Charles Gaba's blog

SUMMARY OF #COVID-19 SPECIAL ENROLLMENT PERIODS:

ALL OTHER STATES: You may qualify for a 60-day Special Enrollment Period (SEP) if you've recently lost (or will soon lose) your employer-based healthcare coverage, or if you've experienced other Qualifying Life Events (QLE) such as getting marrinew yorked/divorced, moving, giving birth/adopting a child, getting out of prison, turning 26 etc. For these SEPs you may have to provide documentation to verify your QLE. Visit HealthCare.Gov or your state's ACA exchange website for details on the process.

The good news out of Minnesota is that the Commerce Dept. has published the preliminary 2021 average rate changes for both the individual and small group markets in a simple table.

The bad news is that they haven't published any of the actual actuarial memos or templates which include the two other critical pieces of data I need to run my analysis: The current effectuated enrollee totals for each carrier, and what (if any) impact the COVID-19 pandemic had on the proposed rate changes.

I was able to estimate the former by looking at MNsure's June executive board meeting slide deck, which breaks out the on-exchange enrollment by carrier by percentage. Unfortunately, this doesn't include off-exhange enrollment. Minnesota's total individual market was around 155,000 people a year ago, so the odds are that nearly 1/3 of the total market is missing below. I also have no idea about any COVID-19 factor in the rate filings yet.

via MNsure (this was actually posted a couple of weeks ago but I missed it):

ST. PAUL, Minn.—99,688 Minnesotans have come to MNsure.org and enrolled in private health insurance through a special enrollment period (SEP) or received eligibility for a public assistance program (Medical Assistance or MinnesotaCare) since March 1. As expected, sign-ups across all programs have been driven by concerns amid the pandemic.

"It’s never been more important to know you’re covered. That’s why we are so glad to have been able to help almost 100,000 Minnesotans gain access to comprehensive health care coverage," said CEO Nate Clark. "But we know there are others out there who are currently uninsured and may qualify to sign up. If you’ve recently lost your employer-sponsored health insurance, had an income change, or have another qualifying life event, come to MNsure.org to see if you’re eligible."

Hawaii only has two carriers participating in the Individual health insurance market. For 2020, they're reducing unsubsidized premiums by 1.7%

COVID-19 isn't listed as a factor at all by either of the carriers, nor by any of the small group carriers in Hawaii either...which makes total sense since Hawaii has the lowest rate of COVID-19 infection in the country.

The small group carriers are requesting a weighted average reduction of 2% as well, although one of the four doesn't have their actual rate change or current enrollment available yet, so this could change.

So far, only 8 states (+DC) have released their preliminary 2020 ACA-compliant individual market premium rate filings. So what's the deal with the other 42 states? Well, here's a handy 2020 Submission Deadline table from SERFF (the System for Electronic Rates & Forms Filing, a database maintained by the National Association of Insurance Commissioners).

However, it's a bit overly cumbersome: It stretches out over 5 full pages, and includes columns for Standalone Dental Plans as well as a bunch of info regarding the Small Group Market.

To that end, I've cleaned up/simplified the 2021 Submission Deadline table considerably to only include the individual and small group market dates. I'll be perfectly honest: I'm not quite sure what the distinction is between the "Form/Rate Filings" and the "Binder Deadlines", but the dates tend to match up pretty closely, so I've included all of them below.

The graph below is a linear depiction of how COVID-19 has spread across the state of Florida every day since March 20th.

As you can see, the thick orange line shows the ramping up of testing, the thick blue line is the increase in cases and the thick red line is the (official) rate of fatalities. In order to fit all three measurements on the same graph in a presentable way, the scale is different for each: Tests are per 100 residents; cases are per thousand, and deaths are per ten thousand.

The thinner lines are for Orange County, Florida specifically...and there's a reason for that which I'll explain below.

 

A rational person might be wondering why the Trump Administration and the entire Republican Party* is still dead set on tearing down the entire Affordable Care Act over ten years after it was signed into law, even in the middle of a global pandemic which has already killed more than 130,000 Americans and infected nearly 3 million more.

