END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

MAINE: 2016 Rate Request: 0.7% weighted average increase

This may seem a bit antlclimactic after today's big California news...unless you happen to live in Maine.

A big shout-out to Amy Fried for the heads up re. this story about Maine's 2016 rate requests:

Most Mainers buying Affordable Care Act insurance will see modest increases in their premiums for 2016, below the national average and much lower than the double-digit increases projected in some cities by a recent study of initial rate filings.

About 80 percent of the 75,000 Mainers purchasing ACA marketplace insurance have a plan through Lewiston-based Community Health Options – formerly Maine Community Health Options. The ACA marketplace, operated on the Web as healthcare.gov, is where those without insurance – often part-time or self-employed workers – can obtain subsidized benefits.

The average increase for a Community Health Options plan for 2016 is 0.5 percent, compared with a 0.8 percent decrease in rates in 2015, according to preliminary rate filings at the Maine Bureau of Insurance.

Anthem Blue Cross Blue Shield patients will see an average increase of 5.7 percent in 2016, and Harvard Pilgrim Health Care customers will experience an average decrease of 4.8 percent. Among the 20 percent of Mainers who don’t have insurance with Community Health Options, most have Anthem plans.

Aetna will offer plans on the ACA marketplace in Maine for the first time in 2016.

Community Health Options’ tiny rate-increase proposal echoes a Kaiser Family Foundation study released in June that shows the Portland metro region will have lower-than-average premium rate increases compared with a selection of metro areas across the country.

Although the rates could change in the coming months, Bureau of Insurance officials expect the revisions to be minor.

Kevin Lewis, executive director of Community Health Options, a nonprofit cooperative, said most people purchasing insurance will see nearly identical prices to last year if they stick to similar plans.

OK, "most" of 20% is vague, so I'll assume around 12% are enrolled in Anthem plans and the other 8% are with Harvard Pilgrim. I also don't know the relative market share for off-exchange individual policies in Maine, but assuming it's similar to the HC.gov breakout, that means 2016 weighted average increases should be roughly:

  • Community Health Options: 80% x 0.5% = 0.004
  • Anthem: 12% (?) x 5.7% = 0.00684
  • Harvard Pilgrim: 8% (?) x -4.8% = 0.00384
  • TOTAL: 0.007 = 0.7% increase

Also, while the CO-OP organizations established by the ACA have had mostly bad news so far, it looks like the Maine variant is kicking ass...and doing exactly what it's supposed to be doing: Helping keep rates low and their competitors honest:

...Emily Brostek, executive director of Consumers for Affordable Health Care, a health advocacy group, said Community Health Options’ domination of the marketplace is helping to suppress prices. The cooperative wants to maintain its commanding market share, and the other insurers must aggressively price to have a shot at knocking the cooperative off its perch.

...Some studies have shown that states with cooperatives – which is a member-run nonprofit – have successfully kept premiums lower than states that don’t. About half of the states have a cooperative.

The cooperatives were created under the Affordable Care Act as a way to provide competition to traditional insurance companies, with federal loans to help the co-ops get off the ground. Maine’s co-op received a $65 million loan. The cooperative’s governing board must include enrollees, who make up a majority of the board.