here's the part which made all the headlines:

Bill Clinton criticized President Barack Obama’s signature policy reform while on the stump for his wife, Democratic presidential nominee Hillary Clinton, calling Obamacare “the craziest thing in the world.”

Here's the problem with this: Clinton wasn't referring to the Affordable Care Act as a whole; he was specifically referring to people on the individual market who aren't receiving APTC assistance.

As I noted a couple of weeks ago: