California

Normally I write two separate annual premium rate change filing entries for each state: One when the preliminary/requested rate filings are submitted, and another one when the final/approved rates are published.

In the case of California, it turns out that the rate rview/negotiation process is...more complicated. The press release/report released by Covered California back in July referred to preliminary 2020 premiums only, but it turns out that Covered California exchange personnel had already completed all their negotiations before posting any numbers.

It also turns out (thanks to "Dena M." aka @HealthEDena) that in California, insurance policy premiums are not reviewed/approved by the state insurance department...but by an entirely different department called the Dept. of Managed Health Care, or DMHC.

*(Yes, I know, the District of Columbia isn't actually a state, and Vermont's mandate is...well, read on...)

As the 2020 Open Enrollment Period rapidly approaches (it starts November 1st nationwide...except for California, where open enrollment is starting on October 15th), it's time to start getting the word out about some important things to keep in mind this fall.

One of the most critical things to remember for residents of California, the District of Columbia, Massachusetts, New Jersey, Rhode Island and Vermont is that each of these states* has reinstated an individual healthcare coverage mandate law/ordinance to replace the federal ACA mandate penalty which was zeroed out by Congressional Republicans back in December 2017. This means that if you live one one of them, unless you receive an affordability, hardship or other type of acceptable exemption, you'll be charged a financial penalty when you file your state/district taxes for 2020 in spring 2021 if you don't have qualifying healthcare coverage.

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:

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

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..

And yet, here we are:

California’s Initiatives Will Lead to Hundreds of Thousands Gaining Health Care Coverage With Lower Premiums and New Financial Help

As I've noted several times, one of the biggest flaws in the Affordable Care Act is a very simple one on paper: The Subsidy Cliff. People who enroll in ACA exchange policies are entitled to financial assistance on a sliding scale...but only if their household incomes fall between 100-400% of the Federal Povery Level. Those below the lower threshold (actually, below 138% FPL) are expected to enroll in Medicaid, but those over the upper threshold of 400% FPL (around $50,000/year for a single person, roughly $103,000/year for a family of four) are completely on their own.

Here's the current federal premium subsidy formula (the precise premium cap percentages change slightly from year to year...and the Trump Administration is even messing with that a bit, so I'm not sure what it'll be in 2020):

Yesterday I noted that both houses of the California state legislature (Assembly and Senate) voted to expand Medi-Cal (the state's Medicaid program) to anywhere between 147,000 - 175,000 undocumented immigrants (young adults age 19 - 25 and seniors over 65), entirely funded using state dollars.

It turns out that this was only part of a marathon voting session yesterday over the past few weeks. Either the state Senate, Assembly or both have also voted to pass three a bunch of other healthcare-related bills (I've included simple descriptions of each):

BREAKING: California Assembly passes our #AB1246(@Limon) to align consumer protections for all Californians, including those in large group coverage. #Care4AllCA

Back in 2016, California passed an important bill which allowed undocumented children to enroll in the state's Medicaid program (called Medi-Cal). The costs are borne entirely by the state, since federal law currently doesn't allow federal taxpayer dollars to be used to pay for Medicaid...although, I should note, this isn't entirely true:

Federal law generally bars illegal immigrants from being covered by Medicaid. But a little-known part of the state-federal health insurance program for the poor has long paid about $2 billion a year for emergency treatment for a group of patients who, according to hospitals, mostly comprise illegal immigrants.

The lion’s share goes to reimburse hospitals for delivering babies for women who show up in their emergency rooms, according to interviews with hospital officials and studies.

via Covered California:

Covered California Announces Grants to Community-Based Organizations Across California in Preparation for 2020 and Beyond

• Community-based organizations and clinics will receive a total of $6.3 million in grant funding to help people enroll in quality health care coverage.

• The 105 organizations reflect California’s diversity and will target populations that are hard to reach, uninsured and eligible for financial help through Covered California.

• Approximately 89 percent of Californians live within a 15-minute drive of these community-based organizations.

Covered California announced Friday that it intends to partner with 105 community-based organizations to educate consumers about their health care options, offer in-person enrollment and renewal assistance and provide ongoing support on how to get the best value from their health plan. The Navigator grants announced are part of Covered California’s ongoing commitment to support robust marketing and outreach, including working with trusted organizations throughout the state to help hard-to-reach people understand this new era of health care.

Back in January, I noted that California Governor Gavin Newsom was proposing a stripped-down version of one of the most important ACA 2.0 provisions I've been pushing for years now: Raising the ACA's APTC subsidy income eligibility cap and beefing up the underlying subsidy formula.

At the time, he was

Well, the latest official revision to the proposed CA 2019 - 2020 state budget has been released, and not only are both the mandate reinstatement and the enhanced subsidies included, the subsidies have actually been increased a bit more than Newsom was originally proposing:

EXPANDED SUBSIDIES TO PROMOTE AFFORDABLE COVERAGE

To improve affordability and access to health care, the Governor's Budget proposed subsidies to help more low and middle class Californians afford health coverage through Covered California.