Charles Gaba's blog

Last year, I noted several times that regardless of what your opinion may be of the ACA's Individual Mandate Penalty (which was, until this year, either $695 per adult/$348 per child or 2.5% of your household income, unless you received an exemption), one of the key things to keep in mind about the penalty is that any impact it has on encouraging people to go ahead and enroll in ACA-compliant healthcare coverage is entirely dependent on two things:

Last May, I noted that Vermont was supposedly joining Massachusetts, New Jersey (and later in the year, the District of Columbia) in reinstating the ACA's Individual Mandate Penalty, which added an additional tax to people who don't enroll in ACA-compliant healthcare coverage (whether private or public) and who don't qualify for an exemption due to an affordability threshold, hardship or some other qualifying reason.

I also noted at the time, however, that Vermont seemed to be dragging their heels on the mandate penalty itself:

Strike One: Vermont's mandate won't go into effect until 2020, leaving a one-year gap. This bill getting signed is still good news, but mostly irrelevant for 2019. The "coordinated outreach efforts" part is really more of a counter to the Trump Administration's slashing of the ACA's marketing/outreach budget...but not really, since Vermont already runs their own exchange and should have their own marketing/outreach budget anyway. So this is more of a token gesture, I'd guess.

Along with Massachusetts and Vermont, the District of Columbia merges their Individual and Small Group markets for purposes of risk pools and risk adjustment. This does not, however, necessarily mean that their Indy and Sm. Group average premium changes are identical. For one thing, there are more carriers which offer small group plans than individual market plans; for another, the market share ratios between the two differ.

A week ago, the DC Dept. of Insurance, Securities and Banking (DISB) issued preliminary 2020 rate filings along with this press release:

Washington, DC – The District of Columbia Department of Insurance, Securities and Banking (DISB) received 181 proposed health insurance plan rates for review from Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and United Healthcare in advance of open enrollment for plan year 2020 on DC Health Link, the District of Columbia’s health insurance marketplace.


OK, this one caught me by surprise. I'm not sure how I missed it last fall, but back in October of last year, around the same time CMS Administrator released her proposal to turn the ACA's 1332 Waiver rules into a complete joke, Trump's IRS, Labor and HHS Dept. got together and came up with this proposal for opening up the rules on Health Reimbursement Arrangements for employer-based healthcare coverage:

Last year individual market carriers here in my home state of Michigan only raised premiums 1.7% on average in 2019, with Oscar Insurance Co. being a new addition to the market. For 2020, they're reducing average premiums by about 2.0%. Oscar made very little headway in their debut year, only enrolling 649 people statewide.

On the surface, it looks like Michigan's total ACA-compliant individual market has plummeted by a whopping 18% (281K vs. 344K last year). However, this can be misleading because the enrollment numbers listed each year only include the number of enrollees actually impacted by the rate changes. For instance, if a carrier pulls out of half the state, then a chunk of their current total enrollment won't be listed since enrollees in that half aren't seeing their current premiums change...they'll be losing coverage altogether and will have to switch to a different carrier.

A couple of weeks ago I noted that Louisiana Governor John Bel Edwards, a Democratic governor in a pretty red state, was trying to take whatever measures he could to provide ACA protections at the state level in case the insane federal "Texas Fold'em" lawsuit against the ACA ends up tearing down the entire law:

On Tuesday, May 21, Governor John Bel Edwards issued an executive order launching the Protecting Health Coverage in Louisiana Task Force after efforts to have protections offered to Louisianans with preexisting conditions repealed.


There's another Congressional healthcare hearing going on right now as well, this time in the House Energy & Commerce Committee; this one is on Surprise Billing:


The Subcommittee on Health of the Committee on Energy and Commerce will hold a legislative hearing on Wednesday, June 12, 2019, at 10 a.m. in the John D. Dingell Room, 2123 of the Rayburn House Office Building.  The hearing is entitled, “No More Surprises: Protecting Patients from Surprise Medical Bills.”  

Key Documents

The New Mexico Office of the Superintendent of Insurance website just posted the preliminary 2020 insurance rate filings. Here's the full list, which includes a mish-mash of Individual Market, Large Group and Small Group Market policies, with a Pediatric Dental standalone plan thrown in as well.

It's worth noting that the NM carriers are being very careful to separate out on & off-exchange policies into separate listings even though they're all part of the same risk pool, and they're even separating out off-exchange "Mirrored" policies, which refers to CSR Silver Switching; this is a very good thing.

I've cleaned up the listings and plugged in the weighted average rate increases in the table below this one:


via Delaware Business Now:

Legislation calls for reinsurance program to aid people with extremely high health insurance premiums

Lawmakers have introduced legislation this week that would create a reinsurance program to help lower the cost of premiums for Delawareans who do not get insurance through their employers.

House Bill 176, which has no Republican co-sponsors, would stabilize the individual health insurance market and help Delawareans struggling with extremely highhealthcare costs to get relief, a release from House Democrats stated.

Last week I noted that Pennsylvania is joining Nevada, New Mexico, New Jersey and (apparently) Oregon in moving away from the federal ACA exchange mothership known as HealthCare.Gov:

Pennsylvania moves to take over health insurance exchange

Pennsylvania is moving to take over the online health insurance exchange that’s been operated by the federal government since 2014, saying it can cut health insurance costs for the hundreds of thousands who buy the individual Affordable Care Act policies.

...The bill is backed by Gov. Tom Wolf, a Democrat, and his administration says it would make two important changes to reduce premiums for the 400,000 people who purchase health insurance through the online marketplace.

A week or so ago I reported that New Jersey is moving forward with fourteen bills related to protecting, repairing and improving the ACA at the state level...including several related to the state's transitioning to their own full state-based ACA exchange.

Today, Lilo Stainton of the New Jersey Spotlight reports that while things are proceeding smoothly for the most part, at least one of the bills is causing a few concerns:

Earlier today I noted that RateReview.HealthCare.Gov, which is a public-facing searchable database for annual health insurance policy premium rate changes, has gone through some updates on the ACA-Compliant side.

I also noted that the other section of the database, which tracks non-ACA compliant rate changes for "Transitional Plans" and "Student Plans", may have had some updates as well, but it's hard to say since I've poked around there so rarely. This morning I decided to rectify that by searching through the entire Transitional/Student plan database and compiling the results. Unlike the ACA side, there's no way of filtering it out by year, so the following table includes every rate change filing entry listed...and the results surprised me:

Warning: There's perhaps 100 people on the planet who'll have any interest in this post. Fortunately, most of those 100 people read this site regularly.

Every year, I spend months painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease. There are hundreds of insurance carriers nationally, with dozens of forms apiece, some of which follow no hard formatting guidelines, and most of which are revised at least once over the course of the spring, summer and fall before being locked in for the upcoming open enrollment period. It's a pretty imposing task.

Regular readers know that I occasionally write freelance blog posts for

In my latest post, I revisited a project which I originally took a crack at last year: Attempting to track every action or legislation introduced, voted on, passed, signed and implemented by every state to protect, repair and/or improve the Affordable Care Act.

At the time I was trying to list the actual legislation and every change in status from start to finish (including bills which died in committee, faile in one house or the other, were vetoed, etc). I quickly discovered that it was next to impossible to keep up with all of that.

This time I took a simpler approach--I only list bills or executive orders which have either been fully approved/implemented or which are pending/in progress. I do plan on going back to updating the spreadsheet, however.