Charles Gaba's blog

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Regular readers know that I spent countless hours last summer tracking down the requested average 2016 rate change filing forms for every single state in the country, and then compiling them into my best guesstimate about the overall, weighted average rate changes for the individual policy market in each state and nationally.

In the end, I came up with a national projected weighted average increase of 12-13%, although I also made sure to note that I expected the effective average to only be around 9% after the dust settled...due to people shopping around.

As it happens, I turned out to be pretty much dead on target: The "presumptive" average (ie, assuming every single enrollee stayed with the same policy whenever possible) ended up being 11.6% nationally, while the effective average ended up being 8%.

Last year, there was roughly a 13% net attrition rate from the end of the 2015 open enrollment period and the end of March, from 11.7 million down to about 10.2 million over a 5-week period (2/22/15 - 3/31/15).

This year, as of the end of the 2016 Open Enrollment Period on January 31st, just shy of 12.7 million people (12,681,874 to be precise) had selected Qualified Health Plans (QHPs) via either the federal exchange (HealthCare.Gov) or one of the dozen or so state-based exchanges (Covered California, kynect, MNsure and so forth). A flat 13% drop should have resulted in the number still effectuated as of the end of the first quarter (3/31/16) having dropped to just barely over 11.0 million (11,033,230 to be precise).

Last month I wrote an extensive piece about Colorado's Amendment 69 initiative, aka "ColoradoCare", which would be the latest attempt to achieve a state-level single payer healthcare system (or at least near-single payer; if enacted, it would replace all current healthcare coverage except for Medicare, the VA/TriCare and the Indian Health Service).

While I was generally supportive of the idea overall, I also concluded that:

For me, however, ColoradoCare addresses many of the criticisms I've had of Bernie's plan. I'm not necessarily "endorsing" it (I still have a lot more to learn about the details and the criticisms before I can do so), but the bottom line is that it's more realistic and far better thought out than Bernie's national plan is. This is the best opportunity for achieving single payer that you're likely to see anytime soon.

The Kaiser Family Foundation released their monthly tracking poll today. In addition to the usual questions about the ACA (spoiler: Republicans generally don't like it, Democrats generally do, and there's absolutely no consensus about what the public wants to do about it anyway), they also mixed things up a bit by asking timely questions about the Zika virus and increasing insurance policy premiums.

Here's the one which I find the most depressing...but also the least surprising:

Overall, nearly nine in ten (88 percent) Americans say they are concerned about increases in the amount people pay for their health insurance premiums. This is followed closely by the percent who are concerned about increases in the costs of deductibles (85 percent), increases in what the nation as whole spends on health care (83 percent), and increases in prescription drug costs (82 percent). Fewer but still large majorities of insured Americans are concerned about increases in spending on government health insurance programs (74 percent) and increases in the amount employers pay for their employees’ premiums (71 percent).

Not much to add here:

A special session for Medicaid expansion will have to wait, Gov. Dennis Daugaard announced Wednesday.

After a weeks-long effort to lobby enough lawmakers to get the proposal approved in the Statehouse, Daugaard announced in a statement that he wouldn't call lawmakers back to Pierre.

Citing the upcoming presidential election that could result in substantial changes to the federal health insurance program for needy people, Daugaard said a special session was off the table.

“We have a good plan that would increase health care access at no additional state cost and guarantee that the federal government won’t shift its responsibility to pay for Native American health care to the state,” Daugaard said in a statement. “Still, I have heard from legislators that they would like more time to study this plan and in particular want to wait to consider the issue until after the presidential election. For that reason, I will not be calling a special session to take up this issue.”

Today is my 46th birthday. Today also happens to be the 4th anniversary of the Supreme Court's decision in National Federation of Independent Business v. Sebelius, (NFIB v. Sebelius), otherwise known as the decision which--unlike the King v. Burwell decision, which could have only crippled the law had it gone the other way--saved the Affordable Care Act from oblivion on June 28, 2012:

The Supreme Court, in an opinion written by Chief Justice Roberts, upheld by a vote of 5 to 4 the individual mandate to buy health insurance as a constitutional exercise of Congress's taxing power. A majority of the justices, including Chief Justice Roberts, agreed that the individual mandate was not a proper use of Congress's Commerce Clause or Necessary and Proper Clause powers, though they did not join in a single opinion. A majority of the justices also agreed that another challenged provision of the Act, a significant expansion of Medicaid, was not a valid exercise of Congress's spending power as it would coerce states to either accept the expansion or risk losing existing Medicaid funding.

In short, the SCOTUS made two major decisions:

UPDATE: This story has, thankfully, gone quite viral since I originally posted it yesterday morning. One important clarification: I estimated the monthly cost for treatment at around $5,200. According to Ms. Nichols in this local story about the situation in the Clarion-Ledger, the cost for her daughter’s treatment/medication is around $2,000; the balance appears to be for her husband, who also has diabetes. This actually makes the family more sympathetic, because she’s only asking for state assistance for her daughter’s portion of the bill.

In addition, according to the updated local story, the message appears to have gotten through to Rep. Guice (at least to the point that he's issued an apology, anyway): 

Guice, who told The Clarion-Ledger Tuesday morning "I don't do interviews" and declined to comment, issued an apology Tuesday night.

