2018 MIDTERM ELECTION

Time: D H M S

UPDATED 6/22/18: Added Indiana and Iowa to the table.
UPDATED 6/25/18: Added Florida, Kentucky, Ohio and Texas* to the table
*(Texas only has about 1/3 of the total ACA individual market accounted for, so it could easily change)
UPDATED 7/3/18: Added Montana and Georgia to the table
UPDATED 7/13/18: Added Tennessee, updated Texas to add BCBSTX
UPDATED 7/16/18: Added Colorado
UPDATED 7/17/18: Added Nevada
UPDATED 7/19/18: Added California
UPDATED 7/20/18: Added Connecticut

I noted a few weeks ago that the Oregon Division of Financial Regulation had issued their preliminary rulings on 2019 individual and small group market rate filings. At the time, they had whittled down the average requested indy market rate changes from 10.5% down to 7.8%, while leaving the requested small group rate changes the same (around 5-6% on average).

However, they also made sure to note that there was still one more round of reviews to go through before final, approved 2019 rate changes were locked in. Yesterday the OR DFR came out with those, making only slight further changes on the individual market (they bumped Kaiser up by 0.2 points while lowering Providence by 1.1 points). Providence has twice as many enrollees as Kaiser, so this resulted in an overall, weighted statewide average rate increase of 7.3%.

The final small group market rates were changed a bit more--Providence's increase was cut in half, while UnitedHealthcare's hike was cut by a couple of points.

This just in from the Connecticut Insurance Dept...

The Connecticut Insurance Department is reviewing 14 health insurance rate filings for the 2019 individual and small group markets. The filings were made by 10 health insurers for plans that currently cover about 293,000 people.

Two carriers – Anthem and ConnectiCare Benefits Inc. (CBI) – have filed rates for both individual and small group plans that will be marketed through Access Health CT, the state-sponsored health insurance exchange.

The 2019 proposed rate increases for both the individual and small group market are, on average lower, than last year:

Less than one month ago:

...back in February...the executive board of the DC ACA exchange unanimously voted to reinstate the mandate. It didn't mean all that much at the time, however, because the authority to reinstate it actually belongs to the DC Council.

Well, thanks to Mr. Levitis for the heads up. If you scroll down to Page 138, you can see that the DC Council has indeed done just that:

TITLE V. HEALTH AND HUMAN SERVICES
SUBTITLE A. INDIVIDUAL HEALTH INSURANCE REQUIREMENT

Sec. 5001. Short title.
This subtitle may be cited as the “Health Insurance Requirement Amendment Act of 2018”.

Sec. 5002. Title 47 of the District of Columbia Official Code is amended as follows:
(a) The table of contents is amended by adding a new chapter designation to read as follows:
“51. Individual Taxpayer Health Insurance Responsibility Requirement”.
(b) A new Chapter 51 is added to read as follows:
“CHAPTER 51. INDIVIDUAL TAXPAYER HEALTH INSURANCE RESPONSIBILITY REQUIREMENT.

California's contains over 12% of the entire U.S. population, around 13% of total ACA exchange enrollment and nearly 16% of the total ACA individual market. As such, when they make any announcements about their ACA exchange policies (or in this case, 2019 premiums), it's a pretty big deal for the national averages.

Today, Covered California, the largest state-based ACA exchange, announced their proposed 2019 ACA premium changes:

Covered California Releases 2019 Individual Market Rates: Average Rate Change Will Be 8.7 Percent, With Federal Policies Raising Costs

 

NOTE: I'll be expanding on explainers for some of the items below over time, but I wanted to make sure this got out well before the August 7th primary.

Dear Democratic candidates for Michigan State House, State Senate or Governor this November:

If you're familiar with me and this site, you probably know three things about me:

  • 1. I strongly support achieving Universal Healthcare coverage, and I'd ideally prefer to utilize some sort of Single Payer system as the payment mechanism to do so.

 

via Amy Lotven of Inside Health Policy:

Update: The court has instead opted to dismiss the case; but states can bring action again if circumstances change i.e. Admin blocks silver-loading in 2020 and beyond. IHP story TK @nicholas_bagley @charles_gaba taking comments ! https://t.co/cPHJlmehsH

— Amy Lotven (@amylotven) July 18, 2018

She's referring to this:

Dem AGs Ask Court To Put CSR Case On Hold In Light Of Silver-Loading

This just in via email...

MNsure again giving Minnesotans more time to shop for health coverage for 2019
Minnesotans will have an extra month to shop for coverage again this year

ST. PAUL, MN--Today MNsure announced the dates during which Minnesotans will have time to shop for 2019 health coverage. Open enrollment will begin on Nov. 1, 2018, and run through Jan. 13, 2019. This is nearly a month longer than the federal open enrollment period that runs from Nov. 1 to Dec. 15. As a state-based marketplace, MNsure has authority to supplement the upcoming federal open enrollment period with a special enrollment period to give Minnesotans more time to shop.

"Shopping for health coverage is a complex process, and Minnesotans rely on the free in-person assistance offered by MNsure’s assister network," said acting CEO Nate Clark. "This year our assisters face additional challenges given the amount of change coming to Minnesota’s Medicare plans. The extra time to shop will ensure that all MNsure consumers who need it will get that vital assistance."

