Kansas House fails to override Brownback Medicaid expansion veto
The effort to expand Medicaid in Kansas fell apart Monday as the House failed to override Gov. Sam Brownback’s veto of a bill that would have expanded the health care program to thousands of low-income people in the state.
The 81-44 vote, three shy of the 84 needed to overcome the governor’s opposition, effectively ends the Medicaid expansion push in Kansas after it successfully passed both chambers with bipartisan support earlier this year.
That was then. This is now. Kansas now has a Democratic governor who supports Medicaid expansion, and yesterday this happened (via Jim McLean of the Kansas News Service):
Premium Rates for Individual and Small Group Markets Individual plan premium rates may vary by age, rating area, family composition and tobacco usage. For example, a person living in Manhattan, KS (rating area 3) may pay a different rate than someone living in Pittsburg, KS (rating area 7) based on the claims data by rating area. A map of the counties included in each rating area is provided on the next page. Kansas is an effective rate review state, which means the actuarial review is conducted by the Kansas Insurance Department. KHIIS (Kansas Health Insurance Information System) claims data is utilized during the rate review process to verify the claims experience submitted by the companies. The following table provides details regarding the average requested rate revisions for companies writing individual policies in Kansas. Rate increases will be partially offset for individuals receiving a premium tax credit.
Kansas is pretty frustrating. There's only three carriers offering ACA individual market policies, but two of the three have heavily redacted actuarial memos, so I don't know what their market share is...and the same two were new (or "semi-new") to the exchange this year so I can't even use last year's effectuated enrollment as a guideline. In light of that, I had to split the estimate right down the middle to get an estimated overall market share.
In addition, Medica is the only one of the three to specifally mention mandate repeal and/or #ShortAssPlans as a contributing factor; that's also redacted in the filings for the other two. Therefore, instead of assuming 2/3 of the Urban Institute's sabotage projection, I'm being extra-cautious and assuming just half (9.6% instead of 19.2%). This gives a rough statewide average increase of around 6.1%, which would likely be closer to a 3.5% premium reduction without mandate repeal and short-term plan expansion.
I've trashed CMS Administrator Seema Verma many times for her callous and backward-logic driven push to impose pointless, counterproductive work requirements on ACA Medicaid expansion enrollees. However, it appears that even she has her limits when it comes to treating people terribly:
The Trump administration has drawn a red line on Medicaid cuts. There are some proposals that the Centers for Medicare and Medicaid Services won’t approve.
In a letter on Monday, CMS Administrator Seema Verma told Kansas officials that her agency would not approve the state’s request to impose lifetime limits, which would have capped a person’s eligibility at three years, after which they could no longer be covered by the program.
Verma noted that the administration had approved proposals by other states to cut off benefits for Medicaid enrollees only if they fail to meet certain work requirements.
Ambetter ("Sunflower State") is new to the state, so there's no "rate hikes" to speak of. My confusion was regarding BCBSKS, which is already on the KS exchange but didn't appear to submit any actual "rate change" request last time I checked. Louise Norris has cleared up this mystery:
As I noted back in June, there are 3 carrers on the KS individual market this year: Medica, Blue Cross Blue Shield of Kansas Solutions and Blue Cross Blue Shield of Kansas City. Any confusion between the BCBS names was made moot, however, as BCBS of KC announced they were dropping out of the indy market anyway.
That leaves Medica and BCBSKS, both of whom filed plans to stay on the market...but only Medica appears to have actually submitted rate requests, for a mere 7,600 enrollees:
Between updating the "Who could lose coverage" graphics, prepping for my town hall thing last night and updating the 2018 Rate Hike project, I've gotten way behind on my "Who's saying 'screw rate hikes, I'm just gonna bail completely next year' updates. Let's take care of that now, OK? The first three updates are courtesy of Louise Norris writing for healthinsurance.org; the fourth is vai Kimberly Leonard for the Washington Examiner:
Insurers in Idaho had to submit forms for 2018 plans by May 15, but they have until June 2 to file rates. Mountain Health CO-OP, SelectHealth, PacificSource and Blue Cross of Idaho all filed forms to continue to offer Your Health Idaho plans in 2018.
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.
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.
The good news about Kansas is that 5 of the 6 carriers which have submitted 2017 individual market rate filings included their current enrollment totals in a clear, easy to see format...and the 6th one is (once again) "Freedom Life" which, judging by the dozen other states they've popped up in, almost certainly has only 1 or 2 enrollees (or none at all) anyway.
The bad news is...well, the requested rate hikes are pretty ugly: About 35.3% on weighted average.
Also, is it really necessary for Blue Cross Blue Shield to operate under three nearly-identical names? Really?
