As regular readers know, I'm currently in the thick of my state-by-state analysis of the requested, weighted average rate changes for 2017 by insurance carriers for the entire ACA-compliant individual market. As of this writing, the overall average looks like it's just a hair over 20% across 28 states + DC.
Does the first sentence above include a lot of clarifiers? Yes, yes it does...and with good reason. I try to be very specific when I discuss this stuff, because it's very easy to get confused about what a given number is actually referring to.
For instance, a few days ago, Avalere Health released their own analysis which concludes that the average requested/proposed premium rates are around 12%. If I left it at that, you might think that either my average is 8 percentage points too high...or that Avalere's is 8 points too low.
Can I first say that I absolutely love the way Nevada's rate filing database is set up, especially their (apparently proprietary and mandatory) filing format system?
Unlike the standard SERFF database, which is comprehensive but also can be confusing as hell, Nevada's system is simple, clean, easy to navigate and, most of all, every single carrier filing listed displays the number of current enrollees clearly.This is a huge pet peeve of mine, which is understandable given what I'm trying to do here!
OK, that said, here's what things look like in the Silver State:
This is really just a summary of my last 4 posts. I've combed through the SERFF databases for every state which uses the system for rate filings, and while very few have the actual 2017 rate filing requests listed yet, at least 4 of them have official individual market exit letters submitted for 2017 from Jane Rouse, the Product Compliance Process Owner for Humana Insurance Co:
This list may grow as additional state filing data and/or press releases come out from Humana, but assuming these are the only 4 states Humana is bailing on, the news isn't quite as bad as it appears at first.
To be clear, I'm not saying this is a good development; when you combine it with the recent UnitedHealthcare Dropout Odometer it's more of a drip-drip-drip sort of thing. But it isn't disasterous for the exchanges either (at least not yet).
UPDATE: I've been informed by a reliable source that Humana is also dropping out of the individual market in Nevada next year, although I don't have any actual enrollment data there. Humana is not currently participating on the Nevada exchange, however, so any dropped enrollments would be OFF-exchange only. In fact, I'm pretty sure that the only individual market enrollees Humana has in Nevada are grandfathered policies anyway, so the numbers should be pretty nominal there.
As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.
If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.
About a month ago, I crunched Nevada's individual and small group rate hike numbers and concluded that the overall weighted average hike in the Silver State next year (assuming everyone stays put and doesn't shop around) will be roughly 9.6% on the individual market and just 5.3% for small businesses.
Now, it's not the lower rate which caught my eye; the 8.7% figure only includes exchange-based carriers, of which there's only three this year, versus the dozen or so who operate throughout the state (there are 9 more insurance carriers who are only operating off of the exchange).
What I'm puzzled by is this part...which also includes some good news:
Nevada's insurance dept. rate filing website has an extremely user-friendly, interactive website which lets you drill down and find exactly what you're looking for: Individual or Small Group policies, HMO or PPO, Under Review or Reviewed. From what I can tell, there are 12 companies offering individual policies in 2016 (a 13th, the Nevada Health COOP, just announced that they've gone belly-up and are being dissolved, meaning a minimum of 16,000 Nevadans will have to switch to a different insurance carrier).
The requested rates were approved for 8 of the companies, but were reduced significantly for Aetna (from 21-24% down to 15%). Here's what it looks like in the end:
The Small Group market is faring somewhat better, with just a 5.3% overall weighted average increase:
After yesterday's ugly news about Alaska's private policy rate hikes, this is welcome relief:
Judge says Alaska Medicaid expansion can go ahead Tuesday
An Anchorage trial court judge Friday said that Alaska Gov. Bill Walker’s administration can expand the Medicaid health care program starting next week, dismissing a request by the state Legislature to temporarily block enrollment while attorneys fully argue lawmakers’ legal challenge.
In a 45-minute opinion delivered from the bench, Pfiffner rejected a series of arguments by the Legislature that starting expanded Medicaid enrollment Tuesday was so problematic that it should be put on hold while the Legislature’s lawsuit proceeds.
The actual lawsuit will still proceed, but this is still great news for up to 40,000 Alaskans.
The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:
The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.
Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.
This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).
The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.
This is a nice article giving a status report on how things are going in Nevada (which, along with Oregon, scrapped their own ACA exchange last year and moved over to Healthcare.Gov). It includes a straightforward enrollment number: "more than 10,000" right in the title.
However, the wording of the article makes it unclear as to whether that number includes unsubsidized QHP enrollments or just the 85% or so who qualify for tax credits:
Compared to last year’s rollout, Nevada Health Link is showing stronger numbers so far in this year’s open enrollment.
More than 10,000 Nevadans have enrolled for subsidized health care plans through the state insurance program.
The enrollment numbers are good news and show signs of improvements at Health Link, Nevada’s online health care market.
At this time last year, only 6,000 people had signed up. It was Health Link’s first year online.
The comparison number below (6,000 last year) make it sound like 10K includes everyone, but the "subsidized" caveat makes it sound like it doesn't, in which case the total number should be roughly 11,700 or so.
I'll go with the lower 10K number for now, however.