A couple of weeks ago, I noted that Louisiana had seen jaw-dropping success with their ACA Medicaid expansion launch, enrolling over 175,000 people in the program in the first 12 hours of the floodgates opening. It later turned out that there was a reason for this astonishing figure: 

1. Virtually all of those enrolled as of yesterday, a total of 189,000 by day's end, were transfers from existing limited-benefit public plans. These include 132,000 enrollees in Take Charge Plus, a program focused mainly on family planning, along with a few free office visits; and 56,000 from the Greater New Orleans Health Connection (GNOHC), a no-cost primary care program for low income people in the greater New Orleans area. GNOHC does not provide drug or hospital coverage.

...which is perfectly fine as well; it still lifts a huge financial burden off of the state while streamlining and consolidating enrollees into the larger Medicaid program itself.

As I've noted the past few times that I've posted Colorado enrollment report updates, the way they report their numbers can be very confusing...which is doubly frustrating since the reports are also chock full of useful data as well.

Anyway, according to their latest report, when you add up the "effectuated enrollments WITH and WITHOUT APTC/CSR" (medical only), it totals 143,430 people as of June 9th, 2016...a slight drop from the 146,000 figure as of the end of April. As I noted last month, however:

I'm still waiting on the 2017 requested rate changes for Minnesota's individual market, but there's one carrier which won't be asking for any changes: Blue Cross Blue Shield of Minnesota:

Minnesota's largest health insurer, Blue Cross and Blue Shield of Minnesota has decided to stop selling health plans to individuals and families in Minnesota starting next year. The insurer explained extraordinary financial losses drove the decision.

"Based on current medical claim trends, Blue Cross is projecting a total loss of more than $500 million in the individual [health plan] segment over three years," BCBSM said in a statement.

The Blues reported a loss of $265 million on insurance operations from individual market plans in 2015. The insurer said claims for medical care far exceeded premium revenue for those plans.

OK, first, read this headline:

Pretty damning, even if you ignore the "even" descriptor regarding the author's opinion of the ACA, right?

Well, that descriptor makes a little more sense when you read the byline...

If that name sounds familiar, there's a very good reason:

Long-time readers may have noticed that after a flurry of posts about Matt Bevin's jackassery last fall, I haven't written much of anything about Kentucky lately. In fact, aside from an entry about KY's 2017 rate hike requests (as part of my national project), I haven't said a peep about Kentucky since March. At the time Jeffrey Young of the Huffington Post noted that it looked very much like for all of Bevin's hot air and bluster...

But a funny thing happened on the way to the governor's office: Bevin's anti-Obamacare rhetoric started to tone down as Election Day approached. And in the months since he's been chief executive of Kentucky,instead of ripping up Obamacare out of his state, Bevin is making alterations to how the law works there and leaving its core elements and benefits in place.

My home state of Michigan has finally published the "Part II - Consumer Justification Narrative" carrier filings for 14 of the 15 carriers offering individual market plans next year. The combined total number of current enrollees comes in at around 390,000 including both on and off-exchange numbers. Last year, Michigan had 560,000 people on the ACA-compliant individual market, so it's important to note that there's likely at least 170,000 people missing from this analysis. However, many of these are likely found here:

  • UnitedHealthcare is pulling out of the MI market (unknown number of enrollees)
  • Humana is dropping their PPO offerings only (1,717 enrollees, included in table)
  • Celtic, Consumer's Mutual, HealthPlus and Time Insurance are all long gone
  • While I have the data for "Priority Health Plan", their counterpart, "Priority Health Insurance Co." has an unknown number of additional enrollees...and an unknown rate hike request (I don't know if it just hasn't been added to the database yet or what).

It should be noted, however, that last year, "Priority Health Insurance Co." had only about 1/10th as many enrollees as "Priority Health". If that ratio holds up this year, that should only be around 9,000 people, which is unlikely to skew the statewide average up or down by much.

With that in mind, here's how the requested hikes shake out in the Wolverine state for the bulk of indy market enrollees next year:

Paul Ryan doesn't even have a "pla".

That's the subheadline of Jonathan Cohn & Jeffrey Young's story this morning about the kind-of, sort-of "replacement plan" for the ACA which Paul Ryan and the House Republicans have finally come up with, more than 6 years after the ACA was signed into law:

The plan, which isn’t legislation and is more like a mission statement, lacks the level of detail that would enable a full analysis, but one thing is clear: If put in place, it would almost surely mean fewer people with health insurance, fewer people getting financial assistance for their premiums or out-of-pocket costs, and fewer consumer protections than the ACA provides.

The Idaho insurance department website has made this really easy for me. Most states either don't provide the requested rate hikes at all (forcing me to track them down via a slew of SERFF filing forms) or, if they do provide the rate requests, they don't provide the actual enrollment numbers for each carrier, making it very difficult to run a weighted average.

In the case of Idaho, they don't give the enrollment numbers, but they've already ran the average and posted the weighted number for me! Better yet, they've done this for both the Individual and Small Group markets:

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