You may have noticed that I recently set up a GoFundMe account as an alternate method of letting people help keep ACASignups.net going as we enter the 4th Open Enrollment Period.
Until now I've exclusively used PayPal for donations, but decided to add GoFundMe as well to see how that works out.
In addition to my general gratitude, I should also note that anyone who makes a donation is added to the official ACA Signups mailing list. Once a week* I send out a weekly digest including a wrap-up of the past week, along with special bulletins when there's a major ACA-related development.
*(well, nearly every week...occasionally I'm a bit late...)
Since it would take 10x as much time as it does now (which is already a lot) to recreate the tables and graphs every time there's a change, I've been holding off on doing so until I've accounted for several states...which is what I'm doing here.
Virginia was the very first state which I ran an estimated 2017 average requested rate hike for, way back in mid-April.
Since then, aside from Humana pulling out (leaving just 1,800 current enrollees to find a new policy), Virginia's ACA exchange market has actually been remarkably calm; the state somehow managed to escape the wrath of both UnitedHealthcare and Aetna relatively intact, with both carriers still participating in the state's exchange next year as of this writing.
There have, however, been a few other changes to some of the rate filings here and there, found via this updated PDF on the VA DOI website as of July 19th. The overall average requested hikes don't really change much, but do nudge a bit higher than I had previously estimated, from 17.5% to 18.4%:
Physicians Health Plan of Northern Indiana announced Tuesday that it will quit selling individual insurance coverage next year through the federal Affordable Care Act.
The nonprofit PHP becomes the second insurer to announce it is leaving the HealthCare.gov insurance marketplace that serves residents of northeast Indiana. UnitedHealthcare said last spring it would drop out of the exchange in most states, including Indiana.
Four other insurers offered individual policies through HealthCare.gov this year in the Fort Wayne area and apparently will continue to do so in 2017. Insurers had until Tuesday to notify the state of their plans, and all four are among federal marketplace filings the Indiana Department of Insurance submitted Tuesday to the Department of Health and Human Services.
Fort Wayne-based PHP said it is paying $1.20 in medical expenses for every dollar it receives in premium payments from HealthCare.gov customers and has lost millions of dollars on the policies.
Following announcements by for-profit commercial carriers Humana and United Healthcare, nonprofits Health Alliance Plan and Priority Health are notifying agents they are pulling all PPO plans for 2017 from the Michigan health insurance exchange, Crain's has learned.
HAP has already announced it is pulling eight Personal Alliance individual preferred provider plans for individuals from the exchange and four PPO plans in the open market next year. HAP will continue to offer HMO individual plans on and off the exchange.
"We believe that these (PPO) plans do not represent the best value for the consumer," said Mary Ann Tournoux, HAP's senior vice president and chief marketing officer, in a statement. "At this time of cost-consciousness, we believe our remaining plans are the most cost-effective and offer our members and consumers greater value for their hard-earned insurance dollar."
About a month ago, when I first plugged in the average requested 2017 rate hikes for Georgia's ACA-compliant independent market, I came up with an overall weighted average of around 27.7%. However, there was one major gap in the data: I had trouble finding Ambetter/Peach State's enrollment numbers or even their average rate hike request, so I reluctantly left them out of the calculation completely.
When Aetna announced that they were dropping out of the Georgia exchange-based independent market, I went back and removed them from the mix. Since Aetna's request had been 15.5% on a substantial share of the market, this meant that the rest of the statewide average shot up to 32.0%.
Today I was able to track down the missing Ambetter/Peach State data--both the average requested rate hike (around 8.0%) as well as the number of current enrollees impacted...around 73,000:
With the growing concerns over expected large premium rate hikes next year, combined with the Big Announcements that major exchange players like UnitedHealthcare, Humana and Aetna are dropping out of most of the ACA exchange markets they're currently participating in, the HHS Dept. has obviously been under quite a bit of pressure to reassure exchange enrollees (both current and potential) to stay the course and not panic.
