We're heading into the home stretch now, with the only remaining "supersize" state, FLORIDA. FL has the largest exchange-based individual market enrollment, and the 2nd largest total individual market enrollment of any state in the country, surpassing California for a variety of local economic/demographic reasons. The Kaiser Family Foundation estimates that FL carriers would have to add about 25% to their Silver plan premiums in order to make up for CSR reimbursements if Trump pulls the plug and/or Congress doesn't formally appropriate them. Since 80% of FL exchange enrollees are on Silver plans, that translates to roughly a 20% additional "Trump Tax" for the CSR factor alone. Note that while none of the carriers mention the CSR issue (meaning they all assume the payments will be made), Molina does call out the individual mandate enforcement issues as being part of their 37.5% rate increase request. Unfortunately, they don't put a hard number on this.
In additon to color-coding their data by the political party of each District's Representative, I'm also adding my own spin on the data: Estimates of how many people currently enrolled in the individual market suffer from "pre-existing conditions" which would likely mean them either being denied coverage altogether if the ACA's Guaranteed Issue, Essential Health Benefits and Community Rating provisions were to be stripped (Alternately, these people would charged massively higher rates to the point of likely not being able to afford the policy).
...the assumption is that as long as insurance carriers either a) know they'll make a profit in a given market or b) think they'll make a profit at some point in the near future, they'll participate in that market, right?
However, that's not necessarily the case. As we saw last year in the case of Aetna, profitability itself doesn't necessarily guarantee participation. Aetna pulled out of 11 states, and while they were losing money on the indy market in most of them, there were at least 2 states (Pennsylvania and Florida) where they were making a profit, yet bailed anyway. In fact, in Florida, the only reason they were making a profit in the indy market was because of their exchange business (they were losing money off-exchange).
Initially, the story seemed to be about a man who railed against Obamacare while both taking absolutely no responsibility for failing to take advantage of the benefits of the law which he was entitled to and simultaneously blaming President Obama for the failure of his own GOP-controlled state to expand Medicaid under the law. Several people wrote up articles ripping Mr. Lang to shreds over his seeming hypocrisy, myself included.
As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.
My standard methodology applies:
Plug in the 2/01/16 QHP selections by county (hard numbers via CMS)
Project QHP selections as of 1/31/17 based on statewide signup estimates
Knock 10% off those numbers to account for those who never end up paying their premiums
Multiply the projected effectuated enrollees as of March by the percent expected to receive APTC subsidies
Then knock another 10% off of that number to account for those only receiving nominal subsidies
Whatever's left after that are the number of people in each county who wouldn't be able to afford their policy without tax credits.
In the case of Florida, assuming they hit 1.825 million exchange enrollees this year, it comes to a whopping 1.35* million people.
I appear to have something of a semi-exclusive here, if only because the Florida DOI isn't formally posting these documents on their website until tomorrow due ot the holiday weekend:
Office Announces 2017 PPACA Individual Market Health Insurance Plan Rates to Increase 19% on Average
TALLAHASSEE, Fla. – The Florida Office of Insurance Regulation announced today that premiums for Florida individual major medical plans in compliance with the federal Patient Protection & Affordable Care Act (PPACA) will increase an average of 19% beginning January 1, 2017. Per federal guidelines, a total of 15 health insurance companies submitted rate filings for the Office’s review in May. These rate filings consisted of individual major medical plans to be sold both on and off the Exchange. Following the Office’s rate filing review, the average approved rate changes on the Exchange range from a low of -6% to a high of 65%. This information can be located in the attached “Individual PPACA Market Monthly Premiums for Plan Year 2017*” document.
The Affordable Care Act's exchanges have not been a bust for every health insurer. Florida's Blue Cross and Blue Shield affiliate made a profit of almost a half-billion dollars on the ACA's new individual plans last year.
The substantial ACA exchange losses exhibited by large health insurers—such as Health Care Service Corp., Highmark, Humana and UnitedHealth Group—have emboldened the law's critics and worried investors about whether the new marketplaces will ever achieve sustainability.
Yet many other companies, including Medicaid insurers Centene Corp. andMolina Healthcare and now Florida Blue, have had no difficulties making money on the new ACA plans, which often have narrow networks of hospitals and doctors as well as high deductibles.
Fifteen health insurers want an average 17.7 percent increase in premiums for Affordable Care Act individual plans, Florida officials said Thursday — higher than last year’s approved average of less than 10 percent.
...In Florida, 15 companies also asked for an average 9.6 percent increase for small group plans, said Amy Bogner, spokeswoman for the state’s Office of Insurance Regulation.
The companies were not identified individually because they claimed trade secrecy, she said.
This may seem like common knowledge now, but in 2014, it felt like I was one of the only people who recognized that there were millions of people enrolling in ACA-compliant policies off of the ACA exchanges, directly via the insurance carriers themselves. My best estimate for 2014 was that in addition to the 7 million or so exchange-based individual market enrollees, there were another roughly 8 million people who enrolled off-exchange (although several million of those were in non-ACA compliant policies).
