UPDATE 8/20/19: I originally posted this in late June. Since then, there have been several important developments: Joe Biden and Kamala Harris have formally rolled out their own official healthcare overhaul plans, with Harris splitting off from Bernie Sanders' fully-mandatory "Medicare for All" bill to her own variant, which keeps the name but has similarities to "Medicare for America". Also, Eric Swalwell and John Hickenlooper have dropped out (ok, not every development was major).
I've updated the post to reflect these changes, while also updating the table graphic, which I've also simplified by removing Swalwell, Hickenlooper and most of the other bottom-rung candidates. I'm keeping everyone who's qualified for the September/October debates as of this writing, plus Tulsi Gabbard, Jay Inslee and Tom Steyer, each of whom is partly qualified.
Sen. Bernie Sanders changes how Medicare-for-all plan treats union contracts in face of opposition by organized labor
Sen. Bernie Sanders announced a key change to his Medicare-for-all insurance plan Wednesday, a move meant to assuage fears on the part of organized labor, whose support is being heatedly sought by all of the candidates for the Democratic presidential nomination.
Back in June, the New Mexico Insurance Dept. posted the preliminary 2020 rate change filings for the ACA individual and small group markets. At the time, the vcarriers were requesting the highest average premium increase in the country for next year: An increase of 13.0%.
The main source of this double-digit hike was New Mexico Health Connections, one of just a handful of original ACA Co-Op carriers to survive. They were requesting a whopping 30% average rate hike for 2020, and with over 1/3 of the market share, this was more than enough to drag the statewide average up. A second carrier, Presbyterian, only sells off-exchange but was requesting a 16.3% increase which also pushed the average up.
Well, today the approved rate filings have been released, and there's several eyebrow-raising developments.
If you've been following me on Twitter lately, you know that I've grown increasingly frustrated with two aspects of the Democratic Presidential primary process in recent months:
First, Sen. Elizabeth Warren's seeming 180-degree turnaround from her March stance on achieving universal healthcare coverage ("a lot of different pathways") to her more recent rhetoric (a simple, point-blank "I'm with Bernie on Medicare for All.") at the first debate in late June. At the time, I assumed this was simply due to the absurdly short time constraints and the terrible framing of the question by the moderators, but it's mid-August now and so far she seems to be sticking to her guns re. being 100% onboard with BernieCare.
Second, the almost complete ghosting of the dangers to and fixes needed for the the ACA itself regardless of what the Next Big Thing ends up being (whether Medicare for All, Medicare for America, Choose Medicare, Medicare X, etc).
I wrote last month that Highmark BCBS, the sole individual market carrier operating in Delaware, has requested a 5.8% average premium reduction for 2020. In the press release from the state insurance department they noted:
It is important to note, that the proposed rate decrease is unrelated to Delaware’s intended submission of a 1332 Waiver to establish a reinsurance program. If the application process is successful, the actuarial consultant’s projections are correct, and the State of Delaware secures adequate funding, the waiver program may decrease rates by an additional 20%.
Context: Political partisanship can influence whether individuals enroll in government programs. In particular, Republicans, ceteris paribus, are less likely to enroll in Affordable Care Act (ACA) individual marketplace insurance than Democrats. The logic of adverse selection suggests low uptake among Republicans would generally put upward pressure on marketplace premiums, especially in geographic areas with more Republican partisans.
Long-time readers may recall that back during the first insane Open Enrollment Period in early 2014, I was constantly screamed at by Republicans demanding to know "BUT HOW MANY HAVE PAID???"
Ffor several months, conspiracy theories abounded about how many of those who selected Qualified Health Plans (QHPs) from the ACA exchanges actually followed through and paid their first monthly premium, thus actually being enrolled in effectuated policies.
The Trends in Subsidized and Unsubsidized Enrollment Report
The report shows that people who do not qualify for APTC continue to be priced out of the market. Following a decline of 1.3 million unsubsidized people in 2017, another 1.2 million unsubsidized people left the market in 2018. These enrollment declines among unsubsidized enrollees coincided with increases in average monthly premiums of 21 percent in 2017 and 26 percent in 2018.
Long-time readers know that I've repeatedly complained about how confusing and difficult it is to try and keep track of all the different divisions, branches, subsidiaries and rebrandings of various health insurance carriers. For instance, the Kansas small group market featurs "Blue Cross Blue Shield of Kansas City" and "Blue Cross Blue Shield of Kansas, Inc.", and in past years I'm pretty sure there was a third "Blue Cross Blue Shield".
In some cases there are multiple names for the same parent company. Here in Michigan, we have "Blue Cross Blue Shield of Michigan", which covers PPOs, and "Blue Care Network", which covers HMOs...but which is simply a division of BCBSM. You get the idea. Keeping track off all this can make my annual premium rate filing project (which I just wrapped up the first phase of) extremely difficult.
Yesterday, the Centers for Medicare & Medicaid released several important data-heavy reports, featuring a lot of month-by-month, state-by-state and year-by-year ACA enrollment data. There's a lot of data to dig into, so I'm breaking this into several posts.
First up: Average monthly effectuated enrollments. It's important to understand the difference between someone selecting a Qualified Health Plan (QHP) from one of the ACA exchanges during the Open Enrollment Period and someone actually being enrolled in an effectuated policy...that is, just because you sign your family up for a policy on HealthCare.Gov (or a state-based exchange), you aren't considered effectuated until you actually pay for the policy.
I've finally analyzed and posted my 2020 premium rate filing analyses for all 50 states (+DC), so this seems like a good time to take a look at the big picture. The table below summarizes the preliminary filings for every state, with four exceptions where the approved (or at least mostly-approved, in the case of Oregon) average rate changes are listed. Nationally, it looks like insurance carriers are only requesting an average premium increase of about 0.6% for the ACA-compliant individual market in 2020. A few caveats:
Vermont is the fourth state to announce their approved 2020 ACA individual/small group market premium rate changes. VT (along with Massachusetts and DC) has (wisely, in my opinion) merged the risk pools for the two markets into one, meaning I have to plug the numbers in differently on my spreadsheet.
Back in mid-May, my initial analysis of the two carriers participating in both Vermont markets put the weighted average rate increase being requested at an even 13.0% statewide: Blue Cross Blue Shield of VT was requesting a 15.6% increase, while MVP Health Care asked for a 9.4% bump.