A few days ago I noted that Blue Cross Blue Shield of Tennessee, which holds over 50% of TN's ACA-compliant individual market, specifically noted in their individual market rate filings that while they're lowering rates by 10.9% on average in 2019, they had been planning on lowering rates considerably more prior to the bombshell announcement that CMS has decided to "freeze" Risk Adjustment fund transfers for an unknown period of time. Specifically:

“Our rate reduction would have been larger, but we had to account for added uncertainty in our rates due to indefinite suspension (the U.S. Centers for Medicare and Medicaid Services) placed on risk adjustment transfers between insurers,” said , said Mary Danielson, a BCBST spokeswoman. “Again, we were planning a larger reduction – around 18 percent – but needed to factor in the prospect of greater costs for 2019.”

So, last night this happened:

Hmmm...the wording here is interesting: “Improved and expanded” Medicare for All. If it’s “for all” isn’t “expanded” redundant? Or is this a nod towards “for all who want it”? Cc @colinb1123

We‘re fighting for Improved & Expanded Medicare for All.

We‘re fighting for college + trade school without crushing debt.

We‘re fighting for dignified retirement for our elders, and a Green New Deal for our children.

We’re here to fight for our future:https://t.co/piU7pXIL1u

— Alexandria Ocasio-Cortez (@Ocasio2018) July 18, 2018

— Charles Gaba (@charles_gaba) July 18, 2018

I’m not slamming her here, I’m just curious because that’s the first time I’ve heard that particular phrasing surrounding it by staunch M4A advocates.

Breaking out of Nevada...

The cost of plans through Nevada’s health insurance exchange are anticipated to only increase by an average of 1.9 percent next year in what the state’s insurance commissioner said is the lowest proposed rate increase from insurance companies since the Affordable Care Act went into effect in 2014.

The announcement, made by the Division of Insurance late Tuesday morning, comes amid ongoing uncertainty about the impact that Congress’s repeal of the Affordable Care Act’s individual mandate and federal rule changes for two types of non-ACA-compliant health plans will have on the individual market as a whole. Insurance Commissioner Barbara Richardson cautioned that the proposed rates are subject to change based on any action by the federal government and said the division is working “diligently” to review the proposed rates from insurance companies.

That 1.9% figure is slightly misleading, though, because...

This year, thanks to their reinsurance program, ACA individual market premiums dropped by around 23.6% on average, from a whopping $1,040/month to "only" $795/month per enrollee.

HOWEVER, they would have dropped about 4.5 percentage points more if not for Trump cutting off Cost Sharing Reduction reimbursement payments, or roughly $560/year per enrollee. AK averaged around 16,000 effectuated ACA-compliant individual market enrollees per month in 2017, so that amounts to right around $8.9 million total. 6,930 enrollees qualify for CSR assistance this year, so that averages around $1,280 apiece in CSR help, which sounds about right to me.

Last fall I wrote a lot about how different states would be dealing with the tens of millions of dollars in losses they were facing after the Trump Administration decided to cut off Cost Sharing Reduction (CSR) reimbursement payments to them. As a quick reminder, there basically four (or five, depending on your POV) options available to each carrier and/or state insurance commissioner for dealign with CSR costs for 2018:

  • No Load: They could gamble that the CSR problem would be resolved and the payments would be made after all (i.e., they would price normally).
  • Broad Load: They could spread the CSR cost out evenly across all of their 2018 ACA policies, on exchange & off.
  • Silver Load: They could load the CSR costs onto all Silver plans only (both on & off exchange).
  • Silver Switcharoo: They could load CSR costs onto all on-exchange Silver plans only, while also creating "mirror" Silver plans off-exchange without any CSR load.
  • Mixed Load: Each insurance carrier could choose whichever of the other 4 strategies they wanted to and let the chips fall where they may. Not sure if this really counts as a "strategy", since it's more or less "all of the above".

Via the Colorado Division of Insurance:

DENVER (July 13, 2018) – The Colorado Division of Insurance, part of the Department of Regulatory Agencies (DORA), today released preliminary information for proposed health plans and premiums for 2019 for individuals and small groups. Colorado consumers can file formal comments on these plans through August 3.

2018 Companies Return for 2019
The same seven companies that offered on-exchange, individual plans are returning for 2019 - Anthem (as HMO Colorado), Bright Health, Cigna Health and Life, Denver Health Medical Plans, Friday Health Plans, Kaiser Foundation Health Plan of Colorado and Rocky Mountain HMO. And like in past years, this means that all counties in Colorado will have at least one on-exchange company selling individual health plans.

 

Over at the Brookings Institute, there's a big wonky forum this morning called (De)stabilizing the ACA’s individual market: A view from the states. The panelists include several of my own healthcare heroes: Louise Norris, Brad Wright, Lynn Blewett, Cynthia Cox, Sabrina Corlette and Matt Fiedler:

The Affordable Care Act (ACA), through the individual health insurance markets, provided coverage for millions of Americans who could not get health insurance coverage through their employer or public programs. However, recent actions taken by the federal government, including Congress’s repeal of the individual mandate penalty, have led to uncertainty about market conditions for 2019. Market stabilization is currently the most critical regulatory issue that public policy officials are facing under the private insurance component of the ACA.

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