After all, they were eventually able to eliminate the single least popular provision of the law: The federal individual mandate penalty. Most of the rest of the elements are actually quite popular...and in fact poll after poll finds that the bulk of the public wants those other provisions strengthened, not weakened or eliminated.

Now that I've brought all 50 states (+DC & the U.S. territories) up to date, I'm going to be posting a weekly ranking of the 40 U.S. counties (or county equivalents) with the highest per capita official COVID-19 cases and fatalities.

Again, I've separates the states into two separate spreadsheets:

Most of the data comes from either the GitHub data repositories of either Johns Hopkins University or the New York Times. Some of the data comes directly from state health department websites.

Here's the top 40 counties ranked by per capita COVID-19 cases as of Saturday, July 4th:

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.

Carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

New Mexico is the latest state to post their preliminary 2021 rate change filings for both the individual and small group markets. There's several key things to note here:

Michigan is the 8th state (by my count) where the insurance carriers have posted their preliminary 2021 premium rate change filings. Every year brings some new twist (in 2018 it was CSR reimbursement payments being cut off; in 2019 it was the zeroing out of the ACA's federal individual mandate penalty; in 2020 it was sort of the repeal of the ACA's health insurer tax (HIT), although that didn't actually happen until after 2020 premiums had already been locked in; and for 2021...it's the COVID-19 pandemic, of course.

I've therefore added a new column for my weighted average rate change spreadsheets. So far only a handful of carriers have tacked on any substantial rate changes due to expected cost increases from testing & treatment of COVID-19 next year...the general rule of thumb seems to be that the added costs are pretty much gonna be cancelled out by reduced claims from non-COVID healthcare services (delayed/cancelled treatments/procedures, etc).

I wrote about this several times last year, but I'm a bit embarrassed to say that I haven't revisited the status of Oklahoma's Medicaid expansion ballot proposal since November:

In Red State Oklahoma, Medicaid Expansion Nears 2020 Ballot

A campaign in Oklahoma to expand Medicaid via the ballot box far eclipsed the necessary number of signatures needed to put the measure before voters next November 2020, supporters said Thursday.

The submission of 313,000 signatures to put a constitutional amendment on next year’s general election ballot shattered the required 178,000 needed by the Oklahoma Secretary of State’s office, organizers said. Media reports in Oklahoma said supporters of Medicaid expansion broke a state record when it comes to signatures needed for a statewide ballot initiative.

Over at healthinsurance.org, Louise Norris has already done the work for me in tracking down the preliminary 2021 individual and small group market rate changes for the state of Maine:

Average premiums expected to decrease Maine’s exchange in 2021

Maine’s three individual market insurers filed proposed rates for 2021 in June 2020 (average proposed rate changes are summarized here by the Maine Bureau of Insurance). For the second year in a row, average rates are expected to decrease for 2021:

Last evening, over three years after I posted my "If I Ran the Zoo" wish list of recommended improvements for the ACA, the U.S. House of Representatives finally passed H.R. 1425, the Patient Protection & Affordable Care Enhancement Act (#AHEA), which I simply dub "ACA 2.0":

House Democrats on Monday passed a bill that would bolster the Affordable Care Act by hiking premium subsidies and incentivizing states to expand Medicaid.

I wrote up a detailed, step-by-step explainer of all 30 provisions of the ACEA last week, and couldn't be happier to see it finally pass through at least one Congressional body.

Unfortunately...

In March 2019, Linda J. Blumberg, Matthew Buettgens, John Holahan and Clare Wang Pan of the Urban Institute ran a detailed analysis to determine what the impact on healthcare coverage would be in every state if the Texas vs. U.S. lawsuit (aka Texas vs. Azar or #TexasFoldEm) caused the Patient Protection & Affordable Care Act (ACA) to be repealed with immediate effect.

They also attempted to calculate how much federal funding every state would lose each year if the ACA were to be repealed as a result of the absurd Texas vs. U.S. (aka #TexasFoldEm) lawsuit. Nationally, they concluded that the U.S uninsured rate would increase by nearly 20 million people, while the 50 states (+DC) would collectively lose out on nearly $135 billion in federal funding.

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