Thus, it's not surprising at all that an hour or so ago they released a new report which reminds people that nearly 4/5 of current ACA exchange enrollees will still be able to find an exchange-based Qualified Health Plan for $100 or less per month (and 3/4 could find one for $75 or less per month) after applying APTC assistance in the event of an across-the-board 25% premium rate increase in 2017:
OK. Last week I wrote up a post speculating about the potential impact to the state- and national-level average rate hike requests of Aetna dropping out of the ACA exchanges in 11 states. My conclusion was that the average will increase in some states...but may actually drop in others, since Aetna would otherwise have asked for rate hikes higher than the average requested by the other carriers in that state. Of course, this isn't really a positive development, since their current enrollees are still losing their plans entirely, and since a 50% hike from Aetna could still end up costing less than a 10% hike from one of the other carriers...but as always, this is the best I can do here.
According to a release from the company on Tuesday, the firm will no longer offer individual market plans through the Affordable Care Act in Dallas, Texas, and New Jersey.
..."We hope to return to these markets as we carry on with our mission to change healthcare in the US."
The "we hope to return" part suggests that Oscar will continue to be available off the exchange in New Jersey, since completely pulling out of a state means a carrier has to wait at least 5 years before re-entering. So...there's that, anyway.
...Oscar currently covers 7,000 people in Dallas and 26,000 in New Jersey.
As noted a couple of weeks ago, all three of the major insurance carriers participating in Tennessee's individual market ACA exchange asked for massive rate hikes this year, ranging from 44-62%. Blue Cross Blue Shield asked for 62% in the first place; Cigna and Humana resubmitted their original requests for higher ones.
This was a double headache: First, because the actual enrollment numbers were only available for 3 out of 11 carriers via the filings; I had to get the rest from the MA exchange's monthly dashboard report. Secondly, even with the dashboard report, I had to merge together 2 different enrollment numbers for each carrier due to MA's unique "ConnectorCare" program.
There are a few states which have technically expanded Medicaid under the ACA, but have done so using an approved waiver which allows them to actually enroll expansion-eligible residents in private Qualified Health Policies (QHPs)...using public Medicaid funding to do so. To be honest, this has always struck me as being essentially no different than someone simply receiving 99.9% APTC/CSR subsidies for enrolling in an exchange policy anyway; it's just a question of which pool of federal funds the subsidies come from. The two states which I know for a fact do it this way are Arkansas and New Hampshire, with Arkansas calling their "Private Medicaid Option" program the "Health Care Independence Program".
In any event, AR "Private Option" enrollees may be categorized as "Medicaid expansion" in the official reports, but for purposes of estimating the risk pool, they're included in with every other ACA-compliant private individual policies, whether on or off the ACA exchange.
Amidst my Aetna Postapalooza yesterday, there's one important point which other outlets have brought up which I haven't addressed yet: Pinal County, Arizona.
Since participation in the ACA exchanges has always been voluntary for carriers selling ACA-compliant individual policies (except for the District of Columbia (and until recently, Vermont), where carriers are legally required to only sell individual policies via the exchange), there's always been the danger that sooner or later there might be a situation where no carriers are selling on the exchange. Not "a few", not "only one"...zilch.
In my mind, I've always thought of this problem in statewide terms; it wasn't until 2015 that I even realized that many carriers only sell policies in some of the counties in a given state, not all of them. That makes the list of 300+ exchange carriers nationwide a bit misleading; some of the carriers listed for a given state might only be selling in a few or just a single county, making the scenario above far more likely to happen.
Under the “third party” arrangements, nonprofit organizations work as a front for medical care providers trying to win higher payments from private insurers that pay more than government programs like Medicaid, insurers say. For example, UnitedHealth Group last month sued a dialysis chain, American Renal Associates, alleging fraud. In its suit, UnitedHealth said American Renal hooked patients up with a charitable organization that helped patients pay their premiums, according to media reports.
When I ran Kentucky's average requested rate hike numbers for the individual market back in May, I came up with a weighted average of 23.8%, but also cautioned that the weighting was likely based on less than 50% of the total ACA-compliant individual market state-wide.
Since then, it looks like a couple of the carriers resubmitted their filings with slightly different average requests, although nothing major. In fact, even Aetna dropping off the exchange doesn't change much, since it looks like they only have around 400 enrollees there anyway (plus, Aetna says they're sticking around the off-exchange market in "most" of the regions they're bailing on next year). Finally, as far as I can tell, Kentucky is among the states that Humana is not abandoning (though they might be reducing their footprint there?).
Anyway, just moments ago, according to SHADAC, the Kentucky DOI has posted their approved rates for the individual market: