Almost exactly ten years ago, in the federal National Federation of Independent Business v. Sebelius case which was the first of several high-profile federal lawsuits which attempted to eliminate or cripple the Patient Protection & Affordable Care Act, the U.S. Supreme Court spared the ACA...mostly:

The Supreme Court, in an opinion written by the Chief Justice, John Roberts, upheld by a vote of 5–4 the individual mandate to buy health insurance as a constitutional exercise of Congress's Taxing and Spending Clause (taxing power). A majority of the justices, including Roberts, agreed that the individual mandate was not a proper use of Congress's Commerce Clause or Necessary and Proper Clause powers, although they did not join in a single opinion. A majority of the justices also agreed that another challenged provision of the Act, a significant expansion of Medicaid, was not a valid exercise of Congress's spending power, as it would coerce states to either accept the expansion or risk losing existing Medicaid funding.

via the Washington Office of the Insurance Commissioner:

Fourteen insurers request average 7.16% rate increase for 2023 individual health insurance market

OLYMPIA, Wash. – Fourteen health insurers filed an average requested rate increase of 7.16% for Washington's individual health insurance market. The plans and proposed rates are currently under review and final decisions will be made this fall.

"More than two hundred thousand people in Washington state get their health coverage through our individual market,” said Insurance Commissioner Mike Kreidler. “It’s critical they have choices for meaningful and affordable coverage. Fourteen insurers have filed plans for next year, and while the choices vary depending on where you live, our market is thriving. I know that premiums and cost-sharing are still high for many, especially those who don’t qualify for subsidies, and we need to do more to address the underlying costs drivers of health care.”

via the Oregon Division of Financial Regulation:

Salem – Oregon consumers can get a first look at requested rates for 2023 individual and small group health insurance plans, the Oregon Department of Consumer and Business Services announced today.

In the individual market, six companies submitted rate change requests ranging from an average 2.3 percent to 12.6 percent increase, for a weighted average increase of 6.7 percent. In the small group market, nine companies submitted rate change requests ranging from an average 0 percent to 11.6 percent increase, for a weighted average increase of 6.9 percent. Our initial review has found that insurers have identified inflation, medical trend, and enrollment changes as factors in the proposed increases. See the attached chart for the full list of rate change requests.

via the Maryland Insurance Administration:

Health Carriers Propose Affordable Care Act Premium Rates for 2023

Public Invited to Submit Comments

BALTIMORE – The Maryland Insurance Administration (MIA) has received the rate filings containing the proposed 2023 premium rates for Affordable Care Act (ACA) products offered by health and dental carriers in the Individual, Non-Medigap (INM) and Small Group (SG) markets.

The carriers’ requested increases are reviewed by the MIA and rates must be approved by the Commissioner before they can be used. Before approval, all filings undergo a comprehensive review of the carriers’ analyses and assumptions. By law, the Commissioner must disapprove or modify any proposed premium rates that appear to be excessive or inadequate in relationship to the benefits offered, or are unfairly discriminatory. The MIA will hold a public hearing on the ACA proposed rates in July and expects to issue decisions in September 2022.

I've been posting weekly looks at the rate of COVID-19 cases & deaths at the county level since the point at which every U.S. adult could theoretically have received 2 COVID vaccination doses nearly a year ago, broken out by partisan lean (i.e, what percent of the vote Donald Trump received in 2020), as well as by the vaccination rate of each county in the U.S. (nonpartisan).

For a long time I used July 1st, 2021 as my start point, but in December I decided to back this up to May 1st, 2021 instead. Pinning down an exact date for this is a bit tricky since a) different populations were made eligible at different points in 2021, and b) it takes 3-4 weeks after getting your first vaccination dose before you can get the second one, but May 1st is what I've finally settled on. This doesn't really change things much, however.

As always, here's my methodology:

Methodology reminders:

• 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:
  • For Vermont , Virginia and West Virginia, I'm using data from the COVID Act Now Risk & Vaccine Tracker database

I originally wrote about this issue back in 2017.

As explained in this Health Affairs article by Katie Keith and Timothy Jost:

The final Senate compromise, which was adopted as part of the ACA, largely reinforces the Hyde Amendment, which has been included in annual Congressional appropriations legislation since the 1970s and prohibits the use of federal funds for abortion services unless the pregnancy is a result of rape or incest, or would endanger the woman’s life (non-Hyde abortions).

The ACA allows the coverage of abortion services through the marketplaces but includes a number of restrictions and requirements that insurers must follow before covering non-Hyde abortions. Many, though not all, of these restrictions are outlined in Section 1303 of the ACA, which includes specific rules related to the coverage of abortion services by Qualified Health Plans (QHPs) and has been the subject of previous litigation. In particular, Section 1303:

One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).

I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):

(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.

And here...we...go...

Every year, I spend months painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

I haven't written much about the ACA's Basic Health Plan (BHP) program for awhile, aside from noting that it's well past time for the Centers for Medicare & Medicaid Services (CMS) to start including BHP enrollment in their official Open Enrollment Period reports, seeing how over a million people in Minnesota & New York now have healthcare coverage via BHP policies.

As a refresher, here's Louise Norris' summary explainer:

Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.